What are you going to do about it?

[WhippleWhileWeWork]

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Non-Trads,

Given many of our backgrounds in the blue collar, white collar, or some other collar that I don't know about, sectors, I'm going to make a few assumptions.

1. We've had bad bosses/managers/supervisors
2. We've had to follow pointless rules/regulations
3. We've gotten sick of it at some point
4. We want/got out

The more I hear MDs complain about the current factors in medicine that are interfering with them doing what they were trained to do, the more I wonder what, if anything, I'll do about it when I'm in their shoes.

Just one of many data points, http://www.kevinmd.com/blog/2014/04/doctors-nurses-overloaded-menial-tasks.html
Another was reading "Assume the Physician" where he constantly alludes to Docs as being sheep, also see my sig, which came from an older Doc in the comment section of Kevin MD's blog.

I wonder if non-trads, maybe, don't bring these same authority issues (fear of rebelling, on any front) with them into this process that trad students do.

What do you think? Will you do something about it? Why or why not? If so, what do you have in mind?


*Shameless plug for the future Doctor's Union, WWWWorkersUnion*

 

[Law2Doc]

Non-Trads,

Give many of our backgrounds in the blue collar, white collar, or some other collar that I don't know about, sectors, I'm going to make a few assumptions.

1. We've had bad bosses/managers/supervisors
2. We've had to follow pointless rules/regulations
3. We've gotten sick of it at some point
4. We want/got out

The more I hear MDs complain about the current factors in medicine that are interfering with them doing what they were trained to do, the more I wonder what, if anything, I'll do about it when I'm in their shoes.

Just one of many data points, http://www.kevinmd.com/blog/2014/04/doctors-nurses-overloaded-menial-tasks.html
Another was reading "Assume the Physician" where he constantly alludes to Docs as being sheep, also see my sig, which came from an older Doc in the comment section of Kevin MD's blog.

I wonder if non-trads, maybe, don't bring these same authority issues (fear of rebelling, on any front) with them into this process that trad students do.

What do you think? Will you do something about it? Why or why not? If so, what do you have in mind?


*Shameless plug for the future Doctor's Union, WWWWorkersUnion*

I think it's quite the opposite. Nontrads didn't grow up in the world of entitlement, with someone telling you you were great every step of the way. They have seen the other side of the fence and have no delusions that the grass is greener there. In general, nontrads are among the happier physicians because they already tried another alternative, rather than daydreamed about what it must be like. If you came right out of college, getting honors all the way, and this award and that, youd think you were pretty hot stuff, so when the music stopped and you ended up an abused hospitalist in a crummy hospital with bad hours, it would really smart. However if you did something else first, and had more perspective of what working life really is like and your role within it, the transition is much less traumatic, the job seems less crummy (you've had worse), the hours not really all that different than other jobs, the amount of disrespect not unexpected. So because nontrads have more perspective and fewer expectations and entitlements, they tend to be happier with their lot, and thus will not try to up-earth the status quo. Employers, per some articles that at one time were posted on SDN, sometimes prefer nontrad employees exactly because they complain less about the little things, and tend to have a more upbeat outlook when asked to deal with "scut". It's always easier to appreciate something when you've had worse.

 

[WhippleWhileWeWork]

So is that it? Non-trad Docs are generally happy or at least OK with the current state of affairs in medicine because they had different expectations going in?

Calling attendings. @QofQuimica @cabinbuilder et al.

 

[Quik]

I like to think I have a tactfully cavalier approach to dealing with bull-****. I hope and expect to push back and try to iron out some of the inefficiencies; that said, I'm one future doc and it's a very large elephant.

It'll take a lot of organization among docs and great leadership; I think doctors do make great leaders, but there is also the problem of autonomy; each doc keeping to his own and focusing on what's most important (his practice) right in front of them.

Change=Organization + Leadership + x (solve for x)

 

[WhippleWhileWeWork]

Change=Organization + Leadership + x (solve for x)

x=y kick the can down the road some more?

Wait: Algebra is kicking in
Change - Organization - Leadership = x

 

[WhippleWhileWeWork]

@EngineerPreMD , read response from Law2Doc vs. what you were being told in that other thread.

 

[Quik]

x=y kick the can down the road some more?

Wait: Algebra is kicking in
Change - Organization - Leadership = x

I'm going to apologize in advance for my malfunctioning sarcasm meter, it's hasn't been picking up **** lately...

Honestly though, that X is the (or one of the) solution(s) to the current bureaucratic BS/Insurance business strangling of the health care system. It's an alternative to the status quo that will at least help to restore the practice of medicine to some intelligibly functioning condition. We (the collective team of doctors and sensible health care administrators) can identify possible solutions all day, but without one (at least one) and a collective, unified, organized approach with some leadership leading the charge, nothing is going to change.

Change - Organization - Leadership = x
Wait... I see what you did there. Too literal.

 

[Iwillhealyou]

I don't post a lot but this is a topic that I've thought a little bit about. If you look the current trends with regard to medicine, I think it becomes clear as day that the direction of medicine is one where physicians will be working much more as employees than as self employed entrepreneurs. There are many problems in the medical industry but one that has, in my opinion,been one of the weakest aspects is the fragmentation of physicians as a collective voice. Unionization would allow for physicians to speak as a collective unit much more powerfully. As WWWW said, change, organization, and leadership are required to make any fundamental change in the industry. I believe most reasonable people can look at the trending state of affairs and say with a certain degree of confidence that physicians will become a focus of administrators cost control measures and a possible target of the general public due to the negative perception of the general public to physician reimbursement based on a skewed view of the sacrifices (both personal and monetary) that physicians make to become what they are. A government that is a proponent of bringing misleading information that is easily misinterpreted and highlighting a few bad apples certainly lets you know what side they stand on, and the government is set to become a major player in medicine, moreso than ever before, and their current actions are an indicator or which direction they intend to go.


People don't like insurance companies, people don't like government interference, people don't like outrageous pharmaceutical costs, but people don't typically interact with those huge groups either. People do however, often interact with physicians, usually much more briefly than they would like (everyone complains about seeing the doctor for less than 10 minutes because he/she doesn't care). They don't understand that it is the government and insurance companies ridiculous paperwork requirements that have made this a reality, and they likely never will understand or ever care. Solidification of our profession as a group is IMHO, the first step that must be taken to put us in a better position to deal with the other organized groups (government, insurance, pharmaceutical, administration) and have a say at the table. The only other course of action is to get public sentiment back on our side which is difficult with our time limitations and active turf wars with mid-level providers. I believe it was Benjamin Franklin who once said 'Gentlemen, if we don't hang together, we will most surely hang separately". While I don't see a redo of the Salem witch trials, I think you get the point. A major show of solidarity would change the calculus of many, potentially hostile groups. I see this as the best first step. Once in a better position to control our professions future, we will be better able to dictate how we practice in the present.

 

[Law2Doc]

I don't post a lot but this is a topic that I've thought a little bit about. If you look the current trends with regard to medicine, I think it becomes clear as day that the direction of medicine is one where physicians will be working much more as employees than as self employed entrepreneurs. There are many problems in the medical industry but one that has, in my opinion,been one of the weakest aspects is the fragmentation of physicians as a collective voice. Unionization would allow for physicians to speak as a collective unit much more powerfully. As WWWW said, change, organization, and leadership are required to make any fundamental change in the industry. I believe most reasonable people can look at the trending state of affairs and say with a certain degree of confidence that physicians will become a focus of administrators cost control measures and a possible target of the general public due to the negative perception of the general public to physician reimbursement based on a skewed view of the sacrifices (both personal and monetary) that physicians make to become what they are. A government that is a proponent of bringing misleading information that is easily misinterpreted and highlighting a few bad apples certainly lets you know what side they stand on, and the government is set to become a major player in medicine, moreso than ever before, and their current actions are an indicator or which direction they intend to go.


People don't like insurance companies, people don't like government interference, people don't like outrageous pharmaceutical costs, but people don't typically interact with those huge groups either. People do however, often interact with physicians, usually much more briefly than they would like (everyone complains about seeing the doctor for less than 10 minutes because he/she doesn't care). They don't understand that it is the government and insurance companies ridiculous paperwork requirements that have made this a reality, and they likely never will understand or ever care. Solidification of our profession as a group is IMHO, the first step that must be taken to put us in a better position to deal with the other organized groups (government, insurance, pharmaceutical, administration) and have a say at the table. The only other course of action is to get public sentiment back on our side which is difficult with our time limitations and active turf wars with mid-level providers. I believe it was Benjamin Franklin who once said 'Gentlemen, if we don't hang together, we will most surely hang separately". While I don't see a redo of the Salem witch trials, I think you get the point. A major show of solidarity would change the calculus of many, potentially hostile groups. I see this as the best first step. Once in a better position to control our professions future, we will be better able to dictate how we practice in the present.

According to wiki, your Franklin pun was not actually even Ben Franklins (probably penned years earlier.) And FWIW, the Declaration if Independence wasn't signed by a single organization acting as one, but by each colony individually.

Again, I think the "negatives" of a career in medicine are partly one of perception, and nontrads know there are a lot worse options and are generally happier because of it. There is less delusion that this career will be one of high pay for light work and nothing but respect. No nontrad thinks they will be living like a rap mogul while curing everyone who walks through the door. We are looking for a few years of a socially valuable job we can sink our teeth into, and anything else is just a bonus. Traditional grads went through college being told they were superstars for getting in to med school, most nontrads were told it was crazy even to start down that road. So already the tables for career expectations were set differently. I don't see many nontrad career changers finally making it into medicine after years of postbacs and grade rehabilitation and other hurdles just to get in, with shorter career horizon to start with, only to unionize and try and shake up the status quo. most are simply grateful for the opportunity, and ready to roll up their sleeves and get to work, not quick to bite the hand that feeds them. Unionization is the gambit of people who expect something better -- where they feel they are not getting the treatment, pay, perqs they should. Makes sense when you are talking about living wages, but less if you are talking about organized professions. Unionization is a tool to deal with an employer, by creating the threat of walking out as leverage. You don't unionize to deal with insurance companies or the government, you set up lobby firms. Essentially you need to open up you wallet, not your mouth. And that's where doctors have fallen far behind lawyers, bankers etc. who more readily spend on this stuff. Most don't even join the AMA let alone send them $.

I really haven't come across that many nontrads who feel this way -- most of us are just happy we got to go to the party. Maybe that's just my circle though.

 

[box1]

what will/would i do? work as professionally (defined as get the best/most optimal results, and always do my best) as i can and eventually transfer to a professional organization. if you are skilled and do well at what you do, you can walk away and shop your skill set around elsewhere.

no job is perfect and we have little right to complain in america. we have a lot of opportunity and chance to change/grow. i often speak to mcjob workers and some are working their way out of poverty while others aren't. it's the same for those who already have professional gigs. you work our way out of it by improving the quality of your work/skills and search for something comparable/better.

 

[QofQuimica]

OP, you want to know what I'm going to do? I'm going to go to work when I'm expected to show up to work, see my patients, attend whatever meetings they say I have to attend, get out of attending any meetings I can get out of attending, maybe start up a program for my med students in a sub specialty area of my expertise and interest, and avoid wasting my free time on pointlessly spitting in the wind.

As L2D pointed out, all work environments have their negatives. I'm not naive enough to think that a union or even the AMA can take on the entire medical industrial/government juggernaut. It can't. You either accept medicine as you find it, self-immolate, or find another job. In your case, maybe politics?

 

[box1]

QofQuimica

well said. or rather, 'nuff said, in the words of stan lee.

 

[The_Sunny_Doc]

.

 

[Law2Doc]

Two words: Concierge medicine. Have you heard about it, @WhippleWhileWeWork? It's a business model that's growing in popularity down here in the Sunshine State. One running a business becomes too burdensome, I'd like to work at a public health clinic later on my career, like the 85 year old physician I shadowed does.

It's not a sustainable business model. People saturate the market and they all go out of business. In law we made a lot of money on workouts of these failed practices. Problem is only the richer people are willing to pay cash in lieu of their insurance, so this only works in wealthy neighborhoods, and most wealthy neighborhoods can only sustain 1-2 of such practices. If they do well a third or fourth practice moves in and they all go bust. This model has failed in a lot of the country already, and will in the sunshine state too before you can hang up your shingle.

But it's not really on point with OPs thesis.

 

[The_Sunny_Doc]

It's not a sustainable business model. People saturate the market and they all go out of business. In law we made a lot of money on workouts of these failed practices. Problem is only the richer people are willing to pay cash in lieu of their insurance, so wealthy neighborhoods can only afford 1-2 of such practices. If they do well a third or fourth practice moves in and they all go bust. This model has failed in a lot of the country already, and will in the sunshine state too before you can hang up your shingle.

But it's not really on point with OPs thesis.

I actually just edited out my reply because I don't know enough about it to speak in an educated fashion. 😛

Thanks for weighing in. We'll see what happens to all of these private practices in a few years.

 

[Iwillhealyou]

OP, you want to know what I'm going to do? I'm going to go to work when I'm expected to show up to work, see my patients, attend whatever meetings they say I have to attend, get out of attending any meetings I can get out of attending, maybe start up a program for my med students in a sub specialty area of my expertise and interest, and avoid wasting my free time on pointlessly spitting in the wind.

As L2D pointed out, all work environments have their negatives. I'm not naive enough to think that a union or even the AMA can take on the entire medical industrial/government juggernaut. It can't. You either accept medicine as you find it, self-immolate, or find another job. In your case, maybe politics?

I couldn't disagree more with this in particular. To hold the attitude that any group of people should just go to work, do as their told, and not ask questions or try to improve their circumstances is so foreign to everything I believe this country to be about, I can't imagine someone growing up in America and truly feel that you must accept something as it is and take no initiative to improve it. I wonder where we would be if our past generations of people in this country all held your same attitude. I'm not judging you, its just unfathomable to me how so many people hold the same kind of mentality.

As far as L2D goes, I've always associated that quote with Franklin, I'm really surprised to hear it isn't really him. Wiki Quote does say it was Richard Penn but is often attributed to Franklin. I agree that often unions are for lower wage workers but this isn't always the case. Obviously all the professional sports groups are unionized, pilots have unions, in fact white collar jobs in general have been gaining in union organizing. Canada in particular has a 25% unionization rate for white collar positions so while it is often perceived that unionizing is a blue collar thing, this isn't always the case. I couldn't agree more with your statement that union groups are people who expect something better, and I feel that a lot of physicians think they are getting an unfair shake, rightly so or not, and as physician autonomy decreases and the burdens placed on them increases I think it is perfectly within reason to assume a lot of people won't take to that well. Obviously, I don't know what the future holds in store, and I am plenty thankful for the opportunity I have to have been allowed to become what I believe is a fantastic profession, that doesn't mean I/we are exempt from trying to make it better. I think medicine attracts a lot of people, and thankfully so, who are obviously willing to sacrifice much to reach a point to do good, and maybe by nature are willing to go the extra mile for others. But I also feel that more and more they are feeling that they are being unfairly targeted by certain groups and perhaps treated unfairly. If this is the case, whether you think their feelings are misplaced or not, I wouldn't be surprised to see greater organization efforts in the future the help deal with some of these problems more collectively instead of in a fragmented fashion.

 

[Quik]

OP, you want to know what I'm going to do? I'm going to go to work when I'm expected to show up to work, see my patients, attend whatever meetings they say I have to attend, get out of attending any meetings I can get out of attending, maybe start up a program for my med students in a sub specialty area of my expertise and interest, and avoid wasting my free time on pointlessly spitting in the wind.

As L2D pointed out, all work environments have their negatives. I'm not naive enough to think that a union or even the AMA can take on the entire medical industrial/government juggernaut. It can't. You either accept medicine as you find it, self-immolate, or find another job. In your case, maybe politics?

Accepting a status quo is a choice. Working to form change in a system, also a choice. Being apathetic about the huge elephant that is the bureaucratic and insurance business hampering the efficacy of medicine... a pathetic choice. Apathy is the plague of the American (US) people. . The medical profession is full of varied personality/professional types, some excellent leaders, some who are great at memorization and following standards. Only one of these personality type is likely to lead any substantive progress while both are likely to beat their head against a wall in agony over the affliction that is a broken system.

 

[WhippleWhileWeWork]

OP, you want to know what I'm going to do? I'm going to go to work when I'm expected to show up to work, see my patients, attend whatever meetings they say I have to attend, get out of attending any meetings I can get out of attending, maybe start up a program for my med students in a sub specialty area of my expertise and interest, and avoid wasting my free time on pointlessly spitting in the wind.

As L2D pointed out, all work environments have their negatives. I'm not naive enough to think that a union or even the AMA can take on the entire medical industrial/government juggernaut. It can't. You either accept medicine as you find it, self-immolate, or find another job. In your case, maybe politics?

My hair is all wrong for it and my smile won't woo the ladies.

For arguments sake, what happens when you accept medicine as you find it but "they" change the game while you're in it? Maybe single payer in 10 years?

 

[LupaCupcake]

Actually, I think my current job (Patient Advocate) is molding me to be respectfully assertive when I see problems that need to be fixed. I am not here for my company although they do give me a paycheck, I am here to protect the patients and when necessary, initiate new policies or call attention to areas with the opportunity for improvement. You see how I worded that? If you say "this area has a problem" then it is negative and people get butthurt and defensive. If you say "this area has an opportunity for improvement" then they feel a bit less defensive lol.

When changes need to be made, one can initiate those changes without pissing everyone off. Well, a few people might get pissed off, but that is to be expected. It is impossible to please everyone.

 

[Nasrudin]

I love these type of things. But as they occur not often here, neither do I.

We are, without question, short on group cohesion. For purposes of funding political and public image battles, the far wiser one as L2D puts forward, or for unionizing. The latter as likely as I at Sunday mass. We're as hard to herd as cats, I'm afraid.

Unions require a cultural identity to nurture them. There's nothing about the squabbling, highly competitive factions within medicine that lends itself to any form of cohesion.

I remain hopeful for more skillful politicking but that's about all.

As far as Q's disposition--one should complete a residency before regarding its sounding with disdain like children who don't like facts of a thing for the romance of playing at it.

I don't know that I, for one , will think any different than she, despite my agreeing with the nature of the status quo at present and what it might forbode.

Interestingly, I will be in the same union as a resident that I was before med school. And from what I understand it has been quite successful, comparatively, at securing good pay and benefits for us. Including thwarting an attempt by administration to sell the buildings that house the residents. So...yeah...makes you wonder if the future of employment conditions for doctors might eventually lend themselves to unionization.

 

[QofQuimica]

I couldn't disagree more with this in particular. To hold the attitude that any group of people should just go to work, do as their told, and not ask questions or try to improve their circumstances is so foreign to everything I believe this country to be about, I can't imagine someone growing up in America and truly feel that you must accept something as it is and take no initiative to improve it. I wonder where we would be if our past generations of people in this country all held your same attitude. I'm not judging you, its just unfathomable to me how so many people hold the same kind of mentality.

Happy to hear it, because as a premed, you really can't judge me. Come back in a decade after you've experienced a good, old-fashioned residency beat-down, and then we'll talk. I imagine it will be a lot more fathomable to you at that point.

And for the record, I speak for what I, QofQuimica, will do. Other people can do whatever the heck they want. You want to go to med school and challenge the establishment as a med student or resident? It's your head to beat against the wall and your fist to pound in righteous indignation; have at it. I'll even arrange for the proper specialists to fix up your subdural hematoma and your boxer's fracture for you. Just spare me the proselytization attempts. (I grew up as a Jew in the South, and no proselytizing effort has yet been successful on me.) I myself have no interest in asking questions or trying to improve my circumstances in the context of taking on the medical establishment. I have intense interest in finishing residency and getting the heck out of Dodge in five weeks. I have intense interest in no longer having my job be the center of my life. I have intense interest in focusing my time and energy on the people who actually matter to me. I have intense interest in getting a full night's sleep and eating three meals a day on a regular basis.

Here's something that I can't fathom: why does everyone think they are an automatic expert on health care policy just because they are a consumer of health care? Do I think I have the knowledge to tell my mechanic how he should rebuild the transmission to make my car function better? Heck no. And along those same lines, why do people think that the average physician knows any more about how to fix the health care system than anyone else does? Does my mechanic call up Subaru headquarters and tell them how they could improve their transmissions nationwide? The idea is laughable. Yet somehow, what would be completely preposterous for a regular driver (or even a regular mechanic) to do strikes many people as being perfectly reasonable for the average person (or health care worker) to do. But if some of the smartest people in the world, people who have PhDs in health care economics and think about these things for a living, can't figure out how to fix the system, why should you or I be arrogant enough to think we would be able to?

Here's what I can tell you from my perspective. The history of medicine is replete with examples of good intentions gone very awry, from residency work hour rule changes, to end of life care, to Obamacare, to EMTALA, to P4P. If there's any way to further break the broken system, those who clamor loudest for change will manage to find it. And usually they won't be the ones who suffer the consequences.

For arguments sake, what happens when you accept medicine as you find it but "they" change the game while you're in it? Maybe single payer in 10 years?

Why people think single payer is going to be such a huge catastrophe beyond the huge catastrophe that already exists boggles my mind. The government is already the majority payer of health care costs in America. Private insurance companies follow their lead (or their mandates) when setting prices and deciding on what services to offer (or what services they'll be forced to offer). They pay my resident salary, and they'll be paying my attending salary too. (I'm working for a state university.) We ain't going back to 1960s style medicine. Ever.

You familiar with the alternative Laws of Thermodynamics? They apply to physicians, too. First Law: You can't win the game. Second Law: You can't break even. Third Law: You can't even get out of the game. Fortunately, the Third Law doesn't hold true in my case, because I can afford to get out of the game. And when I've reached the point where I can't take it any more, I will.

 

[SOOyC52H1Sof]

x=y kick the can down the road some more?
Wait: Algebra is kicking in
Change - Organization - Leadership = x

so basically x=-∞

 

[Nasrudin]

Congrats Q.

Hope it gets awesome from here. I know for me it will. The first day of psych internship is gonna be like:

In rereading the OP I realized I missed the question being posed. But I echo the thoughts of L2D and Q in that older medical students and residents generally abide the path of least resistance with greater facility. All of my rebellious notions go into my pocket protector swag and my sdn posts.

 

[The_Sunny_Doc]

Congrats Q.

Hope it gets awesome from here. I know for me it will. The first day as a psych internship is gonna be like:

Psych internship? I knew you were cool. 😉 Will be looking for posts about your experience.

/threadjack

 

[Nasrudin]

Psych internship? I knew you were cool. 😉 Will be looking for posts about your experience.

/threadjack

Come to the psych forum. I can't even remember what I did to get into medical school. And have displayed minimal prowess therein. So I'm useless in these forums. 8 prime years of my life I spent wandering in a premed desert. And it bleeds together in my memory. Talking about it is as blurry as it is tedious.

But if I can help somebody with specifics it becomes interesting insofar as I want you to get through it if I know you. Feel free to PM me anytime.

 

[cabinbuilder]

So is that it? Non-trad Docs are generally happy or at least OK with the current state of affairs in medicine because they had different expectations going in?

Calling attendings. @QofQuimica @cabinbuilder et al.

OK, there is a reason I still do locums 5 years later: I don't do meetings, I don't care about committees, I don't want to be told how many patients I HAVE to see an hour to make budget, and I don't want to be told to admit patient's beyond the care capacity of the hospital just because it's failing and needs the money.

I do locums: I am the relief help, I get paid by the hour, I am immune to the dealings of administration (they deal with my locums company and if things get ugly I just leave), I take care of the patients how I think it should be done. I am there to help the establishment not be told how to do things or be controlled. Yes, I do my own scut work because I like to make sure it's done right (control freak). I do my own swabs, my own guaiac exams, I make my own phone calls to consultants, etc.

I love my job, I am happy doing it every day. So glad to be out of poverty and have job security. I get to travel and have disposable income at my discretion. I make my own schedule and work as much (or as little) as I want. I don't have to accrue PTO, I don't have to request time, and I don't need permission to take a vacation.

 

[Sumbody1245]

OP, you want to know what I'm going to do? I'm going to go to work when I'm expected to show up to work, see my patients, attend whatever meetings they say I have to attend, get out of attending any meetings I can get out of attending, maybe start up a program for my med students in a sub specialty area of my expertise and interest, and avoid wasting my free time on pointlessly spitting in the wind.

As L2D pointed out, all work environments have their negatives. I'm not naive enough to think that a union or even the AMA can take on the entire medical industrial/government juggernaut. It can't. You either accept medicine as you find it, self-immolate, or find another job. In your case, maybe politics?

So you're going to do practically nothing? Like everyone else? Well never complain when big government comes in to try and make medicine how it is in third world countries, requiring far less schooling with SIGNIFICANTLY lower wages. Even though you will complain. A lot.

You reap what you sow.

 

[QofQuimica]

So you're going to do practically nothing? Like everyone else? Well never complain when big government comes in to try and make medicine how it is in third world countries, requiring far less schooling with SIGNIFICANTLY lower wages. Even though you will complain. A lot.

Actually, what I most resent is the lack of a life, not the lack of wages. I would feel adequately compensated as a resident if I worked a normal work week. Which is what physicians do in most other countries.

FWIW, physicians in third world countries (and other first world countries too for that matter) don't undergo less schooling than we do, although their training is organized differently. Meaning, they don't go to college, but their med school is typically six years instead of four. And their residencies are usually longer than ours are.

Out of curiosity, please do enlighten me on what you think I should be doing to change the system. Also, just what are *you* planning to do to change the system? If nothing else, I'd like to know what kind of future albatrosses you'd like to see tied around my neck to make my job even harder and more onerous than it already is. Anyone else, feel free to jump in. I'm not meaning to specifically call Sumbody out here. As I alluded in my post above, I'm just skeptical that any of you have any more clue about how to fix the health care system than the rest of us do. Especially the more pollyannish amongst you.

 

[cabinbuilder]

I find it interesting how all these pre-meds think they are going to somehow, "change the system" as a doctor. The only way I see to change it is to become a doctor - see how it really is, then go into politics and change the government for us. I, like Q, work way too many hours and deal with too many patients every day to even care or want to know about "Big brother" and changing the system. I get asked about what Obamacare is, and honestly I don't know and don't want to know. Since I work in the trenches with the super poor all I see the Government trying to do is force health insurance that is unaffordable on people who are already struggling to feed their kids and have gas money on a weekly basis. It will eventually implode upon itself - too flawed. I say bring the military home from over seas and use the billions of dollars saved on the people of America to provide health care for everyone.

It used to be doctors were rewarded on the "quality of care given and time spent with the patient". Now it's all about how many boxes you mouse click on the EMR as to how most get paid. It's disgusting and not medicine.

 

[Gauss44]

Happy to hear it, ...
[edited, see above for full quote]
...Here's something that I can't fathom: why does everyone think they are an automatic expert on health care policy just because they are a consumer of health care? Do I think I have the knowledge to tell my mechanic how he should rebuild the transmission to make my car function better? Heck no. And along those same lines, why do people think that the average physician knows any more about how to fix the health care system than anyone else does? ....

My answer to quesiton #1 in bold: Thank the news media.

My answer to question #2 in bold: That's what the news media implies. (I suspect that a combination of higher ups in public health, insurance, and hospital management, and everyday people who have fallen through "cracks" in the healthcare system know far more than the average physician (about how to improve the "healthcare system.")

My comments to OP: Having played a small role in changing local laws and insurance policy in the past as a non-medical student/non-premed/non-doctor, I can add that it takes a lot of expertise (allies are important), support from others, and the right connections. If there's something you feel strongly about and are willing to sacrifice your time for it, then you can start coalition building and brainstorming for solutions. You might create email lists and hold meetings. You might hold discussions with politicians, CEOs, etc. to study the problem. Eventually, you might have an appropriate group of people meet with human resources to present a proposal to change that organization in some small or large way. Or, work on gathering support in the community, write a law, and work on getting it passed. (A human rights issue that mattered to us: I, as well as many others, met with HR at my old company, a top international law firm, and helped convince HR to include insurance coverage for intersex and transgender people. We had transgender and intersex people in the community and company and became aware of an issue. Previously, among other problems, intersex and transgender people had to choose to purchase either a male or female policy which only covered female or male parts, not both. Most of us saw this as a human rights issue. The diversity committee at my firm was in a coalition with other top finance and legal firms, and they all did about the same thing around the same time, as planned. Next thing I knew, many insurance companies started offering similar coverage for the first time in American history! In this example, financial incentives mattered as did cooperation.) It takes patience, sometimes years or decades of patience, coalitions of people, the willingness to learn and yield to more experienced allies, the right STRATEGY, the ability to visualize, and the strength NOT to give up.

A word of caution to anyone who hasn't worked for a corporation much before: There are often reasons for existing problems that are NOT immediately obvious. If a substantial problem seems too easy to fix, you are probably overlooking something. Every system and company has it's SNAFUs. Pick your battles wisely. Learning what you are up against and why it is the way it is, before jumping in, is usually sound advice. I frequently encounter new young people who have what seems like a million suggestions about how to improve old ways. IMO, that spirit is fantastic.

This all reminds me of Margaret Mead's famous quote, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has."

 

[EngineerPreMD]

@EngineerPreMD , read response from Law2Doc vs. what you were being told in that other thread.

It's actually quite nice to see a response like that. I've met too many doctors who seem to think that no other job could possibly have the hours, stress, or disrespect that medicine requires physicians to endure. It's not like I have any perspective on being a physician, I'm sure it's tough as hell. I just find it naive when people who never had a real job outside of their gap year research position try to say that their job must be the most stressful, underpaid, and time-intensive job on the planet, when often their complaints (work coming home with you, executives telling you how to do your job, complete lack of positive feedback, etc...) are the same complaints people have in any career job with significant responsibility.

As far as unionizing, I feel that this would have to happen on a very local level and probably within specialties. The issues that different specialties face are so different and specific. I don't know if it will happen within our careers, but my guess is that it won't happen until doctors salaries fall into "normal" levels (equivalent of <150K for most specialties) and the option of private practice is basically out the door. I don't think it's possible to predict anything at this point, and I doubt the non-trads would be a huge part of the movement. They'll generally be farther along in their lives and happy to have made it into a career they take pride in. My guess is they will also be more likely to join the more lifestyle friendly specialties and care less about making tons of money. I've worked plenty, but I still don't think I'm very qualified to talk about these kinds of things though.

 

[Pons Asinorum]

All of this discussion of unionizing is essentially moot. Or some kind of thought experiment. Physicians can not unionize as long as they lack the ability to credibly threaten and execute a strike. Due to the obligation we have with our patients, this is not feasible. A union without the ability to mobilize a group-wide labor withdrawal is...what, exactly? Can all the Critical Care physician walk out of the ICU when the hospital refuses their labor demands? No. I can hear someone thinking, "yeah, but what about air traffic controllers. Life and death and stuff!" Well, pilots and airlines companies can make the rational decision not to leave the ground. Patients can't decide not to get sick to avoid the negative externalities of the labor action. Regardless, the federal gov't would smash any attempt, if it were even ethically or morally possible, to strike by physicians, as it did in the highly inconvenient, but not "life and death", strike by the federal ATC union.

 

[worfndata]

Physicians are already afraid of NPs and PAs encroaching. You all think they would really want to give anymore "food for thought" about replacing MD/DO that would certainly come to mind if a strike occurred?

 

[QofQuimica]

It doesn't matter, because it's not legal for physicians to strike. Nor, I would argue, is it ethical unless there is another physician who can cover your patients for you. The vast majority of hospitalized patients don't choose to be sick enough to require hospitalization, and someone needs to care for them. Nursing strikes without replacements would also be unethical for the same reason, but they're legal because the hospital is able to bring in enough scabs and travelers to care for patients. In order to make it work though, the nursing union and the hospital brass plan out these nursing strikes months in advance so that the hospital has time to line up replacements for the nurses to avoid interruptions in patient care during the strikes. The striking nurses even give signout on their patients to the scabs/travelers before they walk out. The whole thing is a farce.

Don't get me wrong; I'm all for nonviolent civil disobedience in the proper context. But if you aren't able or willing to do the right thing for your patients because you don't like your working conditions, then medicine ain't the right career for you, regardless of whether you are a physician, a midlevel, or a nurse.

 

[Apollo1]

I couldn't disagree more with this in particular. To hold the attitude that any group of people should just go to work, do as their told, and not ask questions or try to improve their circumstances is so foreign to everything I believe this country to be about, I can't imagine someone growing up in America and truly feel that you must accept something as it is and take no initiative to improve it. I wonder where we would be if our past generations of people in this country all held your same attitude. I'm not judging you, its just unfathomable to me how so many people hold the same kind of mentality.

So you're going to do practically nothing? Like everyone else? Well never complain when big government comes in to try and make medicine how it is in third world countries, requiring far less schooling with SIGNIFICANTLY lower wages. Even though you will complain. A lot.

You reap what you sow.

I believe Louis L'Amour would classify you both as "tenderfoot."

 

[WhippleWhileWeWork]

So when do we say damn the mandates and requirements from bureaucrats who are not in the healing profession? When do we stand up and say we are not going to take it any more?

http://online.wsj.com/news/articles...0001424052702304279904579518273176775310.html


I think there is an unintentional strawman being built in this thread. To clarify, I'm not claiming to know how to "fix the healthcare system", and so far, no one else on this thread has either. It seems as though Doctors can stand up for themselves and say "We're not going to do this/that anymore" without having all the answers to "fixing the healthcare system" in this country.

 

[LupaCupcake]

I will say this, call me selfish if you like. I care very much about the welfare of patients, I just recently made a friend upset with me because I filed a grievance against her at work. Do I feel bad for doing that to her? To some extent yes, but I am the PATIENT advocate, not the friend advocate. I seek to change issues within our facility that are affecting the patients and improve morale of our employees because that shows correlation with how they treat patients and handle stressful situations. That being said, I do not seek to fix the healthcare system as a whole and claim to be some "special person" that has discovered a way to please everyone. This is where the selfish part comes in. I will always stand up for patient rights, but I really don't want to put forth tons of effort into changing the way healthcare works. I have a husband and a daughter, they mean more to me than healthcare policy. If something is hurting the patient or causing care to be diminished then I will speak out, but if the patients are taken care of and my family is taken care of then I will sleep soundly.

 

[WhippleWhileWeWork]

But if you aren't able or willing to do the right thing for your patients because you don't like your working conditions, then medicine ain't the right career for you, regardless of whether you are a physician, a midlevel, or a nurse.

I think the argument being put forth by most physicians is that parts of the working conditions (unnecessary bureaucratic tasks and systems) are interfering with the right thing for the patients.

 

[ridethecliche]

From your article:

"Meanwhile, our Medicare and Medicaid reimbursements have significantly declined, let alone kept up with inflation. In orthopedic surgery, for example, Medicare reimbursement for a total knee replacement decreased by about 68% between 1992 and 2010, based on the value of 1992 dollars. How can this be? Don't doctors have control over what they charge for their services? For the most part, no. Our medical documentation is pored over and insurers and government then determine the appropriate level of reimbursement."

I'm curious how the time spent doing these procedures has changed as well. I've seen orthopods knock out hip and knee replacements in around the hour mark. The residents get to close, of course.

 

[Nasrudin]

I'm going to play satan's advocate here--because god has a line of advocates as do patients. Whereas physicians, also greedy and satanic, do not. I don't think there is an ethical absolutism that prohibits doctors from striking. I can't imagine it currently. But conditions could arise such that I would be in favor of it. I think it is amoral to prohibit radar traffic controllers from striking for example. Because nobody needs to fly. Doctors I can see the problem there. But I don't think its impossible to strike or to perform some sort of group civil disobedience as a union or just as any group of employees. Particularly as physicians are increasingly just that--employees.

Patients need advocates. But they also need to be their own advocate. The whole obese, diabetic, hypertensive, hyperlipidemic, slobbish hoard of them. And like the OP I think we need the same. It's just...i don't have the energy for it...perhaps the dark lord will stand in my stead.

 

[Iwillhealyou]

"I think there is an unintentional strawman being built in this thread. To clarify, I'm not claiming to know how to "fix the healthcare system", and so far, no one else on this thread has either. It seems as though Doctors can stand up for themselves and say "We're not going to do this/that anymore" without having all the answers to "fixing the healthcare system" in this country."

It is this, I read what Q of Quim was saying and he/she is right, nobody knows how to fix the healthcare system exactly. That isn't the point of unionization, however, and I think most people here really do understand the difference between fighting to fix a crazy system and having a more unified voice in order for physicians to stand up for themselves and their colleagues if it comes to a point where it is felt that too much is being asked of them. I mean being realistic about it, what harm could possibly be incurred by existence of a strong physicians union? I'm really interested in hearing some of your sentiments about this.\

Edit to say: Unions would allow physicians some capacity to better influence the health care system than they currently have, I believe, which would play into Q's ideas. I do believe that physicians should have a seat at the table alongside the other players in determining policies or programs. Certainly teachers unions have a seat at the table regarding changes in education, pilots in travel, sports figures in athletics, and so should doctors with regards to health care. I don't think that is such a stretch to make.

 

[ridethecliche]

I also think that a lot of the issues stem from the divide between policy and practice being far too great.

I think that enough people are starting to talk about it now that the issue is coming to the forefront and people are realizing the reality of how things are. They're not good. Certainly could be worse, but there's a lot to work on.

 

[worfndata]

I agree, some physicians are whiny because they have basically been lifelong students until finishing residency and have not the slightest clue about the real world other than healthcare. I promise you 40 hours per week as an over the phone agent for some vaginal mesh lawsuits is 10000000x worse than anything a doctor will ever do in is or her life. Just of the many things people do to live.

 

[Nasrudin]

I agree, some physicians are whiny because they have basically been lifelong students until finishing residency and have not the slightest clue about the real world other than healthcare. I promise you 40 hours per week as an over the phone agent for some vaginal mesh lawsuits is 10000000x worse than anything a doctor will ever do in is or her life. Just of the many things people do to live.

Who are you agreeing with?

How about people are whiny. Including everyone who is convinced they can do physicians' work better than they can. And everybody and their advocate who wants their 15 medical problems handled in 15 minutes for $15, and just can't understand why doctors don't talk to you all slow and cheery and grandpa like as if there's not a whole waiting room full of whiny, attention starved health trainwrecks.

Truthfully. I used to sound like you. And of course there's some whiny physicians. They are after all...people. With the normal distribution of this or that we all don't like.

People always talk about patient rights like there's romantic movie music playing in the background. When they hold their end of the bargain so pitifully horribly bad that they just don't have much to complain about. I wish I could clear the whole set and replace everyone with poor villagers from Mindanao. Might just change the mindset of your doctor--grateful, friendly, patients who just can't believe finite American taxpayer money is actually regarding their well-being in any way.

 

[worfndata]

@Nasrudin


You used to sound like me until you became jaded, the put it kindly. You lack perspective and self awareness, wake up!

"attention starved health trainwrecks. "

Can you imagine what would happen if a pre-med referred to people this way during say their interviews? Did you? I dont think so. Actually, other than this forum where people think they have anonymity; where else would you refer to people as "attention starved health trainwrecks" so casually? Oh let me guess, among other jaded folks just like yourself?

You are exactly what is wrong with healthcare. You have no business becoming a healthcare provider. There are many careers where you will NOT be around "attention starved health trainwrecks. " Hopefully you go into something like Rad or whatever else has zero patient contact. For your sake and for the sake of people who might look at you and mistake you for someone who gives a damn.

 

[Nasrudin]

@Nasrudin


You used to sound like me until you became jaded, the put it kindly. You lack perspective and self awareness, wake up!

"attention starved health trainwrecks. "

Can you imagine what would happen if a pre-med referred to people this way during say their interviews? Did you? I dont think so. Actually, other than this forum where people think they have anonymity; where else would you refer to people as "attention starved health trainwrecks" so casually? Oh let me guess, among other jaded folks just like yourself?

You are exactly what is wrong with healthcare. You have no business becoming a healthcare provider. There are many careers where you will NOT be around "attention starved health trainwrecks. " Hopefully you go into something like Rad or whatever else has zero patient contact. For your sake and for the sake of people who might look at you and mistake you for someone who gives a damn.

I guess I'll just go about my misanthropic, merry way. You best hurry on yours. The lights of heros are all slipping into darkness. #horribledoctor #evildoer #fairytalehater

 

[Nasrudin]

@worfndata

You know what the funny thing is. I have one of the mellowest, burn out resistant, equanimous dispositions you're likely to see, which I attribute to the thing in me you despise--low expectations and a base and cruel estimation of my fellow primates myself included. But I abide my duty just the same. And will be at it till I'm dead. In the most unglamorous clinical sectors of medicine.

I don't think I ever understood the nature of these types of moral judgements. Or their casual and prevalent use in our profession.

We represent all types of minds and dispositions and personalities. It's not as simple as you would like it to be in terms what signifies right and wrong. And from these words no one here can be certain which of us if either is a rogue and which a saint.

 

[Law2Doc]

... I think it is amoral to prohibit radar traffic controllers from striking for example. Because nobody needs to fly. Doctors I can see the problem there. But I don't think its impossible to strike or to perform some sort of group civil disobedience as a union or just as any group of employees. Particularly as physicians are increasingly just that--employees...

Doesn't matter what you think is amoral. In this country the president of the US (Reagan) previously saw fit to deny air traffic controllers the right to strike and the administrations argument would be much much much stronger in denying physicians the same right. The precedent has been set. Nobody in the profession really thinks they would be allowed to strike en masse. And without that threat a union is meaningless -- just a pit into which you dump dues.

And that ignores the fact that despite being treated as employees we have all taken an oath to put patients first. so even if the administration dragged their feet on the issue, we really couldn't just walk out of the ICU, tell the nurses "good luck" and join the picket line. So a union isn't part of the equation in this field. The way to influence is to put up lots of money and use lobby groups. Lawyers have figured his out. Other fields too. But doctors have shown resistance to this form of influence and it's easier to get blood out of a stone.

 

[worfndata]

@nasrud, Yeah good luck with that passive aggresive thing you got going on.

 

[QofQuimica]

Who are you agreeing with?

How about people are whiny. Including everyone who is convinced they can do physicians' work better than they can. And everybody and their advocate who wants their 15 medical problems handled in 15 minutes for $15, and just can't understand why doctors don't talk to you all slow and cheery and grandpa like as if there's not a whole waiting room full of whiny, attention starved health trainwrecks.

Truthfully. I used to sound like you. And of course there's some whiny physicians. They are after all...people. With the normal distribution of this or that we all don't like.

People always talk about patient rights like there's romantic movie music playing in the background. When they hold their end of the bargain so pitifully horribly bad that they just don't have much to complain about. I wish I could clear the whole set and replace everyone with poor villagers from Mindanao. Might just change the mindset of your doctor--grateful, friendly, patients who just can't believe finite American taxpayer money is actually regarding their well-being in any way.

Agree with all of this wholeheartedly.

Medical professionalism dictates that health care providers (HCPs) must treat everyone in a manner that is respectful and looks out for their best interest, even when it's not what the patient wants (or thinks they want). And on the whole, I'm proud to say that we do a decent job of this; the exceptions where HCPs treat patients in a blatently unprofessional way are unusual and noteworthy enough to make it on the evening news. But there isn't any such thing as patient professionalism. Why is it acceptable for patients to yell at HCPs, spit on them, attack them, threaten them, just because the patients are d-bags or drunk or have a personality disorder? Actually, I can still muster up some empathy for the latter two groups because they have bona fide psychiatric disorders. But what excuse do the d-bags of the world have for unloading on HCPs just because they can?

Can you imagine what would happen if a pre-med referred to people this way during say their interviews? Did you? I dont think so. Actually, other than this forum where people think they have anonymity; where else would you refer to people as "attention starved health trainwrecks" so casually? Oh let me guess, among other jaded folks just like yourself?

Most premeds can't talk like that, because most premeds don't have the experience with dealing with the level of human entitlement and ingratitude where no good deed goes unpunished that fosters this kind of self-protective response in HCPs. So you are correct that such an attitude would be extremely off-putting coming from the average premed. To put it bluntly, you don't have the street cred yet.

You are exactly what is wrong with healthcare. You have no business becoming a healthcare provider. There are many careers where you will NOT be around "attention starved health trainwrecks. " Hopefully you go into something like Rad or whatever else has zero patient contact. For your sake and for the sake of people who might look at you and mistake you for someone who gives a damn.

I hope you come back in 5-10 years and re-read this post. And I hope you have the introspective ability and the intellectual honesty at that time to admit that you were wrong now. Nas is going to be a psychiatrist. There aren't too many other specialties that take care of a less desirable, more soul-crushing patient population, a group of patients that most other HCPs work to avoid like the plague, than psychiatrists do. I've never met Nas, but I have to respect him and his colleagues for doing what they're doing. For all the wacky eccentric types that psych seems to attract, one thing you cannot say about most of them is that they are typically people who don't care about patients.