Karen Siebert MD calls out the "mommy-trackers"

[BuzzPhreed]

Interesting article she posted a few years ago (that I just saw) as an Op-Ed in the New York Times. She's an anesthesiologist, but the article isn't specific to the field.

http://www.nytimes.com/2011/06/12/opinion/12sibert.html?pagewanted=all&_r=0

I'll quote some of the more relevant parts...

I’M a doctor and a mother of four, and I’ve always practiced medicine full time.

Since 2005 the part-time physician workforce has expanded by 62 percent, according to recent survey data from the American Medical Group Association, with nearly 4 in 10 female doctors between the ages of 35 and 44 reporting in 2010 that they worked part time.

About 30 percent of doctors in the United States are female, and women received 48 percent of the medical degrees awarded in 2010.

Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine. It’s fair to ask them — women especially — to consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency.

You can’t have it all. I never took cupcakes to my children’s homerooms or drove carpool, but I read a lot of bedtime stories and made it to soccer games and school plays. I’ve ridden roller coasters with my son, danced at my oldest daughter’s wedding and rocked my first grandson to sleep. Along the way, I’ve worked full days and many nights, and brought a lot of very sick patients through long, difficult operations.

Patients need doctors to take care of them. Medicine shouldn’t be a part-time interest to be set aside if it becomes inconvenient; it deserves to be a life’s work

Given the diminishing perception of the difference between what a CRNA can offer (at a fraction of the training cost), does she have a point? There are only about 25-30% of female anesthesiologists right now in the work force. It's up to 80% of CRNAs, many who work part time or PRN when they have small kids. But she raises a lot of points about commitment to the profession and the fact that male physicians tend to work harder and longer hours. We're talking women in the early 30's who may not work again full-time until they're in their 50's. For what it's worth I am the child of a professional woman who worked full-time when I was growing up. I hear a lot of what she is saying. I never felt robbed not having my mom around full-time, especially after I was about 8 years old. I can see how it might be more important iup to that point.

What do you guys think? Fair criticism? When I was at my (brief stint) job before I returned to my current job there seemed to be a disproportionately higher number of female anesthesiologists. There were a few full-timers who were female and others who were married to surgeons, bankers, one real estate guru and worked part-time. It was a great job for them to work PRN. But at the same time I hear her points about not being fully committed to a 'profession'.

Interesting article. Written by a woman. Don't shoot the messenger.

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[deleted126335]

The world has changed. There is and will be plenty of work to be done. There will also be lots less rewards for that work. Accommodating the Mommy trackers and old guys who will want to go part time will occur out of necessity.
Of course the Mommy trackers and other part timers will pay for it and can't have it all. The A-list jobs don't go to part timers, night call tends to be highly compensated relative to day work and is not Mommy track friendly, there are less opportunities for leadership roles for part timers in groups and med staff politics, part timers tend to have less security, etc.

 

[BuzzPhreed]

The world has changed. There is and will be plenty of work to be done. There will also be lots less rewards for that work. Accommodating the Mommy trackers and old guys who will want to go part time will occur out of necessity.
Of course the Mommy trackers and other part timers will pay for it and can't have it all. The A-list jobs don't go to part timers, night call tends to be highly compensated relative to day work and is not Mommy track friendly, there are less opportunities for leadership roles for part timers in groups and med staff politics, part timers tend to have less security, etc.

While all of this is true, I think her bigger point is that we shouldn't be "wasting" residency positions on people who aren't fully committed to the field. We inherently tolerate this lifestyle choice in CRNAs. Tolerating it in doctors, who have a vastly larger "debt to society" if you will, is a different story. Or is it?

 

[BuzzPhreed]

I think this is what you're talking about Doze.

http://www.fdu.edu/newspubs/magazine/05ws/generations.htm

 

[deleted126335]

While all of this is true, I think her bigger point is that we shouldn't be "wasting" residency positions on people who aren't fully committed to the field. We inherently tolerate this lifestyle choice in CRNAs. Tolerating it in doctors, who have a vastly larger "debt to society" if you will, is a different story. Or is it?

I no longer believe that doctors have a larger debt to society. The profession offers less rewards both emotional and financial. It should expect less sacrifice.

 

[BuzzPhreed]

I no longer believe that doctors have a larger debt to society. The profession offers less rewards both emotional and financial. It should expect less sacrifice.

The "debt to society" has more to do with the fact that a large portion of our training is subsidized by the Federal Government, a point Siebert makes in her article. Plus, more time spent practicing makes for a stronger clinician. There's no room for tourists in our profession.

 

[caligas]

I get up every morning and my first thought is "I cant wait to get to the hospital to work on my dept to society."

F-that. I went to med school, I didnt rob a bank.

 

[deleted126335]

The "debt to society" has more to do with the fact that a large portion of our training is subsidized by the Federal Government, a point Siebert makes in her article. Plus, more time spent practicing makes for a stronger clinician. There's no room for tourists in our profession.

A resident owes the training program their best when there. Afterwards, if they want to "waste" their training and work one day a week or pump gas for a living that is their business and nobody else's. As long as they aren't committing crimes and pay their student loans and aren't on the public dime god bless 'em.

 

[Mman]

The "debt to society" has more to do with the fact that a large portion of our training is subsidized by the Federal Government

It is subsidized via medicare. And residents provide cheaper labor to hospitals than NPs or PAs or whoever else they'd be replaced with. So really the government is subsidizing the hospital via medicare, not the resident.

 

[DreamLover]

The "debt to society" has more to do with the fact that a large portion of our training is subsidized by the Federal Government, a point Siebert makes in her article. Plus, more time spent practicing makes for a stronger clinician. There's no room for tourists in our profession.

I know exactly how much the government didn't subsidize my education when I pay them their loan repayment check every month with a big fat interest payment attached.

Oh yeah, and I'm female and work full time...since I was 16...through high school and college. I even taught classes in the one summer break I had in med school between 1st and 2nd year.

 

[DermViser]

Interesting article she posted a few years ago (that I just saw) as an Op-Ed in the New York Times. She's an anesthesiologist, but the article isn't specific to the field.

http://www.nytimes.com/2011/06/12/opinion/12sibert.html?pagewanted=all&_r=0

I'll quote some of the more relevant parts...


Given the diminishing perception of the difference between what a CRNA can offer (at a fraction of the training cost), does she have a point? There are only about 25-30% of female anesthesiologists right now in the work force. It's up to 80% of CRNAs, many who work part time or PRN when they have small kids. But she raises a lot of points about commitment to the profession and the fact that male physicians tend to work harder and longer hours. We're talking women in the early 30's who may not work again full-time until they're in their 50's. For what it's worth I am the child of a professional woman who worked full-time when I was growing up. I hear a lot of what she is saying. I never felt robbed not having my mom around full-time, especially after I was about 8 years old. I can see how it might be more important iup to that point.

What do you guys think? Fair criticism? When I was at my (brief stint) job before I returned to my current job there seemed to be a disproportionately higher number of female anesthesiologists. There were a few full-timers who were female and others who were married to surgeons, bankers, one real estate guru and worked part-time. It was a great job for them to work PRN. But at the same time I hear her points about not being fully committed to a 'profession'.

Interesting article. Written by a woman. Don't shoot the messenger.

The responses to her when her article was put on Kevin MD were hilarious to say the least. Apparently she hasn't heard Ezekiel Emmanuel's opinion that Anesthesiologists jobs can be done mainly by CRNAs.

 

[Impromptu]

In residency I got paid a small salary, treated Medicaid, Medicare, and VA patients, and worked 60-90 hours a week for 4 years. I believe this was a fair exchange and I owe no further debt to society.

I went to a private medical school and am paying off that debt by working hard and postponing the "good life" for a few more years. I am paying every cent of interest, set artificially high by politicians. I am paying heavily for the cost of that money. I owe no further debt to society.

 

[bronx43]

In residency I got paid a small salary, treated Medicaid, Medicare, and VA patients, and worked 60-90 hours a week for 4 years. I believe this was a fair exchange and I owe no further debt to society.

I went to a private medical school and am paying off that debt by working hard and postponing the "good life" for a few more years. I am paying every cent of interest, set artificially high by politicians. I am paying heavily for the cost of that money. I owe no further debt to society.

I would say that it's actually not even a fair exchange, since we are actually providing our services at a discount when compared to the midlevels they would have to hire in our stead. Maybe back in the day when medical school was essentially free, you can whisper the "debt to society" argument, but not anymore - not when we're all 200-300k in debt in a era of ever-decreasing reimbursements and encroachment by midlevels.

 

[BuzzPhreed]

I hear that you all feel like you paid your "debt to society" by laboring in indentured servitude for four years, but what about the other points? Do you really think with the looming doctor shortage that we can afford to train 40% of the future physician workforce to work part time? These people may be potentially taking away spots from otherwise qualified individuals who would be willing to fill that gap. Or is the answer that we just keep churning out more mid-level practitioners to fill the gap?

Sounds like a lot of you want to eat your cake and still have it too. And I'm certainly not knocking the female physicians who make the difficult choice to put their career first, and are still getting screwed (especially in anesthesiology) with non-partnership tracks and even possibly less pay. It's about choices and fairness. Both to the individual and society.

 

[Mman]

the answer seems to be to train more doctors here. As the US population has expanded, higher education has not expanded at the same rate. Hence it's generally much tougher to get into any school than it was 20 or 40 years ago. Medical schools need to expand along with everything else.

 

[jwk]

the answer seems to be to train more doctors here. As the US population has expanded, higher education has not expanded at the same rate. Hence it's generally much tougher to get into any school than it was 20 or 40 years ago. Medical schools need to expand along with everything else.

Not sure I believe that - the current overall acceptance rate to medical school (positions available / applicants) exceeds 40%. Individual schools may be far less than that, but taken as a whole nationwide, it's not bad, and certainly a far cry from the overall 10% rate when I was applying in the late 70's.

 

[Baller MD]

Not sure I believe that - the current overall acceptance rate to medical school (positions available / applicants) exceeds 40%. Individual schools may be far less than that, but taken as a whole nationwide, it's not bad, and certainly a far cry from the overall 10% rate when I was applying in the late 70's.

WAO.

 

[urge]

Are we in a socialist country where the common good trumps individual good?

People should do what they think is best for themselves and their family. I'm not even sure why we are considering this.

 

[bronx43]

I hear that you all feel like you paid your "debt to society" by laboring in indentured servitude for four years, but what about the other points? Do you really think with the looming doctor shortage that we can afford to train 40% of the future physician workforce to work part time? These people may be potentially taking away spots from otherwise qualified individuals who would be willing to fill that gap. Or is the answer that we just keep churning out more mid-level practitioners to fill the gap?

Sounds like a lot of you want to eat your cake and still have it too. And I'm certainly not knocking the female physicians who make the difficult choice to put their career first, and are still getting screwed (especially in anesthesiology) with non-partnership tracks and even possibly less pay. It's about choices and fairness. Both to the individual and society.

Taking spots from who, men? That's pretty much what it comes down to, especially since that women who choose medicine are already pre-selected as a whole to have a higher likelihood of choosing career over family. The only way to actually correct this problem is to admit more men into medical school than women. That would probably correct the issue of part-time workers, but female physicians would then be the first to cry foul.

Then, you have to address whether or not this "physician shortage" can actually be corrected by more physicians or midlevels. Unless you completely flood the market with providers, you will probably see people just practice in medium and big sized cities in exchange for lower pay. This is exactly what's going on. And when you flood the market with providers, I would be concerned about quality of said providers.

 

[Mman]

certainly a far cry from the overall 10% rate when I was applying in the late 70's.

Huh? The US population increased by something like 60% since then late 70s but medical school spots have barely budged. We went almost 25 years without the opening of a single new medical school and the current schools weren't exploding in size. I find it hard to believe that a significantly higher percentage of the population was applying to medical school in the 1970s compared to the last decade, especially since there are far more female applicants recently to outweigh any drop off in male applicants.

 

[IlDestriero]

I don't feel any obligation to work any specific amount of time or number of years. I could go 80% right now and consider it often. That's probably 15-20 years too early for the author. Oh well. The only people that are inconvenienced are my colleagues. If they're fine with it, that's all the OK I need. I trade income for time. Income used to hire another physician. Little Johnny will still get his surgery.
People going part time are actually good for the job market.
We should all go part time, spend quality time with family, walk in the park and smell the roses. I think of our fallen brother often and his lesson for us all.
That author can go work 60+ hours a week for 35 years. I'll pass. Oh man will I pass.

 

[BuzzPhreed]

Are we in a socialist country where the common good trumps individual good?

When we live in a country where the government, through taxes and redistribution of the wealth, subsidizes a large part of the training of those doctors then the answer is "yes". Yes, we are living in said country.

 

[BuzzPhreed]

Taking spots from who, men? That's pretty much what it comes down to...

No, it's those who choose an easier more self-centered lifestyle over a career. Regardless whether their 23rd chromosomes are "XX" or "XY". Statistics and demographics (and Siebert's argument) states those now tend to be the "XX" variety, generally the "Generation Y" flavor (not trying to mix alphabetical analogies).

 

[urge]

When we live in a country where the government, through taxes and redistribution of the wealth, subsidizes a large part of the training of those doctors then the answer is "yes". Yes, we are living in said country.

The numbers speak for themselves and the answer is no.

 

[BuzzPhreed]

The numbers speak for themselves and the answer is no.

Which numbers? The 40% of female physicians between the age of 35-44 who work part-time?

 

[IlDestriero]

When the government pays for my education and training they can have a say in how much I work...
oh wait, they did...
Well that doesn't count.

 

[BuzzPhreed]

When the government pays for my education and training they can have a say in how much I work...
oh wait, they did...
Well that doesn't count.

Exactly! You're arguing the point.

 

[deleted171991]

Huh? The US population increased by something like 60% since then late 70s but medical school spots have barely budged. We went almost 25 years without the opening of a single new medical school and the current schools weren't exploding in size. I find it hard to believe that a significantly higher percentage of the population was applying to medical school in the 1970s compared to the last decade, especially since there are far more female applicants recently to outweigh any drop off in male applicants.

Yes, Mman, but when you have a 40% acceptance rate for med schools, you know that something is seriously wrong. Where I went to medical school, due to similar measures, they went from a 15% acceptance rate to 40+. The effects were disastrous. Once the old generations are gone, my native country will not have many real physicians left, just medical school graduates. My folks are almost afraid to trust anything they are told by their doctors (and one of them is a physician). All the wealthy people in the country go abroad for medical treatment. But now we have more than enough "doctors", so many that most of them emigrate to live a decent life.

Let me give you an example: family member with benign hypothyroidism kept on hormone replacement to the level where TSH is almost undetectable, having signs of hyperthyroidism, goes nicely into AFib. "Doctor" sees her, recommends cardiology consult and treatment (in a female with no previous cardiac history). I realize that it is the stupid Synthroid, stop it; 3 days later, AFib gone, patient feeling better. When she asks the board-certified endocrinologist why the F she was on high dose Synthroid in the first place, when she does not have cancer and does not need to inhibit remaining cancerous tissue, she gets a bunch of err and hmm's, and no explanation or apology. Patient taught how to self-adjust her Synthroid based on the TSH, still doing fine years later. That's what you get with a 40+% acceptance rate, long-term (the same **** you get with high acceptance rates for law school or business school). And this is just one example of medical analphabetism.

 

[Doctor4Life1769]

Yes, Mman, but when you have a 40% acceptance rate for med schools, you know that something is seriously wrong. Where I went to medical school, due to similar measures, they went from a 15% acceptance rate to 40+. The effects were disastrous. Once the old generations are gone, my native country will not have many real physicians left, just medical school graduates. My folks are almost afraid to trust anything they are told by their doctors (and one of them is a physician).

Let me give you an example: family member with non-cancerous hypothyroidism kept on hormone replacement to the level where TSH is almost undetectable, having signs of hyperthyroidism, goes nicely into AFib. "Doctor" sees her, recommends cardiology consult and treatment (in a female with no previous cardiac history). I realize that it is the stupid Synthroid, stop it; 3 days later, AFib gone, patient feeling better. When she asks the board-certified endocrinologist why the F she was on high dose Synthroid in the first place, when she does not have cancer and does not need to inhibit remaining cancerous tissue, she gets a bunch of err and hmm's, and no explanation or apology. Patient taught how to self-adjust her Synthroid based on the TSH, still doing fine years later. That's what you get with a 40+% acceptance rate, long-term. And this is just one example of medical analphabetism.

Oh good grief.

Back in the day, there were so many smart, talent doctors. Yeah, we get it. We see the dinosaurs trolling the hallways stuffing their faces.

They're so bright and talented, they deserve being grand-fathered in. They deserve paying little tuition and making the big bucks. They deserve being respected for who they are and what they did.

We don't deserve anything. We fight for it and we jump through so many hoops in the name of board certification, and later, recertification. Crappy market, economy, pricey education, worked full-time since a teen, being compared to mid-levels and folks saying we are crappy doctors. Yeah, we still plow through. Not because we don't have a choice but because we enjoy what we do (or at least try to). Yet, we are the lazy self-centered generation because we actually want to enjoy our lives. A life, something I've delayed having for a long damn time.

 

[IlDestriero]

Exactly! You're arguing the point.

Not really, I was in the military. That debt is PAID IN FULL.

 

[deleted171991]

Doctor4Life, I completely agree with you, and I find the article populist BS.

The reason why we have these high rates of psychiatric disease and divorces is the lack of work-life balance. We are expected to work like entrepreneurs (or slaves, whichever you prefer), while we are mostly employees. The Americans have been indoctrinated that working 50-60 hours/week with 3-4 weeks of vacation/year is normal. In the real world (the one where you are not just a "battery"), this is far from normal. And I am not talking just about doctors.

 

[Mman]

Yes, Mman, but when you have a 40% acceptance rate for med schools, you know that something is seriously wrong. Where I went to medical school, due to similar measures, they went from a 15% acceptance rate to 40+. The effects were disastrous. Once the old generations are gone, my native country will not have many real physicians left, just medical school graduates. My folks are almost afraid to trust anything they are told by their doctors (and one of them is a physician). All the wealthy people in the country go abroad for medical treatment. But now we have more than enough "doctors", so many that most of them emigrate to live a decent life.

Huh? I'm not arguing for any particular rate of acceptance into medical school. Just pointing out that as the US population has increased, the # of spots in medical schools and residencies has not grown at the same rate. Ideally they should increase at the same rate so as to provide a stable pool of physicians in the country and maintain the same ratio of physicians to patients as in the past.

I'm not arguing lesser applicants should be brought in. I'm arguing that all of higher education needs to step up.

 

[deleted171991]

The problem is that, at a medical school acceptance rate of 40%, increasing the number of spots will only lead to a further significant decrease in the quality of both students and graduates. The best and the brightest are already turning away from medicine; we need to attract them back, to the level where the acceptance rates would fall under 20%. Only then should we start increasing slowly the number of spots, both in medical schools and residencies.

Weak candidates will make weak students, and weak graduates. And once we lose/lost quality in medicine (just look at the value of that POS board certification which is given to 80+%, even 90+% in some specialties), we are asymptotically approaching the status of overpaid nurse practitioners.

 

[DermViser]

The problem is that, at a medical school acceptance rate of 40%, increasing the number of spots will only lead to a further significant decrease in the quality of both students and graduates. The best and the brightest are already turning away from medicine; we need to attract them back, to the level where the acceptance rates would fall under 20%. Only then should we start increasing slowly the number of spots, both in medical schools and residencies.

Weak candidates will make weak students, and weak graduates. And once we lose/lost quality in medicine (just look at the value of that POS board certification which is given to 80+%, even 90+% in some specialties), we are asymptotically approaching the status of overpaid nurse practitioners.

You think specialty boards should fail more people?

 

[deleted171991]

Yes. Board certification used to be a measure of excellence, not a piece of paper. If we knew what the passing level (of knowledge) was, I think many of us would feel ashamed. Same for the USMLE Steps.

Btw, in the previous post I was talking about passing rates for first-time takers. Overall, I think 95% of the recent graduates get board-certified at some point, which makes the entire thing almost worthless.

Doctor used to mean "a teacher or learned person". And we physicians used to be among the most learned, so nobody ever thought about confusing/replacing us with a nurse (practitioner). But now we take 40% of the candidates, make sure that almost all make it through medical school, then residency, then board-certification etc.

It's all a big money-making machine for the medical schools, the academic hospitals, the certification boards etc. More graduates, more money for all these people. Plus it's good for politics: society needs more doctors, more cannon fodder for the front lines, so we just go ahead and increase the numbers across the line, diluting the candidate pool even more, right? (Just look at where anesthesia is going.)

If I were a patient, I would have no idea who's worth her salt, with all these semi-worthless diluted titles. Heck, I am a doctor, and I still have no idea who are the good ones, except for the surgeons I have worked with.

To put it in medical jargon: these titles have high sensitivity, but low specificity.

 

[Mman]

Doctor used to mean "a teacher or learned person". And we physicians used to be among the most learned, so nobody ever thought about confusing/replacing us with a nurse (practitioner). But now we take 40% of the candidates, make sure that almost all make it through medical school, then residency, then board-certification etc.

Many "candidates" get weeded out before they even apply. Because first you gotta take the prerequisites in undergrad. Then you gotta take the MCAT. In my limited experience, about 80-90% of people that thought they were going to medical school don't even apply after those first 2 steps.

The credentials of people getting accepted/attending 3rd tier MD schools in the US are very impressive.

 

[drccw]

It's all about productivity... My generation of physicians isn't as productive as the previous generation.. Male or female. Full time or part time... There is too much BS to cut through, too much paperwork and etc. Plus, we just don't want to work as hard. For example my father was an OB. He averaged between 45-55 deliveries a month, with his max being 68. ACOG data shows that the average OB does 12 vaginal and 5 ceasarean deliveries a month. so, it would take roughly 3-4 physicians to replace him. But, that was in the golden age of fee for service. It's just not worth it to work that hard these days....

drccw

 

[pgg]

Buzzphreed, I'd like to say that I'm not the least bit concerned with what you think I owe society, but the truth is, despite my usual ability to ignore such things, it actually annoys me that you presume to know how many hours of my labor will settle whatever debt you think I have, and that you'd criticize me or anyone else for working less.

 

[urge]

Well, my school had a 5% acceptance rate. I had to learn over 100 times the medical knowledge that an old fart 40 years before me had to. Plus I paid thru the nose for it. And now I'm in a world where these old farts have run medicine to the ground while they enjoyed vacations paid by drug companies, parties, gifts, .....

I think it is the old farts who owe me.

 

[BuzzPhreed]

Buzzphreed, I'd like to say that I'm not the least bit concerned with what you think I owe society, but the truth is, despite my usual ability to ignore such things, it actually annoys me that you presume to know how many hours of my labor will settle whatever debt you think I have, and that you'd criticize me or anyone else for working less.

Well, I didn't write the article, slim, and then have it posted in the New York Times. If you have a particular problem with the points raised, address them. Don't assume to know what I think. Otherwise your statement is just ad hominem.

I do think we have a lot "perception problems" with our profession, though. I worry about "tourist" doctors and their clinical acumen, those who take spots from people equally qualified and maybe who deep down want it more, and the message this sends to mid-levels. If you have a problem with that, then... well...

Well, my school had a 5% acceptance rate. I had to learn over 100 times the medical knowledge that an old fart 40 years before me had to. Plus I paid thru the nose for it. And now I'm in a world where these old farts have run medicine to the ground while they enjoyed vacations paid by drug companies, parties, gifts, .....

I think it is the old farts who owe me.

People always confuse "acceptance" rate with "application" rate. But that's an aside.

But I agree with the sentiment rest of your post. And it is a large part of the "greed" of medicine, also reflected by tourist physicians and a theme echoed in many of my other posts, who expect to eat their cake and still have it too.

 

[urge]

People always confuse "acceptance" rate with "application" rate.

What is an application rate?

 

[BuzzPhreed]

What is an application rate?

In any given year there are only a select number of applicants. This rate grows or wanes depending on the year and the ease of getting jobs out of undergrad the economy etc.

This gives you a fixed number of applicants who submit multiple applications. For example the medical school I went to (not going to out myself) always used to brag that they had a "4% acceptance" rate. However it was perceived to be one of the easier schools to get into so many people applied there as a back-up. Their application rate, in comparison to other schools, was much higher than many other schools so looking at acceptance:application the number was lower.

As Mark Twain once said there are only three types of lies: lies, damn lies, and statistics.

The only truly important percentage as has already been pointed out is the actual number of applicants who get accepted into some program during a cycle. As stated that is usually around 40%. Doesn't mean you get to go to your first choice.

 

[Numbex]

I hear that you all feel like you paid your "debt to society" by laboring in indentured servitude for four years, but what about the other points? Do you really think with the looming doctor shortage that we can afford to train 40% of the future physician workforce to work part time?

I'm not sure I follow the reasoning here. On the one hand, we are training too many anesthesiologists (expanding residency positions, in fact) into a field that appears to be shrinking due to mid-level (CRNA) encroachment. My impression is that you agree that that is the state of affairs. Yet you bring up this nebulous "doctor shortage". Says who? If there were a shortage of anesthesiologists would not the pooled RVU rate have been rising, not falling, in inflation adjusted terms, for the past decade?

The way I see it, the more people retire and work part-time, the better my job prospects are.

 

[BuzzPhreed]

Yet you bring up this nebulous "doctor shortage". Says who?

Nothing nebulous about it.

According to the Association of American Medical Colleges (AAMC), unless something changes rapidly, there will be a shortage of 45,000 primary care doctors in the United States (as well as a shortfall of 46,000 specialists) by 2020.

http://www.huffingtonpost.com/2013/12/30/obamacare-doctor-shortage_n_4519440.html

If there were a shortage of anesthesiologists would not the pooled RVU rate have been rising, not falling, in inflation adjusted terms, for the past decade?

Why do you think we have mid-level encroachment?

The way I see it, the more people retire and work part-time, the better my job prospects are.

No. Not so. Just more people with less training convincing regulators this is a more "cost effective" solution and taking your job.

 

[Ipassgas]

Yes. Board certification used to be a measure of excellence, not a piece of paper. If we knew what the passing level (of knowledge) was, I think many of us would feel ashamed. Same for the USMLE Steps.

Btw, in the previous post I was talking about passing rates for first-time takers. Overall, I think 95% of the recent graduates get board-certified at some point, which makes the entire thing almost worthless.

Once upon a time, board certification was truly optional. It meant superb command of the specialty. It was a mark of distinction.

Then a hospital demanded everyone must be board certified, because our local patient population is a group of super special flowers, and need super special docs. Then the hospital down the road said they aren't any better than us, we need that too. Then the hospital in Bumpkinville said our country bumpkins are also special, so we need it too!

Now, the insurance companies demand the same specialness for all of their customers.

If you went to a 50% board failure rate, a third (or more) of our hospitals would close. Half of us would be unemployable, with $200k loan debts, after being beaten on, dare I say tortured, for a decade.

You think the best and brightest avoid medicine now. Imagine that world as a patient, student, or doctor!

If you can convince America that not everyone needs a ribbon, we can't all win, and you don't need a board certified doc for every single case, you have my undying support and admiration. In the mean time, I'll go ahead and frame my "almost worthless" certificate (seriously, I haven't framed it yet - it's dusty but not moldy) and do the best job I can for my patients while I'm at work.

And if someone tells me I don't work enough, they have to find a way too make it worth my while. We all (attendings at least) have reached the point of diminishing returns in income. Working harder doesn't bring enough extra $ to justify killing myself for ungrateful patients who feel entitled to my skill, knowledge, and compassion, for free.

 

[pgg]

Well, I didn't write the article, slim, and then have it posted in the New York Times. If you have a particular problem with the points raised, address them.

You didn't write it, but you sure seem to agree with it, and I think it's a bunch of crap.

NO professional, in any field, anywhere, OWES society or the government anything beyond any contracts that may be in effect.

If society and the government want more out of doctors because they're paying soooo much of the bill, then they can change the deal to demand X years of service at Y production rate in return for getting educated and trained in that system. And people thinking about becoming a doctor can decide if they want that, or not.

What the author is bleating on about, and you're agreeing with, is nothing more than YOU DIDN'T BUILD THAT so you need to pay more of your fair share, and that's a bunch of pinko commie crap and I want no part of it.

Do you think that because K-12 education is state funded, that every American who graduates from high school owes society, say, 50 years of full-time labor to repay that debt? Is someone who works part time and lives frugally or stays at home to raise a kid robbing society of that K-12 investment?

I was educated and trained in the USA, I signed a contract to get it, and I'm living up to the terms of that contract. And when those terms are up, I'll do as I please with my time and labor, and all the whiny NYT- and SDN- published handwringers can gripe about my selfishness until they're blue.

 

[Numbex]

Nothing nebulous about it.

http://www.huffingtonpost.com/2013/12/30/obamacare-doctor-shortage_n_4519440.html

Biased sources are biased. Of course the government wants to paint a picture of a physician shortage. It helps justify increasing the scope of midlevel practice, increasing midlevel training opportunities, increasing midlevel penetrance of practice, increasing med school slots and increasing residency spots. That's not the same as an actual shortage. Everything they can do to put more warm bodies into practice drives down the price Medicare has to pay. If you were the government, what would you be saying?

Why do you think we have mid-level encroachment?

Because they have people advocating for them in places that increase their opportunities to work and get paid more. [NB: this probably has more to do with insurance companies wanting to pay less for a provider visit than the midlevels being so effective at lobbying- who has deeper pockets, after all?] Doctors are doing a horrible job of advocating for ourselves. By trying to play the game fairly we're being screwed by everyone else. Doctors' compensation is not by any means the problem in the out-of-control cost of health care in this country. Not at all. Anyone who says otherwise has an ax to grind.

No. Not so. Just more people with less training convincing regulators this is a more "cost effective" solution and taking your job.

Supply and demand. Increasing numbers, penetration and scope of midlevels drives down the price for MD work. Increasing the number of residency spots for MDs drives down the price. On the other hand, increasing the numbers of MDs retiring and working part time, all things being equal, drives the price up.

 

[D P356]

.

 

[Random Anesthesiologist]

Are we in a socialist country where the common good trumps individual good?

People should do what they think is best for themselves and their family. I'm not even sure why we are considering this.

My family is none of her business. I have student loans but will pay back in droves with interest. I work long hours for peanuts in residency.

She always sounds so bitter and angry in her op-eds. Bedsides, how many women anesthesiologists actually do a "mommy track"? I don't know any, but I know a lot with babies and young children.

And, as far as I know, every educator in my educational career was paid to educate me. I owe them nothing, my tuition was paid.

 

[circulus vitios]

I fail to see how an individual is responsible for meeting the labor demands of the country. This isn't the ****ing USSR.