How being a Doctor Became the Most Miserable Profession

[utvol23]

An interesting read for the many people in the medical field, interested in pursuing medicine or those that just thing being a doctor is a glamorous job raking in money hand over fist.

Just to clarify the title of the thread is just the title of the article. I personally am not miserable and enjoy my job but the article does point out many good points.

http://thebea.st/1sY36mA

By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second-most suicidal occupation—the level of sheer unhappiness amongst physicians is on the rise.

Simply put, being a doctor has become a miserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.

Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retire as quickly as possible. Physician MBA programs—that promise doctors a way into management—are flourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.

It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician. Imagine, for things to get better for patients, they need to empathize with physicians—that’s a tall order in our noxious and decidedly un-empathetic times.

After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.

Unfortunately, things are only getting worse for most doctors, especially those who still accept health insurance. Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care. To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.

Neither patients nor doctors are happy about that. What worries many doctors, however, is that the Affordable Care Act has codified this broken system into law. While forcing everyone to buy health insurance, ACA might have mandated a uniform or streamlined claims procedure that would have gone a long way to improving access to care. As Malcolm Gladwell noted, “You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”

To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.

In fact, difficulty dealing with insurers has caused many physicians to close their practices and become employees. But for patients, seeing an employed doctor doesn’t give them more time with the doctor—since employed physicians also have high patient loads. “A panel size of 2,000 to 2,500 patients is too many,” says Dr. Schimpff. That’s the number of patients primary care doctors typically are forced to carry—and that means seeing 24 or more patients a day, and often these patients have 10 or more medical problems. As any seasoned physician knows, this is do-able, but it’s certainly not optimal.

Most patients have experienced the rushed clinic visit—and that’s where the breakdown in good medical care starts. “Doctors who are in a rush, don’t have the time to listen,” says Dr. Schimpff. “Often, patients get referred to specialists when the problem can be solved in the office visit.” It’s true that specialist referrals are on the rise, but the time crunch also causes doctors to rely on guidelines instead of personally tailoring medical care. Unfortunately, mindlessly following guidelines can result in bad outcomes.

Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their jobs. Industry leaders are fixated on patient satisfaction, despite the fact that high scores are correlated with worse outcomes and higher costs. Indeed, trying to please whatever patient comes along destroys the integrity of our work. It’s a fact that doctors acquiesce to patient demands—for narcotics, X-rays, doctor’s notes—despite what survey advocates claim. And now that Medicare payments will be tied to patient satisfaction—this problem will get worse. Doctors need to have the ability to say no. If not, when patients go to see the doctor, they won’t actually have a physician—they’ll have a hostage.

But the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” list continues to lengthen. A stunning and unmanageable number of forms—often illegible—show up daily on a physician’s desk needing to be signed. Reams of lab results, refill requests, emails, and callbacks pop up continually on the computer screen. Calls to plead with insurance companies are peppered throughout the day. Every decision carries with it an implied threat of malpractice litigation. Failing to attend to these things brings prompt disciplining or patient complaint. And mercilessly, all of these tasks have to be done on the exhausted doctor’s personal time.

Almost comically, the response of medical leadership—their solution— is to call for more physician testing. In fact, the American Board of Internal Medicine (ABIM)—in its own act of hostage-taking—has decided that in addition to being tested every ten years, doctors must comply with new, costly, "two year milestones." For many physicians, if they don't comply be the end of this month, the ABIM will advertise the doctor's "lack of compliance" on their website.

In an era when nurse practitioners and physician assistants have shown that they can provide excellent primary care, it’s nonsensical to raise the barriers for physicians to participate. In an era when you can call up guidelines on your smartphone, demanding more physician testing is a ludicrous and self-serving response.

It is tone deaf. It is punitive. It is wrong. And practicing doctors can’t do a damn thing about it. No wonder doctors are suicidal. No wonder young doctors want nothing to do with primary care.

But what is a bit of a wonder is how things got this bad.

Certainly, the relentlessly negative press coverage of physicians sets the tone. “There’s a media narrative that blames physicians for things the doctor has no control over,” says Kevin Pho, MD, an internist with a popular blog where physicians often vent their frustrations. Indeed, in the popular press recently doctors have been held responsible for everything from the wheelchair-unfriendly furniture to lab fees for pap smears.

The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations. Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands.

To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving out doctors. Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to most people.

But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone.

 

[bamez]

i work in an ER and one of the patients who came in was a suicidal physician.  slit his wrists down the street not accross, stuck a knife in his neck and twisted it.

he lived thogh

 

[moonman818]

Most miserable profession huh?

Spoiler: Warning: Spoiler!

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[currensy]

I'ma have to come back and read this, brb.

 

[00david00]

Sombering read as I'm pursuing medicine. We'll see.

 

[Top Boy]

I wanted to be a doctor too..

Unfortunately im not a fan of wasting away in my 20's with my head buried in books pulling slave hours for slave wages.

Switched majors after I took my first bio class

 

[milestailsprowe]

I can see this professions sucking for the fact you see death day to day and you worked for 12 years of college to get there makes it abit sad but still. Your making 100-200k a year then I just stop caring. Most people in America only make $30-$40k and work much worse things. The doctors never have to worry about their personal bills and more. Just stress.

Try being a Walmart Janitor were you can barely afford rent food and on public assitance.

 

[yeezusdisciple]

i wonder how @thadocta feels about this

 

[ayotayo]

P4l

 

[bamez]

just don't go into internal medicine or family practice.  Thats what the article is saying.  

 

[djyoung08]

Most miserable profession huh?

Spoiler: Warning: Spoiler!

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That gif gets me every time

 

[pepperjackchees]

 
I wanted to be a doctor too..

Unfortunately im not a fan of wasting away in my 20's with my head buried in books pulling slave hours for slave wages.

Switched majors after I took my first bio class

My cousin is in residency and makes 50-60K. But that's only for 2 years. In no time, she'll be pushing close to $200K.

 

[nawghtyhare]

u know what i peeped the other day
the nurse does most of the work
the doctor comes in looks around and just prescribes something
nurses do the shots and all that other stuff

 

[Comparison Ford]

My brother is about to graduate from Columbia and even he says that if he had the chance to do it over again he would have chose a different path. 

 

[beh235]

It depends on what type of doctor you want to be. A lot of people don't fully understand what being a doctor entails. Yeah, they know a lot, but they miss a lot too. I'm not an MD, but I work with doctors often. Like any profession, some are really good, some are average, and some are bad. Doctors can be just as lazy in what they do, just like everyone else in any other profession. It can be stressful. Depending on what you do, you can make a lot of money but you have to pay back $ for school and malpractice insurance so it adds up. I would say do it if you really love it, but from my POV not too many love it, they love the prestige of being an MD. I've witnessed simple misdiagnoses and horrible bedside manner from MD's in hospitals that people trust and hold in high regard. But that's anecdotal. I wanted to be an MD when I was younger, but the older I got I decided to do something else.

 

[nawghtyhare]

just read the article
i dont wanna hear this ******* sob story
u notice the article doesnt say how much the average primary care physician makes
talking about its hard for them to make ends meet
i aint never seen or heard of a doctor apply for food stamps or at the local welfare office
to get a damn xray cost a grip if u aint got insurance
im playing the worlds smallest violin for them right now

 

[beh235]

just read the article
i dont wanna hear this ******* sob story
u notice the article doesnt say how much the average primary care physician makes
talking about its hard for them to make ends meet

i aint never seen or heard of a doctor apply for food stamps or at the local welfare office
to get a damn xray cost a grip if u aint got insurance
im playing the worlds smallest violin for them right now

It happens. People really don't understand the details of it. Like I said, it depends upon what your specialty is. The longer you stay in school, the more loans you rack up. You make a lot, but you have to pay a lot. Most of the time, the profession is glamorized in our society because of the prestige of the title and the money that some specialists make. US healthcare is such a convoluted beast man, I don't think we'll ever untangle the mess. 

 

[Stay Lowkey]

Where's Hank and TypeRPinoy to chime in?

 

[utvol23]

My cousin is in residency and makes 50-60K. But that's only for 2 years. In no time, she'll be pushing close to $200K.

not sure what residency is 2 years all I know of are 3 -6 years. Mine was 5 years plus fellowship. Maybe if you consider intern year seperate.

 

[utvol23]

Lol loving the comments so far

 

[nawghtyhare]

just read the article

i dont wanna hear this ******* sob story

u notice the article doesnt say how much the average primary care physician makes

talking about its hard for them to make ends meet

i aint never seen or heard of a doctor apply for food stamps or at the local welfare office

to get a damn xray cost a grip if u aint got insurance

im playing the worlds smallest violin for them right now

It happens. People really don't understand the details of it. Like I said, it depends upon what your specialty is. The longer you stay in school, the more loans you rack up. You make a lot, but you have to pay a lot. Most of the time, the profession is glamorized in our society because of the prestige of the title and the money that some specialists make. US healthcare is such a convoluted beast man, I don't think we'll ever untangle the mess. 

naw i understand its just man they making it seem like oooooh i have it so bad
man they should be blessed they are in a position to help so many people
**** i thought that was the point of being a doctor
to help people
not complain about ur loans
when u knew damn well it costs a lot to go to college

 

[champagne papi]

WHAT ABOUT A PHYSICIAN ASSISTANT ?
100k a year to be a doctors assistant ?

 

[guzzy]

Where's Hank and TypeRPinoy to chime in?

Hank's in IB iirc.

Hate insurance companies.

 

[Comparison Ford]

WHAT ABOUT A PHYSICIAN ASSISTANT ?
100k a year to be a doctors assistant ?

$100K+/year for a 27-month program (on average) after undergrad with the responsibility of prescribing medications and doing a lot of tasks physicians would perform seems warranted.

 

[00david00]

Problem isn't just the wages. Docs aren't signing up to become insurance company clerks. You go to school for all those years, to be told how to take care of patients by people that aren't even trained in medicine. And of course there is the narrative that these raises in medical costs are the physicians fault.

As Malcolm Gladwell noted, "You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies."

I need to take some time and throughly study policy.