My attending had a mini breakdown during coffee break today

[Doc mu]

He is nearing retirement and while making small talk today I asked him if he regrets his career in ortho looking back

He went wild, he said the first few years were great but he breaks into a cold sweat when he thinks about what awaits us new trainees, in short the points he made were:

- Lawsuits, left right and center nowadays

- Everyone referring everything remotely ortho related to him because of "defensive medicine" regardless of appropriateness for fear of legal action, diluting the quality of his work

- The specialty has taken a toll on his body and he found it very physically demanding

- He no longer makes nearly as much as he used to while malpractice insurance and costs have been steadily rising and it is getting worse every year

- He didn't like that he was always tied to hospitals and ASCs and fighting for OR time...

He told me he would have done radiology looking back and recommended I look into it or ophtho/derm before it's "too late"



I guess I am posting here looking for some motivation or other attending opinions, idk this convo really made the light at the end of the tunnel seem less bright

---

Members don't see this ad.

 

[Staphbreak]

its not that bad i'm sure. he's probably an anomaly and having a bad day ... or week ... or month =)

 

[Vandalia]

Actually medical malpractice suits have decreased dramatically.

Watch television. Look at the billboards. All they lawyers today are going after "big truck accidents." Or Roundup.

In a med-mal case, the lawyer has to pay several hundred K out of his own pocket, wait years, and there is a decent chance he won't even make his initial outlay back.

Compare that with a truck accident. Res Ipse Loquitor. "Did the truck pass in a no-passing zone and did he hit the plaintiff?" No expert witness needed. Just get the check from Walmart.

In Indiana, maybe 5% of the cases make it past the medical review board, and if there is a medical review board opinion against you, there is basically no chance of winning at trial. (Or getting an offer to settle.)

If you take a look at the firms that do med-mal defense, they are all dropping lawyers. There simply aren't enough cases around to defend.

 

[Iamnew2]

Actually medical malpractice suits have decreased dramatically.

Watch television. Look at the billboards. All they lawyers today are going after "big truck accidents." Or Roundup.

In a med-mal case, the lawyer has to pay several hundred K out of his own pocket, wait years, and there is a decent chance he won't even make his initial outlay back.

Compare that with a truck accident. Res Ipse Loquitor. "Did the truck pass in a no-passing zone and did he hit the plaintiff?" No expert witness needed. Just get the check from Walmart.

In Indiana, maybe 5% of the cases make it past the medical review board, and if there is a medical review board opinion against you, there is basically no chance of winning at trial. (Or getting an offer to settle.)

If you take a look at the firms that do med-mal defense, they are all dropping lawyers. There simply aren't enough cases around to defend.

You are certainly right re: indiana. I wish all the states could institute a system like that. If the med review board feels that there is no case, apparently if the person goes forward with the lawsuit and lose they can potentially be on the hook for legal fees for the physician. I think there is some law that the person is able to go forward with a lawsuit without the board's approval if less than $17,000 something but otherwise yes there is slim to no chance of winning. Med Mal has gone significant change in the last number of years due to such a high number of ridiculous and non-sensical lawsuits, patients think that they can complain about everything and everything is a lawsuit. One patient literally complained about the color of the walls in the room they were in on the feedback!!! And you are also spot on that apparently there are high costs to the lawyer/legal firm to pursue med Mal cases, reason why med Mal lawyers tend to either be big law firms or it has to be something really big. Too many players and too many complexities in healthcare to really win unless really clear cut.

It's easier to pursue the car accidents, the big companies with deep pockets, etc.

 

[HemeOncHopeful19]

I’m not any of the mentioned specialties but it basically comes off as a dude that has little insight into other fields.

We all deal with MedMal but I have no doubt Radilogy is stressful as hell being able to be sued years later for some random pulmonary nodule on a CT Abd ordered for pancreatitis that patient had no follow up and then turned out to be malignant.

We all get dumb referrals/consults.

Ortho may not make what it used to but it is still one of the only specialties that still gets paid in the same realm as what we all made in the 90s…

 

[anonperson]

He is nearing retirement and while making small talk today I asked him if he regrets his career in ortho looking back

He went wild, he said the first few years were great but he breaks into a cold sweat when he thinks about what awaits us new trainees, in short the points he made were:

- Lawsuits, left right and center nowadays

- Everyone referring everything remotely ortho related to him because of "defensive medicine" regardless of appropriateness for fear of legal action, diluting the quality of his work

- The specialty has taken a toll on his body and he found it very physically demanding

- He no longer makes nearly as much as he used to while malpractice insurance and costs have been steadily rising and it is getting worse every year

- He didn't like that he was always tied to hospitals and ASCs and fighting for OR time...

He told me he would have done radiology looking back and recommended I look into it or ophtho/derm before it's "too late"



I guess I am posting here looking for some motivation or other attending opinions, idk this convo really made the light at the end of the tunnel seem less bright

Sounds a bit over dramatic to be honest but some valid issues.

1. Lawsuits suck. In the midst of one currently but will eventually be dismissed in the coming weeks. It is an unfortunate part of the field.

2. Isn't Ortho notorious for not even admitting their own patients even if the primary issue is orthopedic?

Besides, why $hit on other docs who aren't comfortable with orthopedic issues? I don't begrudge the consults for 3cm fibroids or simple ovarian cyst. See the patient and move on.

Medicine is complex.

3. How is he super busy but fighting for OR time? Why doesn't he petition for block time or go to a hospital that will give him block time.

I have Monday block time and it's very nice knowing I don't have to worry about getting cases on.

4. As a physician, you typically only work as hard as you want. Your attending could easily cut back and still make a nice income.

You can have anything you want but not everything you want.

5. I do agree that it's best to choose a specialty that isn't dependent on the hospital. But most hospitals bend over backwards to appease the orthopedic surgeons.

 

[DoctwoB]

Most of these are medicine problems. Not ortho problems. All surgery fields can have issues with block time. All fields deals with pressures on reimbursement. All of medicine has suffered loss of autonomy.

He’s of a generation where he probably expected and lived the physician being the king of his fiefdom. That is just no longer the case.

 

[operaman]

He is nearing retirement and while making small talk today I asked him if he regrets his career in ortho looking back

He went wild, he said the first few years were great but he breaks into a cold sweat when he thinks about what awaits us new trainees, in short the points he made were:

- Lawsuits, left right and center nowadays

- Everyone referring everything remotely ortho related to him because of "defensive medicine" regardless of appropriateness for fear of legal action, diluting the quality of his work

- The specialty has taken a toll on his body and he found it very physically demanding

- He no longer makes nearly as much as he used to while malpractice insurance and costs have been steadily rising and it is getting worse every year

- He didn't like that he was always tied to hospitals and ASCs and fighting for OR time...

He told me he would have done radiology looking back and recommended I look into it or ophtho/derm before it's "too late"



I guess I am posting here looking for some motivation or other attending opinions, idk this convo really made the light at the end of the tunnel seem less bright

Some of the things he mentions haven’t changed in a hundred years. Surgery is definitely physically demanding. If you ever have to give a grand rounds and want to ignite a great discussion, talk about surgical ergonomics and physical complications for surgeons and you’ll hear a ton of senior surgeons share their struggles. This is an inherent part of surgery and most surgeons have some kind of plan to adapt their practice as they age and have less physical tolerance.

Surgery has always been tied to hospitals and ASCs because that’s where you can do big surgeries. I’m not sure where else you’re going to be able to do them safely. And block time has always been an issue as is anesthesia coverage if you’re somewhere private where that’s a DIY endeavor. It’s not like there was tons of unused OR time 30 years ago either, though it probably has gotten a bit tighter as the communities around hospitals have grown.

Other things you can control somewhat.

Getting crap referrals you can fix by just not taking those referrals. I have directed my staff that I don’t take snoring/sleep apnea referrals until they have seen a sleep medicine doc and had a sleep study and, if indicated, started cpap. I almost never see anyone without a referral because I don’t want to be wasting my time with untreated sniffles that any PCP can manage. And the list goes on, and sure I’m losing some business but I’m busy enough and this lets me spend my time with more patients who need a specialist. Your attending could easily start refusing certain referrals and clean up his schedule that way.

Lawsuits can’t be entirely prevented but risks can be lowered by being a good surgeon and being careful in who you operate on. Doing a fellowship can also be protective in that you become more of a recognized expert in a certain area so if you have a complication it’s going to be harder for an attorney to argue you were simply negligent or failed to deliver standard of care. You can also lower risk by maintaining good relationships with patients and managing complications effectively.

His concern re increasing costs and declining pay is true. Some address this by seeking employed positions when the economics dictate. Others by entrepreneurship building ancillary income streams for their practice. Others by getting an incredible reputation then going cash only. I think that last one may become a bit more viable for some fields as patients have higher and higher deductibles. But overall this is a fact of life in medicine because we are still correcting from an era where third party payors would pay huge sums for care but now that simply isn’t sustainable.

 

[90sportsfan]

I’m not any of the mentioned specialties but it basically comes off as a dude that has little insight into other fields.

We all deal with MedMal but I have no doubt Radilogy is stressful as hell being able to be sued years later for some random pulmonary nodule on a CT Abd ordered for pancreatitis that patient had no follow up and then turned out to be malignant.

We all get dumb referrals/consults.

Ortho may not make what it used to but it is still one of the only specialties that still gets paid in the same realm as what we all made in the 90s…

Agree with this. I had a strong interest in Radiology as a med student. I ultimately decided on Neurology because I was more interested in the brain, but in the back of my mind, I thought about the sheer volume of images you'd be reading on a daily basis in Rads many with esoteric presentations. With that much volume and the uncertainty around image presentation, it's almost a forgone conclusion that you are going to unfortunately get sued at some point.

I think because of volume and increasing complexity of imaging, that is why Radiology is often now listed in the top tier of specialties for lawsuits.