Question for current physicians...

[bennyhanna]

I am looking for responses from current physicians, not pre-meds, not current med students, not residents... current practicing physicians.

I have been deeply thinking about a medical carrer for several years while in high school and now college. I've always had a medical job (medic, cna, etc).

I'm stuggeling with physian responses I've had from 3 physicians and wanted more input...

3 physicians I've talked to said that if they could become physicians IN TODAYS MEDICAL WORLD (not when they initially did), that they would not do it. 2 said that they would consider being a P.A. and 1 said he would choose another field alltogether.

All 3 cited several factors for their frustrations with current medicine, high malpractice insurance costs, extreme regulation on what you can and cannot do by insurers and, if not self employed, by the hospital or group, and the increasing trend of loss of autonomy. One physician pointed out that they have one of the losgest post-graduate programs in order to get their Doctorate degree, while an M.B.A with 2 years postgrad is many times their boss.

So, my question is, given today's medical climate, rising costs of malpractice insurance, more semi-advanced providers entering medicine (P.A.s and FNPs), more insurer and group control, less autonomy, would you do it again if you were becoming a student today? Why or why not?

Thanks to all who reply! You are busy, so any response and time you give is greatly appreciated!

~BB

 

[MarzMD]

I am looking for responses from current physicians, not pre-meds, not current med students, not residents... current practicing physicians.

I have been deeply thinking about a medical carrer for several years while in high school and now college. I've always had a medical job (medic, cna, etc).

I'm stuggeling with physian responses I've had from 3 physicians and wanted more input...

3 physicians I've talked to said that if they could become physicians IN TODAYS MEDICAL WORLD (not when they initially did), that they would not do it. 2 said that they would consider being a P.A. and 1 said he would choose another field alltogether.

All 3 cited several factors for their frustrations with current medicine, high malpractice insurance costs, extreme regulation on what you can and cannot do by insurers and, if not self employed, by the hospital or group, and the increasing trend of loss of autonomy. One physician pointed out that they have one of the losgest post-graduate programs in order to get their Doctorate degree, while an M.B.A with 2 years postgrad is many times their boss.

So, my question is, given today's medical climate, rising costs of malpractice insurance, more semi-advanced providers entering medicine (P.A.s and FNPs), more insurer and group control, less autonomy, would you do it again if you were becoming a student today? Why or why not?

Thanks to all who reply! You are busy, so any response and time you give is greatly appreciated!

~BB

There is a thread addressing this in the "general residency issues" forum.
http://forums.studentdoctor.net/showthread.php?t=195799

 

[bennyhanna]

There is a thread addressing this in the "general residency issues" forum.
http://forums.studentdoctor.net/showthread.php?t=195799

I appreaciate that link... saves me days of waiting for responses!

 

[Flopotomist]

Hmm.. why would a physician be trolling around in the pre-allo forum?

 

[QofQuimica]

Hmm.. why would a physician be trolling around in the pre-allo forum?

My thought exactly.

 

[robotsonic]

bennyhanna,
There aren't too many "practicing physicians" on here... so I don't know how many responses you would actually get from them. You should read the responses given on the other thread anyway, though. Most of them don't address your specific issues, so I thought I would just add something to think about. Note: I am a fourth year med student, not an MD yet. With regards to the whole "medicine has changed, you no longer have autonomy, etc argument": A lot of older doctors seem to say this, but if all you know is the new way, then you won't notice a difference, right? Current med students I've talked with seem to agree with me on this - the issues you mention don't bother us as much as they do older physicians because we are learning within the new system, rather than having to change with it.

Also, in the hospital, PAs do seem to have nice hours, but they aren't the ones making the important decisions.

 

[bennyhanna]

bennyhanna,
There aren't too many "practicing physicians" on here... so I don't know how many responses you would actually get from them. You should read the responses given on the other thread anyway, though. Most of them don't address your specific issues, so I thought I would just add something to think about. Note: I am a fourth year med student, not an MD yet. With regards to the whole "medicine has changed, you no longer have autonomy, etc argument": A lot of older doctors seem to say this, but if all you know is the new way, then you won't notice a difference, right? Current med students I've talked with seem to agree with me on this - the issues you mention don't bother us as much as they do older physicians because we are learning within the new system, rather than having to change with it.

Also, in the hospital, PAs do seem to have nice hours, but they aren't the ones making the important decisions.

Well... working as a medic for several years and seemingly always being in a medical profession, I've enjoyed the 'autonomy' I had as a medic, within standing orders of course...

I'm worried about the cooperate and insurance bureaucracy that will say, "you can do this, you cannot do this"... it kind of defeats the purpose of being a physician does it not? In a sense, I could immagine being autonomous and then being told, you have to follow this plan, you must use these procedures for this, you will only get paid for this and not for this etc... what then is the purpose of med school?

Doing trauma surgery is what I want to do... currently working in the hospital I'm more than positive that I do not want to be a nurse, but I'm unsure about another medical carrer, like a P.A. or a dentist.

I know several P.A.s (my brother in law and several friends), that say they would become Dr.s if they could, but of course, most p.a.s I know, to be blunt, are med school rejects and don't have the 'respect' from dr.s or patients...

And true, P.A.'s ultimately answer to the MD, some other professions have medical autonomy with much less schooling and very similar salaries to M.D.s(FNPs can practice independantly in many states, as can CRNAs, and Newsweek had a recent article on the expanding practice of Dental surgeons and pharmacists prescribing)....

But, Dr.s today seem to be losing their autonomy, as the link to the other forum suggests, and discussions with physicians I"ve talked to have also suggested.

With 'helping others' being the primary reason to go into medicine, my very close second reason would be autonomy...

This is the only reason I've questioned my wanting to be a Dr. I realize there will be ungodly grueling hours of study, residency, internship, on-call and time away from family with low pay. I realize more often than not peers and patients really won't care that you went to school for x years, and really don't care about you and only want you to do your job and fix them... but the autonomy is sooo important.

To say, 'were going to do this for you' without fear of chastisement or being forced to do something else because you can't pay for the patients healthcare, and the one's who do, the insurer's have told you what you're going to do, in what order, and what they'll pay for, will influence your medical decisions while you pay off student loans, mortgages etc...

So, really, I wonder if given the current medical climate and its trends where Dr.s will be in 10 years and if this is somewhere I want to be, answering to an MBA CEO or insurer. It takes the individuality out of helping people, and has given me somethig serious to consider.

I do appreciate your time to reply, thank you so much. Every response is of course appreciated, I do realize the decision is ultimately mine, but I would like to make an informed decision, which this forum certainly helps to do!

~BB

 

[MarzMD]

Being an applicant, I too worry about the loss of autonomy in the profession. However, I do not think it is enough to deter me from becoming a physician. I still feel as though becoming a physician will allow me to achieve my life goals.

*Also, I think Im a little masochistic....so that helps.

 

[bennyhanna]

My thought exactly.

Well, you never know do you? I'll settle for a resident... maybe some person somewhere who also happens to be a practicing M.D. is surfing the net and finds him or herself in here....

Regardless, this seemed the most appropriate forum as there are no "physician forums" though I did find some online...

Just increasing my chances of responses. I have talked in person to several physicians and wanted to see if the trend I was hearing was the norm.

Do you guys have any thoughts on the original post other than its location in the forums?

 

[QofQuimica]

Well, you never know do you? I'll settle for a resident... maybe some person somewhere who also happens to be a practicing M.D. is surfing the net and finds him or herself in here....

Regardless, this seemed the most appropriate forum as there are no "physician forums" though I did find some online...

Just increasing my chances of responses. I have talked in person to several physicians and wanted to see if the trend I was hearing was the norm.

Do you guys have any thoughts on the original post other than its location in the forums?

lol, sorry for busting your chops, kid. But you have to admit that it's funny to see a post looking for responses from docs in the pre-allo forum. Most of these guys and gals in here are college students just like you.

Plus, you are definitely going to get a biased answer here as well as an inexperienced one. We're pre-meds, so we're mostly still at that idealistic stage where we want to go to med school and save the world in here. I agree with whomever said that you should try asking this question down in the residency forums. Do you have any ideas about what kind of medicine you'd be interested in doing? If not, just ask in the general residency forum.

 

[bennyhanna]

lol, sorry for busting your chops, kid. But you have to admit that it's funny to see a post looking for responses from docs in the pre-allo forum. Most of these guys and gals in here are college students just like you.

Plus, you are definitely going to get a biased answer here as well as an inexperienced one. We're pre-meds, so we're mostly still at that idealistic stage where we want to go to med school and save the world in here. I agree with whomever said that you should try asking this question down in the residency forums. Do you have any ideas about what kind of medicine you'd be interested in doing? If not, just ask in the general residency forum.

Well, the link above is to the residency forums, (which says "RESIDENTS ONLY PLEASE", which is why I didn't post there), but is full of responses both ways.

I would like to be an trauma surgeon or ER doc. I'm not misinformed about what becoming a dr. takes, as I assume many 'pre-meds' are. I've worked as a medic and as a CNA for several years, so I'm not a stranger to the bottom step of the medical staircase...

But I see going to school for at least 8 years as a 'licence' to say, this is what you have, and this is what we're going to do...

But that is changing. Now, someone with 2 years postgraduate experience, an MBA CEO of your hospital or insurance company gets to tell you, with at least 8 years (usually more) postgratuate education what to do.... you will do this for this, you will not do this. You will follow this order, and you will get paid this...

With several hundred thousand dollars in student and mortgage debt, you really wont have a choice to say no.

The declining autonomy of medicine is what spurs me to ask about it from physicians... as a medic I couldn't immagine being told I was suddenly limited in what I could do because of this or that...

It would be like, joe schmo, CEO, who took a CPR class in 4th grade thinks you don't need to defibrillate with v-tach anymore... you should first ensure the patient has proper insurance, then try basic meds, then try cpr, then if all else fails, defibrillate because as a last resort because its too expensive to do initially...

That's the whole point of going to med shcool is it not, is to say, this is what you've got and this is what we're going to do, and then do it? To have some cooperation with MBAs and RNs (insurers usually hire nurses to 'approve' items for insurance) telling you the M.D. what you will and will not do is outrageous, yet there's not much that can be done about it.

To be limited by MBAs degrades the time and hours spent in medical school... and gives me cause to seriously think about this decision.

 

[jebus]

If you're concerned about autonomy go practice medicine in the developing world. Seriously.
I met a few physicians in India who left lucrative positions in the states for those reasons you enumerated. They don't have bean counters telling them what they should or should not do.
That said, they don't practice on most native Indians - most Indians are too poor. Outsourcing is big in India. Bigger than you might know. British, Israeli, Australian, Malaysian, and patients from Singapore go to India (the Apollo hospitals are really big there) for procedures and these are paid for by the patient's HMOs - the HMOs in Israel, Singapore, and Australia! A few months after I last went to India I recall seeing a story about this on 60 minutes. Some people call it medical tourism, I'll call it outsourcing. Here are a couple of stories from the reputable news organizations about it: http://www.washingtonpost.com/wp-dyn/articles/A49743-2004Oct20.html & http://msnbc.msn.com/id/6160812/site/newsweek/ These doctors in India are well trained. But you've got a lot of clinical experience, I'm sure you've seen how many Indian doctors there are in the states.
Frankly, that's not for me, I'm more interested in actually working within the (flawed) system and practicing medicine on people simply because I'm interested in applying knowledge about the human body in a wholly beneficent manner, working as part of a healthcare team, easing patient's pain and suffering and giving them reassurance - despite the restrictions you cite. Based on my clinical experience, doctors have two major parts of their job: one is biological and the other is more personal, it's providing emotional and intellectual support, etc. An HMO can never take the latter away from you.

 

[bennyhanna]

If you're concerned about autonomy go practice medicine in the developing world. Seriously.
I met a few physicians in India who left lucrative positions in the states for those reasons you enumerated. They don't have bean counters telling them what they should or should not do.
That said, they don't practice on most native Indians - most Indians are too poor. Outsourcing is big in India. Bigger than you might know. British, Israeli, Australian, Malaysian, and patients from Singapore go to India (the Apollo hospitals are really big there) for procedures and these are paid for by the patient's HMOs - the HMOs in Israel, Singapore, and Australia! A few months after I last went to India I recall seeing a story about this on 60 minutes. Some people call it medical tourism, I'll call it outsourcing. Here are a couple of stories from the reputable news organizations about it: http://www.washingtonpost.com/wp-dyn/articles/A49743-2004Oct20.html & http://msnbc.msn.com/id/6160812/site/newsweek/ These doctors in India are well trained. But you've got a lot of clinical experience, I'm sure you've seen how many Indian doctors there are in the states.
Frankly, that's not for me, I'm more interested in actually working within the (flawed) system and practicing medicine on people simply because I'm interested in applying knowledge about the human body in a wholly beneficent manner, working as part of a healthcare team, easing patient's pain and suffering and giving them reassurance - despite the restrictions you cite. Based on my clinical experience, doctors have two major parts of their job: one is biological and the other is more personal, it's providing emotional and intellectual support, etc. An HMO can never take the latter away from you.

Worth looking at... I had planned on doing 'mission' work in developing countries regardless of what profession I choose. Thanks for the info and links.