Reconsidering...

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forte9528

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I know this is probably a stupid question, but it seems pretty important to me as it's at the center at why I've wanted to go to medical school and become a doctor.

It seems that what ultimately happens when one becomes a doctor is the necessity to rush through a bazillion patients. Are there any routes there in the MD path (other than maybe psych, family pract.) that avoids this problem? I'm aware of the incentives that are in place with managed care, etc, and the only way out of this seems to be a part of an organization such as mayo.

Am I missing something? Any help there?
 
I know this is probably a stupid question, but it seems pretty important to me as it's at the center at why I've wanted to go to medical school and become a doctor.

It seems that what ultimately happens when one becomes a doctor is the necessity to rush through a bazillion patients. Are there any routes there in the MD path (other than maybe psych, family pract.) that avoids this problem? I'm aware of the incentives that are in place with managed care, etc, and the only way out of this seems to be a part of an organization such as mayo.

Am I missing something? Any help there?

Get a MD/JD (the latter from a top school), and use political connections to land a job within the government arena. Use skills to change how MDs are paid (results instead of patient volume). Good luck.
 
If you want to do a clinic-based practice, the only way around the patient rush is to get a salaried position, and that would likely require you to work for an academic institution. Family practice is probably the worst one as far as blowing through as many people as possible in a day goes, by the way.
 
If you want to do a clinic-based practice, the only way around the patient rush is to get a salaried position, and that would likely require you to work for an academic institution. Family practice is probably the worst one as far as blowing through as many people as possible in a day goes, by the way.

I'm sure that even salaried positions have unspoken rules on patient load. No hospital wants to hire more doctors than it absolutely needs.
 
What he said. The doctor I shadow these days told me that while he sees dozens and dozens of patients per day, a neurologist might see six.

A neurologist may see a mix because the type of work he does requires a baseline average of greater time than the doctor you shadow. In other words, every specialty feels that the healer-patient time was rushed.
 
I'm sure that even salaried positions have unspoken rules on patient load. No hospital wants to hire more doctors than it absolutely needs.
Well, yes, but they're not going to force you to slam through 60 patients in a day like you'd probably have to in the private sector to make a decent wage.
 
Sounds like you don't like the nature of the work...
 
Sure there are lots of options. Be something that's hospital based. Be a hospitalist, a neonatologist, an intensivist or find your way into some medical condition that needs a multidisciplinary approach - something that requires visits from the nutritionist or speech therapist or psychologist. Examples of such include Eating Disorders or Developmental Pediatrics.

Also consider fields that are more supportive (though still very important) in nature - radiology, pathology, anesthesiology.


The big thing to point out though is that if you were to become a general internist or FP physician in private practice, if you have a production model contract (ie what revenue you generate determines your pay), then if you want to take more time with your patients, you're going to be sacrificing your own financial security. If you're okay with that, if you can reach a lifestyle you're comfortable with then that's your prerogative.

For example, I had two internal medicine attendings that demonstrated this to me quite clearly. As a pre-clinical med student I had an internal medicine preceptor who never scheduled any appointments shorter than 20 minutes. He avoided double bookings in all but the most dire situations (and his staff did not perform well when having to work sick patients in). His practice was very laid back and reflected his personality. He rarely saw more than 10 patients a half day. The other attending, on the other hand was VERY different. Returning patients never got an appointment scheduled for longer than 15 minutes, and new patients only got 30 minutes. He triple booked EVERY appointment time, sometimes going quadruple deep, meaning that he and his PA routinely saw a total of 50-60 patients in an afternoon. His clinic was always 2 hours behind. But it fit his personality and his lifestyle - he had an awesome vacation home in Breckenridge CO he always talked about, he had an amazing boat and house, and worked hard to maintain the lifestyle he desired.

The thing was these were two men who had been in residency at the same time, were in private practices that they were partners in and were affiliated with the same medical school as adjunct professors because they enjoyed teaching medical students. They were both excellent physicians, and their patients loved them (yes even the patients who routinely waited two hours to see attending #2 - they were perhaps even more effusive in their praise compared to the other doc's patients). And yet, they had very different practice models and pushed themselves in very different ways. Based on the time I spent with them, it really came down to lifestyle. They saw the number of patients they needed to see to make the money they needed.
 
i was extremely impressed by a family MD i recently shadowed. he had zero staff, rented his office out of a converted house with other medical professionals, and essentially ran everything from his locked down laptop, a website for scheduling and a fax machine for billing. visits were usually half an hour to a full hour -- chatty, relaxed and quite helpful to his patients. patients handed him cash for copayments, or he used his little credit card reader.

he was possibly the most peaceful person i have ever met. i doubt he was financially wealthy -- he just doesn't care about the fancy house or boat or anything else the joneses may have. spending time with patients was important to him, and i think his privileged role in medicine is reward enough. i wouldn't know if this type of guerrilla-medicine approach is possible outside of primary care, but it certainly seems attractive to me.
 
i was extremely impressed by a family MD i recently shadowed. he had zero staff, rented his office out of a converted house with other medical professionals, and essentially ran everything from his locked down laptop, a website for scheduling and a fax machine for billing. visits were usually half an hour to a full hour -- chatty, relaxed and quite helpful to his patients. patients handed him cash for copayments, or he used his little credit card reader.

he was possibly the most peaceful person i have ever met. i doubt he was financially wealthy -- he just doesn't care about the fancy house or boat or anything else the joneses may have. spending time with patients was important to him, and i think his privileged role in medicine is reward enough. i wouldn't know if this type of guerrilla-medicine approach is possible outside of primary care, but it certainly seems attractive to me.

physician doing a nurse's or front desk scheduler's job is a good way to maximize efficiency.


o wait
 
Well, yes, but they're not going to force you to slam through 60 patients in a day like you'd probably have to in the private sector to make a decent wage.

I knew one FP whose group once got up to 120 patients in an 8 hour day (4 minutes/patient, including all the coding and writing).

That being said, 15 minutes/patient seems to be the norm in Family Medicine these days, these are horror stories.
 
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