Breaking Up with Medicine...

[drusso]

Written by an OB/GYN, but also relevant for pain specialists.

Retired at 37: Breaking up with a career in medicine

"You are not “burned out.” The problem is the current environment in medicine which puts physicians last on the list. Your stories are not unique, and all too common amongst others in the field. Leaving for you is taking control back. Control of your life and also making a statement for those still in this unhealthy relationship. You join the increasing ranks of young physicians that are finally taking a stand and demanding better from this toxic relationship. The hope is that someone is listening."

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[pastafan]

An old parable that is applicable:

A young surgical resident is on call and about to scrub for an emergency case at 4:30 in the morning. He has been up since this time the day before. As he wearily approaches the scrub sink he is joined by a senior attending surgeon.

His attending tells him: I know that you have been up for 24 hours and you are presenting in grand rounds in a few hours. The fact that you have been ill with the flu and feeling terrible is also well known. You haven't seen your wife all week and your dog does not recognize you when you arrive home. Despite this, I am going to give you some advice that will serve you well in the years to come as you struggle with the demands of our profession. Please remember them and keep them close.

The attending places his arm around the resident's shoulder, looks him in the eye, and states "nobody cares".

 

[Ducttape]

Couldn't find a good clip...

“Arrogance and fear still keep you from learning the simplest and most significant lesson of all.”
“Which is?”

“It's not about you.”

 

[Pathman1000]

It's also no longer about the patient. It's about making scumbags in the hospital administration more money.

 

[SSdoc33]

a doctor not happy with her job? stop the presses!

i started my career in medicine, what, almost 20 years ago now. wow, im old, but i digress. i have been hearing this nonsense since then. "medicine isnt what it used to be". it was better before, yada yada yada. what has REALLY changed? we still get paid a buttload. there are more buttons to click now, but electronic medical records do make things easier. interest in medicine as a profession has not waned. dont let yourself get taken advantage of, and keep working. i cant think on another profession where some people arent going to bitch.

 

[VA Hopeful Dr]

a doctor not happy with her job? stop the presses!

i started my career in medicine, what, almost 20 years ago now. wow, im old, but i digress. i have been hearing this nonsense since then. "medicine isnt what it used to be". it was better before, yada yada yada. what has REALLY changed? we still get paid a buttload. there are more buttons to click now, but electronic medical records do make things easier. interest in medicine as a profession has not waned. dont let yourself get taken advantage of, and keep working. i cant think on another profession where some people arent going to bitch.

This part should be tattooed on every intern when they start residency.

 

[Aether2000]

Pain medicine does impart value to society, but less than what we hoped and projected twenty years ago. Every advance has been met with insurance company blockade of new procedures, using an ever escalating bar of efficacy. The reputation of the profession was definitely sullied by opioids in excess and now by refusal to provide opioids at all to the consternation of both patients and referring physicians. Our toolbox is much larger than 20 years ago but the tools we can use from that box are much more limited. All of this leads to frustration and disenchantment. One solution is to do what we can for patients with what is still allowed by insurance and then expend energy and time elsewhere, finding a happy place beyond the reach of insurance restrictions.

 

[neutro]

treat it as a job/business like every other professional/working person.

do you think an IT guy cares this much about their work environment. heck no. they do their 9-5 (or 3:30) and go home.

 

[epidural man]

a doctor not happy with her job? stop the presses!

i started my career in medicine, what, almost 20 years ago now. wow, im old, but i digress. i have been hearing this nonsense since then. "medicine isnt what it used to be". it was better before, yada yada yada. what has REALLY changed? we still get paid a buttload. there are more buttons to click now, but electronic medical records do make things easier. interest in medicine as a profession has not waned. dont let yourself get taken advantage of, and keep working. i cant think on another profession where some people arent going to bitch.

SS,

I don't disagree with you -BUT....it is a crappy field. The whole field has so much wrong with it. Yes there are issues with lots of professions, but medicine has so many unique problems that make it harder and harder to do. 20 years ago, you didn't have to deal with "locking" your anesthesia cart for JC ....or the blatant corruption of the FDA, or the immense power of administrators telling you what to do which minimizes your ability to delivery high quality care, or the outrage at high costs while people point the finger at your pay check all while the insurance companies continue to shatter profit records all while screwing the patient, or the list of boxes that need to be checked despite good clinical judgment against these boxes, or 100 other things that keep getting piled on.

I wish so bad I could do something else. But like you said, there is nothing I could do and make the same kind of money - so it is really hard to leave.

 

[clubdeac]

Pain medicine does impart value to society, but less than what we hoped and projected twenty years ago. Every advance has been met with insurance company blockade of new procedures, using an ever escalating bar of efficacy. The reputation of the profession was definitely sullied by opioids in excess and now by refusal to provide opioids at all to the consternation of both patients and referring physicians. Our toolbox is much larger than 20 years ago but the tools we can use from that box are much more limited. All of this leads to frustration and disenchantment. One solution is to do what we can for patients with what is still allowed by insurance and then expend energy and time elsewhere, finding a happy place beyond the reach of insurance restrictions.

That happy place my friend is called the VA

 

[SeniorWrangler]

The attending places his arm around the resident's shoulder, looks him in the eye, and states "nobody cares".

I've seen that same attending express irritation about trainees being less professional and less committed to medicine than he was back in the day. It's two sides of the same coin.

 

[drusso]

That happy place my friend is called the VA

Or as my VA psychiatrist friend says, "I go to work and turn my brain off." But, he's at the gym every day by 4 PM while I'm signing notes, returning phone calls, etc...do they even have phones at the VA?

 

[clubdeac]

Or as my VA psychiatrist friend says, "I go to work and turn my brain off." But, he's at the gym every day by 4 PM while I'm signing notes, returning phone calls, etc...do they even have phones at the VA?

Yes! Gym by 4pm is the norm...you can't get these massive gains in private practice

 

[drusso]

Yes! Gym by 4pm is the norm...you can't get these massive gains in private practice

If I weren't in private practice, I'd totally go work for the VA...or the prisons...

 

[deleted185747]

I am closing my practice and already accepted a VA job to start in May. Seriously. I'm sick of getting faxes asking for prior auths for cyclobenzaprine and lidoderm patch. Denials for claims. Stupid billing company submitting multiple incorrect claims. Secondary insurance paying me the other $5 a few months later. Referring doctors expecting me to take the opioid ball and keep it going because thats what all my competitors do. I am in an economically disadvantaged area with poor insurance. I realized I would make the same at the VA as in an ethical PP I owned but with a lot less work. I'm not down for the DME/UDT/opioid/jail gig.

 

[Aether2000]

Excellent choice.

 

[BobBarker]

I have only been in practice since 2015, but I really feel like I don't deal with 90%+ of what you guys frequently complain about.

 

[Ducttape]

but... havent there been recent issues with high dose and questionable opioid prescribing practices at various VAs across the country?

other VA/opioid concerning articles:
VA vows more drug tests, inspections amid rising cases of opioid theft
By the numbers: VA making progress in reducing opioid use in Veteran patients - VAntage Point

 

[Disciple]

I am in an economically disadvantaged area with poor insurance.

No chance of practicing in OC?

 

[Dr. Ice]

I am closing my practice and already accepted a VA job to start in May. Seriously. I'm sick of getting faxes asking for prior auths for cyclobenzaprine and lidoderm patch. Denials for claims. Stupid billing company submitting multiple incorrect claims. Secondary insurance paying me the other $5 a few months later. Referring doctors expecting me to take the opioid ball and keep it going because thats what all my competitors do. I am in an economically disadvantaged area with poor insurance. I realized I would make the same at the VA as in an ethical PP I owned but with a lot less work. I'm not down for the DME/UDT/opioid/jail gig.

I've been having the exact same thoughts lately...

 

[Nivens]

I have only been in practice since 2015, but I really feel like I don't deal with 90%+ of what you guys frequently complain about.

What do you think is the difference?

 

[BobBarker]

work for the hospital on rvu is the main difference.

They have a prior auth person for meds and one for procedures that are in the main hospital. I never think about that stuff. I also don't try to nail a round peg through a square hole with medicines I know Medicare will not pay for. Mostly Medicare +/- a secondary, a bit of straight Medicaid, and less than 20% private insurance.

I am home by 4 everyday but probably work 4 hours a week at home doing charts after the kids are asleep.

 

[SSdoc33]

I am closing my practice and already accepted a VA job to start in May. Seriously. I'm sick of getting faxes asking for prior auths for cyclobenzaprine and lidoderm patch. Denials for claims. Stupid billing company submitting multiple incorrect claims. Secondary insurance paying me the other $5 a few months later. Referring doctors expecting me to take the opioid ball and keep it going because thats what all my competitors do. I am in an economically disadvantaged area with poor insurance. I realized I would make the same at the VA as in an ethical PP I owned but with a lot less work. I'm not down for the DME/UDT/opioid/jail gig.

funny. i doubt you would make the same decision in, say, oklahoma. california has you by the balls. not that there is anything wrong with that -- but it is hard to make PP work in california or so i hear.

 

[gdub25]

Oklahoma is good. Nobody wants to move here to work but since I grew up here it's easy to stay and the work environment is great.

 

[hyperalgesia]

Baby goats, wide open spaces, career satisfaction - very appealing.

What other "undesirable" areas are people generally satisfied with?

 

[DrCommonSense]

Written by an OB/GYN, but also relevant for pain specialists.

Retired at 37: Breaking up with a career in medicine

"You are not “burned out.” The problem is the current environment in medicine which puts physicians last on the list. Your stories are not unique, and all too common amongst others in the field. Leaving for you is taking control back. Control of your life and also making a statement for those still in this unhealthy relationship. You join the increasing ranks of young physicians that are finally taking a stand and demanding better from this toxic relationship. The hope is that someone is listening."

Probably better to be on the administrative side of medicine these days than being a practicing doctor, especially after the "efficiency" experts get done cutting the salaries of all the more "lucrative" fields while maintaining high malpractice risk (with increasingly LARGE settlements that are >5M, well past malpractice limits for individual physician), longer work hours, HUGE debts from medical school/undergrad that are INCREASING far fast than inflation with 7% interest rates, etc.

Medicine is looking bad.