Half of primary-care doctors in survey would leave medicine – CNN.com
(CNN) — Nearly half the respondents in a survey of U.S. primary care physicians said that they would seriously consider getting out of the medical business within the next three years if they had an alternative.
Just half?
I work only part-time now. It’s just not worth the anxiety/hassle factor any more.
Thanks for the share. It was a good read.
The liability is going up and the price pressure from the insurance companies pushing down earnings definitely would have me looking for an exit. I hope there are still some docs who are in it because they love it.
Their study is accurate, and I’m not surprised at all… In fact, I thought it would be even a little higher.
And it’s not just primary care. I’ve heard these rumblings from some of my surgical colleagues, and my fellow ER docs, particularly as Obama’s tax plan gets bandied about. Several of my partners are looking at cutting back to part time and/or fewer shifts.
Why continue to bust your ass in the pit, just to give an ever-larger chunk to the government?
I am not surprised! It’s a new day! The time has come for the individual to take absolute control of their health. My medical advisors promote the vegan diet for cancer, arthritis and MS patients. As an individual who was diagnosed with MS in 1984 becoming a vegan in 2002 gave me my life back. After years of just existing and am finally living my dreams. You do not have to be sick!!!
I’m a solo FP and overall I’m doing OK. Yet if a medical student were to ask me I’d tell them they would be insane to go into primary care. You accumulate all of the debt, go through just as much BS, and then make half or less of what specialists make. Reimbursement is set up to reward procedures and not cognitive services, and I don’t see that changing. Paperwork is nuts and I continually have to jump through hoops to keep the insurance companies and government agencies happy.
Eventually I think the FP’s role will be mainly overseeing staffs of NPs and PAs. Like I said I am doing fine now, I actually love having my own business but I just hope I can get to retirement and then let someone else deal with all the foolishness.
Even before recent events, one could see the signs of medicine as a career trap, when you saw doctors who weren’t very good doctors, mainly because they weren’t suited to being doctors, but what else could they do to earn anywhere near the same amount of money.
Primary care is incredibly challenging. The reimbursement is pathetic, the patient load is heavy, and the rewards are shrinking. Something has to give!
This may not be the forum, but Greg P has to realize that that his statement is equally applicable to lousy lawyers, accountants, architects, interior designers, etc inasmuch as these are professions that reward their practitioners for both objective and subjective qualitative measures. This is what Gaussian distributions are defined by in the practicable sense. I am not certain how you identify someone who isn’t “suited to be” anything, short of omnipotently evaluating ability and execution of evidence-based practice but that then diminishes the significance of the personal interaction that often defines the connection patients feel with their primary care physicians, regardless of whether or not they are prescribed the right dose of Lipitor. Is that a “bad” doctor? I’m not sure the patient would agree but they may not be the best person to ask; of course, they would tell you they are the only person to ask. If you are to define “good doctor” and, say, “good lawyer” similarly, most would agree that these persons embody characteristics of technical competence and compassion and empathy. It seems to me that you could be a really lousy, say, lawyer, and be thoroughly despised as a person by anyone you ever represented but quite successful financially due to your ability to pressure a defendant into a settlement under the threat of a long and expensive course of litigation using questionable evidence or unscrupulous testimony. Does that make for a “bad” lawyer? How else could this person make the same amount of money? Of course, this entire premise breezily overlooks myriad circumstantial and anecdotal elements of any professional practice, but so does Greg P’s statement. It seems to me that, like lawyers, accountants, interior designers, etc doctors as a group are a liquid group of individuals that must be populated by persons of various intellectual and emotional capabilities and they will always be redefining themselves as a group based on emerging evidence, evolving relationships and expanding awareness in the community of knowledge that was previously the domain solely of yesterday’s professionals. The good ones, the smart ones, they roll with it, look ahead and dynamically work to make themselves better, never ever satisfied with what someone else says is a “good” practitioner-be it lawyer, doctor or whoever.
What does it mean in the article, would leave “if they had an alternative?” They do have an alternative. Everyone has an alternative. I’m guessing what it means is that they would leave, “if they had an alternative that would allow them to continue affording their current lifestyle.” If that’s the case, I have little sympathy.
So, You Want To Be A Doctor…..
In recent times, others have said and appear to express concern about the apparent shortage of primary care doctors in particular- both now and in the speculated future. Typically, the main reason believed and speculated by others for this decline of this health care profession specialty that historically has been the apex of our health care system is lack of pay of this specialty when compared with other specialties chosen by potential physicians while in training, as it has been reported that PCPs, along with Pediatricians, have an annual salary below 150 thousand dollars a year often.
Viewed as one with great esteem and respect historically, a career as a PCP doctor may not be desired as a vocation by many that requires such admirable commitment and dedication, as reflected in their training regimen in the U.S. that consumes about a third of their lifespan. Such reasons for this paradigm shift may include:
Primary Care Doctors perhaps more than other physician specialties, seem to be choosing to practice medicine under the direction and financial security of one of the many and newly created health care systems in the United States. These regional and nationally created systems are typically composed of numerous hospitals and clinics under combined ownership- frequently of a profitable nature that is not dependent upon their beliefs as it is perhaps on their organizational motives and intentions. Yet their approach and etiology of their views regarding the restoration of the health of others are usually similar with such mergers of multiple medical facilities.
This monopolizing business model of these health care systems of increasing popularity is not necessarily a desired method to practice medicine as a primary care physician. Often, these systems employ their powers by limiting as well as dictating how their health care providers practice medicine. This is further aggravated by possible and clearly unreasonable expectations of their health care system employer, such as mandating that doctors they employ are required to see as many patients as they can in a day, and there have been cases of physicians being fired by a health care system. Conversely, there are instances where health care providers receive financial rewards for seeing more patients a day than what is determined as average visits by the organization. Such requirements likely and potentially affect or alter the clinical judgment determined by physicians employed in what may be viewed as rather authoritarian employers that potentially limit the medical care their employees provide to their patients, and the quality of this care. Also, such health care systems may have their own managed health care sub-organization which may be determined by factors not in the best interest of the patients of doctors employed by the health care system to ‘control costs’.
The primary etiology and stimulus for a doctor to practice medicine in this way is due to their frequent inability to provide and employ ancillary staff in a private practice setting. This is also combined with the increasing premiums for their mandatory malpractice insurance, which may make doctors financially unable to work independently.
Malpractice laws and premiums, which are determined in large part on a state level, are an issue with those required to have this adverse aspect of their professions. Also, these premiums become more expensive for doctors as it relates to their chosen specialty as a health care provider. For example, the premiums of an OB/GYN doctor are usually higher than one of a specialty viewed less risky for lawsuits, such as Dermatology, perhaps. With malpractice cases that are initiated, plantiffs win about 25 percent of the time on average a half a million dollars. 95 percent of these cases are settled out of court, it has been said.
In addition, the issue of medical malpractice is also frequently a catalyst for a doctor to practice what has been called defensive medicine. This basically means that the health care provider is prohibited from relying upon their subjective factors in their assessment of their patients, which in itself raises the question of what the point was of all of their training in the first place. Because if a doctor practices medicine in such a way with defensive medicine, it typically involves what may be considered as unnecessary diagnostic testing for their patients to rule out what may be unlikely disease states of their patients’ medical conditions. This waste of medical resources is further validated by the legality reflected in the tone of the notes a doctor usually annotates or dictates with their patients. So one could speculate that over-treatment is as common as under-treatment of patients in today’s health care system.
Such restrictions and limitations imposed on today’s primary health care provider are usually not fully illustrated during their training for this profession, which is one that has been viewed as one that is quite noble and of great responsibility on a societal level. This may be why this medical profession may no longer be viewed as distinct from other vocations as it once was. In large part, it seems that presently the profession of a doctor has been reduced to one dependent on the financial stability and growth of its employer, which may alter how the doctors perceive what is expected of them as well, which may affect the importance of how they view their profession, as it has been said that overall, doctors are somewhat understandably more cynical and demoralized, which may be replacing the pride they historically have viewed their callings as doctors, as well as the perceptions of patients in the U.S. Health Care System.
Further complicating and vexing to these restrictions is the usual financial state of the individual physician, as they normally have to pay off the debt acquired from attending medical school and training, which averages well over 100,000 dollars today after their training is completed, it has been estimated, along with this debt amount presently is about 5 times higher than it was only a few decades ago.
Conversely, there are some who believe that doctors in the U.S. are over-paid and are compared with some corporate monster, who behaves based upon the premise of greed. In spite of how they are judged, physicians are likely not absent of financial concerns as with many others- which may be of more of an issue than many other professions, comparatively speaking, in addition of taking on more responsibility that is of greater importance compared with other vocations. Such realistic variables should be factored in when one chooses to judge the profession of a physician. On the other hand, no physician should view their jobs as no different from any other venture capitalist when rationalizing their income and motives related to this exceptional vocation as a physician, as others are more dependent on their judgment.
It has been determined by others, and suggested often and lately, that many of today’s physicians practicing medicine in the United State do not recommend or speak favorably of their professions compared with their typical views of their profession in the not so distant past. While this self-perception physicians may have of a negative nature may be somewhat understandable it is also and potentially unfortunate for the health of the public in the future, and the nature normally associated with the medical profession which could deter ideal medical care for others
There have been cases where doctors do in fact change careers, and get into vocational fields such as medical communications or corporate medical companies. Also, expert witnessing is another consideration for those who choose to leave their profession. Finally, other choices considered include consulting and research. The training of doctors fortunately leaves them with options not involved directly with the flaws of medical care, but this is bad for us as citizens, overall. The etiology of their departure from their designed profession is largely due to the negative state perceived by themselves as well as others of their profession as medical doctors.
Then again, not all doctors are deities. Like others, some are greedy and corrupt, which complicates others in this profession in relation to how their vocation is viewed by others and based on limited judgment and analysis. Yet citizens overall should determine what sort of health care they desire, and it seems that often they fail to voice this right as a citizen.
For perhaps Primary Care Physicians in particular, the medical profession and those who provide medical care clearly needed by others to some degree appears to be absent as a desired path of today’s careerist. The authentic reasons for what many believe to be a negative perception of possibly the entire health care system may never be known, yet many would agree that most U.S. citizens are understandably concerned with the state of this system of great importance to society. Yet need to be active more in assuring this necessity is more aseptic.
“In nothing do men more nearly approach the Gods then in giving health to men.” — Cicero
Dan Abshear (ex-military medic and physician assistant for nearly 20 years)
Author’s note: What has been written has been based upon information and belief of a layperson, yet also the assessments of a patient.