Our Ailing Medical System

[ThisCouldBeYou]

Yikes. Someone sent this to me recently and I wanted to get some input.

http://online.wsj.com/articles/the-u-s-s-ailing-medical-system-a-doctors-perspective-1409325361
"In surveys, a majority of doctors express diminished enthusiasm for medicine and say they would discourage a friend or family member from entering the profession. In a 2008 survey of 12,000 physicians, only 6% described their morale as positive. Eighty-four percent said that their incomes were constant or decreasing. Most said they didn't have enough time to spend with patients because of paperwork, and nearly half said they planned to reduce the number of patients they would see in the next three years or stop practicing altogether." Thoughts?

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[GH253]

The government has already pretty much destroyed medicine. And the same people who destroyed it have appointed themselves to fix it.

 

[NickNaylor]

Not sure what kinds of thoughts your expecting. This has been the tune for quite some time and will likely continue to be so in the era of cost-cutting. If you want to avoid this sort of thing, my advice would be to either go into a field where you can run a cash practice, thus eliminating the third payer middleman and the influence he exerts on your practice, or work at a big practice, which will divorce you from the billing aspect of medicine though at the cost of being a highly trained employee.

 

[bjb305]

I'm a first year radiology resident. I absolutely love my job and couldn't imagine doing anything else. With that said, I still wouldn't and won't recommend being a doctor to my family or future children. It's too big of a risk and a huge time commitment. Your 20s are basically gone since you have very little free time. Some of my surgery friends are pulling 100-130 hour work weeks for several years. And to think, I initially thought I wanted to do that. I think the problem is that a lot of people go into medicine for the wrong reasons. I would only suggest this career if this is the only thing you can see yourself doing. If you are doing it for money, it's obviously the wrong choice. If you're doing it cause you want to care for patients, well just wait till you see that the vast majority of your time will be charting and not actually seeing the patients. These things along with a lot of other nuisances (drug abusers that get admitted and do nothing but lie to you just to try and get dilaudid) have left a lot of people jaded, myself included.

 

[Lucca]

The prevailing sentiment from doctors is that you shouldn't do medicine unless it is the only thing you can see yourself doing.

The prevailing sentiment on this forum is HIGHLY conservative and I would strongly advise you to take whatever they say with a grain of salt because a lot of the posters on here do not know anything about policy implementation or politics outside of what they hear about in the media. That goes for the minority of capital-L Liberals here too.

If you want an honest appraisal, listen to Nick or other residents/attendings.

There are many negative opinions, yes. But this is why you should get out there and shadow and see if you could stand the job and - my advice - STAY THE WHOLE DAY. When I shadowed this summer I came in at 5 with the physician and left at 7pm when they were done with their charting/paperwork. The number-1 biggest complaint I heard all day, from every physician was how much charting their was versus actual patient interaction. Every physician performed very well with their patients and it was clear to me how much they cared about them. Of course, this was an oncology/hematology hospital so the patient dynamic is WAY different than the drug-jockeying one might experience in an ER and patient compliance is much better.

The reason for all the dissatisfaction is obvious to me:

A highly conservative workforce (physicians) currently experiencing a time of extreme change that often conflicts with the values that drove them to the profession in the first place.

Change like: Declining reimbursement, declining professional respect, declining autonomy, increased bureaucracy, being the guinea pigs in a transition period to a different insurance scheme, working for an employer with non-clinical based motives that conflict with your intentions, a population with increased access to health information that more often leads to misinformation than education, the lack of infrastructure to properly give every patient the time they need to be educated or examined without in turn reducing your compensation further, charting as a central part of the job rather than a minor aspect of it, the list goes on.


I recommend reading "For the Young Physician About to Burn Out" by Dr. Gunderman in The Atlantic.

 

[bjb305]

The prevailing sentiment from doctors is that you shouldn't do medicine unless it is the only thing you can see yourself doing.

The prevailing sentiment on this forum is HIGHLY conservative and I would strongly advise you to take whatever they say with a grain of salt because a lot of the posters on here do not know anything about policy implementation or politics outside of what they hear about in the media. That goes for the minority of capital-L Liberals here too.

If you want an honest appraisal, listen to Nick or other residents/attendings.

There are many negative opinions, yes. But this is why you should get out there and shadow and see if you could stand the job and - my advice - STAY THE WHOLE DAY. When I shadowed this summer I came in at 5 with the physician and left at 7pm when they were done with their charting/paperwork. The number-1 biggest complaint I heard all day, from every physician was how much charting their was versus actual patient interaction. Every physician performed very well with their patients and it was clear to me how much they cared about them. Of course, this was an oncology/hematology hospital so the patient dynamic is WAY different than the drug-jockeying one might experience in an ER and patient compliance is much better.

The reason for all the dissatisfaction is obvious to me:

A highly conservative workforce (physicians) currently experiencing a time of extreme change that often conflicts with the values that drove them to the profession in the first place.

Change like: Declining reimbursement, declining professional respect, declining autonomy, increased bureaucracy, being the guinea pigs in a transition period to a different insurance scheme, working for an employer with non-clinical based motives that conflict with your intentions, a population with increased access to health information that more often leads to misinformation than education, the lack of infrastructure to properly give every patient the time they need to be educated or examined without in turn reducing your compensation further, charting as a central part of the job rather than a minor aspect of it, the list goes on.


I recommend reading "For the Young Physician About to Burn Out" by Dr. Gunderman in The Atlantic.

Highly agree with this. Well put

 

[Cyberdyne 101]

Not sure what kinds of thoughts your expecting. This has been the tune for quite some time and will likely continue to be so in the era of cost-cutting. If you want to avoid this sort of thing, my advice would be to either go into a field where you can run a cash practice, thus eliminating the third
payer middleman and the influence he
exerts on your practice, or work at a big practice, which will divorce you from the billing aspect of medicine though at the cost of being a highly trained employee.

Which fields can effectively run a cash practice? I'm asking out of mere curiosity (it's not really something that I find appealing).

 

[bjb305]

Elective procedures... Ie cosmetic derm and plastics

 

[Lucca]

Which fields can effectively run a cash practice? I'm asking out of mere curiosity (it's not really something that I find appealing).

Psych in some locations/scopes of practice. Elective derm, plastics.

 

[Cyberdyne 101]

Psych in some locations/scopes of practice. Elective derm, plastics.

I believe some ortho surgeons in my area don't take insurance. But they are likely the exception.

 

[Lucca]

I believe some ortho surgeons in my area don't take insurance. But they are likely the exception.

Technically - correct me if im wrong - i think you could be ANY specialty and be cash only but you would have to be concierge only and have a very specific population you are serving (rich people).

 

[ThisCouldBeYou]

Which fields can effectively run a cash practice? I'm asking out of mere curiosity (it's not really something that I find appealing).

Peridontics. My dentist tells me they make TONS of $$$ and don't take insurance. Problem is: they mostly serve in higher-income cities/towns. Lower income folks just get their teeth out.

 

[ThisCouldBeYou]

I think this issue is a particularly important for medical schools. For that reason, their need to determine a strong class is more crutial than ever (and I don't think everyone with a 4.0 gpa/high mcat qualifies).

"In the end, the problem is one of resilience. American doctors need an internal compass to navigate the changing landscape of our profession. For most doctors, this compass begins and ends with their patients. In surveys, most physicians—even the dissatisfied ones—say the best part of their jobs is taking care of people. I believe this is the key to coping with the stresses of contemporary medicine: identifying what is important to you, what you believe in and what you will fight for. Medical schools and residency programs can help by instilling professionalism early on and assessing it frequently throughout the many years of training. Introducing students to virtuous mentors and alternative career options, such as part-time work, may also help stem some of the burnout.