How being a Doctor Became the Most Miserable Profession

[metsn13]

More responsibility should be assigned to other health care professionals: Physician Assistants, Nurse Practitioners, Health Coaches etc in order for Primary Care Physicians to get help.
 

You make some excellent points in your post, but I have to disagree with this idea of health coaches and relying on mid level providers such as PA's and Nurse Practitioners.  In my 4 years out of residency as a physician I have seen countless mismanagement of patients by mid level providers who I feel don't have the training or knowledge base to properly diagnose or manage common complaints and diseases.  Just last week I was sent a patient for evaluation by a nurse practitioner from a primary care office for chief complaint of pruritis.  The patient was in her 50s without visible rash, but severe pruritis causing her to visibly excoriate her legs in front of me as I obtained the history from her.  The patient had not seen a physician in over 30 years and saw the nurse practitioner last month for work up.  An allergy panel was ordered along with referral to our office.  The allergy panel was unremarkable except for allergy to grasses.  The patient had icteric sclera with slightly jaundiced skin.  I immediately ordered a comprehensive metabolic panel and a hepatitis panel and it showed hepatitis C infection with high elevations in Bilirubin, Alk Phos, and AST/ALT.  The nurse practitioner completely missed the eye and skin exam and jumped to an allergy panel that was essentially useless.  I immediately referred her to GI/Hepatology for treatment of Hepatitis C in the setting of acute elevations in liver enzymes.

Primary Care Physicians are the point guards of the medical team and the complexity of our patient population continues to rise as patients are living longer and are becoming so dependent on medications and technology to stay alive.  It is imperative that our brightest medical minds be in primary care as this is where disease and morbidity can be most effectively managed.  Leaving the complexity of diagnosis and management to mid level providers without the knowledge and training to treat our evolving population will only lead to more health care waste.  There is a reason we work 80 hours a week as interns and residents during our training.  It is a rite of passage that our mentors and attendings went through and without it we wouldn't have the knowledge or skill to treat the most difficult cases that present to us.  

 

[utvol23]

You make some excellent points in your post, but I have to disagree with this idea of health coaches and relying on mid level providers such as PA's and Nurse Practitioners.  In my 4 years out of residency as a physician I have seen countless mismanagement of patients by mid level providers who I feel don't have the training or knowledge base to properly diagnose or manage common complaints and diseases.  Just last week I was sent a patient for evaluation by a nurse practitioner from a primary care office for chief complaint of pruritis.  The patient was in her 50s without visible rash, but severe pruritis causing her to visibly excoriate her legs in front of me as I obtained the history from her.  The patient had not seen a physician in over 30 years and saw the nurse practitioner last month for work up.  An allergy panel was ordered along with referral to our office.  The allergy panel was unremarkable except for allergy to grasses.  The patient had icteric sclera with slightly jaundiced skin.  I immediately ordered a comprehensive metabolic panel and a hepatitis panel and it showed hepatitis C infection with high elevations in Bilirubin, Alk Phos, and AST/ALT.  The nurse practitioner completely missed the eye and skin exam and jumped to an allergy panel that was essentially useless.  I immediately referred her to GI/Hepatology for treatment of Hepatitis C in the setting of acute elevations in liver enzymes.

Primary Care Physicians are the point guards of the medical team and the complexity of our patient population continues to rise as patients are living longer and are becoming so dependent on medications and technology to stay alive.  It is imperative that our brightest medical minds be in primary care as this is where disease and morbidity can be most effectively managed.  Leaving the complexity of diagnosis and management to mid level providers without the knowledge and training to treat our evolving population will only lead to more health care waste.  There is a reason we work 80 hours a week as interns and residents during our training.  It is a rite of passage that our mentors and attendings went through and without it we wouldn't have the knowledge or skill to treat the most difficult cases that present to us.  

Very well put unfortunately the route I see primary care headed is that most of the care will be administered by midlevels in so called doc in the boxes at your local Walmart Walgreens etc

 

[champagne papi]

If the doc is the point guard
What's the PA

 

[derrtay]

Just about to start rotations, finished step 1 and all that. Excited to move on to the next phase in my education, but a lot of what needs to be said has been said very well by the already MD's. As someone who actually wants to get into primary care, it's a daunting task and a constant uphill battle with insurance companies breathing down your neck and trying to meet quotas just to keep a practice open. Which, one could imagine, should not be how physicians/practices should operate. From the time I was a kid seeing my Pediatrician work, to now when I shadow him during my breaks the difference has been night and day, and that wasn't even too long ago. 

But as everyone has already said, getting into medicine, especially primary care, it shouldn't be about the money. I see how terrible some primary care physicians can be(partly due to time restraints, others due to a lack of compassion) and it makes me want to be that change moving forward to get rid of that bad rap that primary care physicians get. 

Glad to see so many MD's on this board. Hope to become your guys' colleague in 2 years!

PS: who's the resident NT Pediatrician? I have a few questions for him/her

 

[utvol23]

Just about to start rotations, finished step 1 and all that. Excited to move on to the next phase in my education, but a lot of what needs to be said has been said very well by the already MD's. As someone who actually wants to get into primary care, it's a daunting task and a constant uphill battle with insurance companies breathing down your neck and trying to meet quotas just to keep a practice open. Which, one could imagine, should not be how physicians/practices should operate. From the time I was a kid seeing my Pediatrician work, to now when I shadow him during my breaks the difference has been night and day, and that wasn't even too long ago. 

But as everyone has already said, getting into medicine, especially primary care, it shouldn't be about the money. I see how terrible some primary care physicians can be(partly due to time restraints, others due to a lack of compassion) and it makes me want to be that change moving forward to get rid of that bad rap that primary care physicians get. 


Glad to see so many MD's on this board. Hope to become your guys' colleague in 2 years!


PS: who's the resident NT Pediatrician? I have a few questions for him/her

congrats man glad to see our numbers keep growing

the NT pediatrician is Dr DAMON

 

[youngdoc]

Radiologist

This is DOPE! I'm an Xray tech and I can't picture ANY of my radiologists i work with being a sneakerhead, much less on NT. LOL.

Nice read, btw.

Radiologist here as well (resident)

 

[youngdoc]

One of my boys who is a 2nd year gen surg resident just quit. Unsure if he's gonna go for another field of medicine or do biotech/pharm etc

 

[typerpinoy]

Honestly not that surprising. Most surgery residents are miserable

 

[thepointgod]

People are so soft now.

 

[fontaine]

I heard surgeons get all the nurse yambs

 

[youngdoc]

Honestly not that surprising. Most surgery residents are miserable

Yeah I mentioned it earlier but one of my other GS friends is switching to Anesthesia

I heard surgeons get all the nurse yambs

Any doctor can get the nurse/tech/RT yambs. I've seen it across all specialties. I personally stay away from it because I don't want potential drama and there's enough yambs outside of the workplace

 

[thegr8blkhope]

My girl is a second year resident, gen surg i believe. shes on call right now for the second time since thursday. i ask her how she does it and she says that while it is stressful that she's in it because she cares about people and making them better is satisfying. I have a 6figure job that I hate but i know she deals with more stress than i do and only makes half the money, so i tend not to complain about my situation. after reading this thread I just sent her a text letting her know that im here for her no matter what. knowing somewhat the types of patients/hospital drama you guys deal with has changed my opinion. hats off to you NT doctors. i do have one gripe with y'all though...

when you guys bring your spouses to these social "doctor gatherings" can you PLEASE talk about something other than medical stuff?? I swear most of the time i just sit there and blindly shake my head like i actually understand stuff but in reality im super lost. talk about sports/weather/cars/ANYTHING...please.

 

[typerpinoy]

Last thing I want to talk about outside of work is work

 

[youngdoc]

Last thing I want to talk about outside of work is work

This

 

[mr jordan04]

Dr Dre ain't trippin

 

[blazinrook]

 In my 4 years out of residency as a physician I have seen countless mismanagement of patients by mid level providers who I feel don't have the training or knowledge base to properly diagnose or manage common complaints and diseases.

This is a valid point as well. I'm not in your position, but i am trying to understand it.

From an outside perspective, the point you've made states that You don't trust mid level providers to a certain point.
But Doctors are complaining to have all the responsibility/stress, but not enough compensation.

(Being realistic) increasing compensation is probably not an option.


At the same time, you didn't provide a solution.

I'm not saying mid-level providers replace Dr.'s (which is not an option) , but rather work more complimentary to them/more efficiently with them.

If primary care Dr's are responsible for increased in training, then mid-level providers should get an increase in training as well.
If primary Care Dr's are held accountable for more responsibility, then mid-level providers should be trained to lighten their load.

I'm about protecting the Dr's rights because it seems like Legislators and Health Administrators (along with lawyers out to sue) continue to attack the Dr's.

Some Dr's don't complain, and face adversity head on (it comes with the territory)

But other's, feel there is a reason to raise arms, which is why the article was written in the first place.

 

[girlslovewaffles]

To the radiologists (both attending and residents), what made you decide on that specialty?

 

[lamekilla]

Do we have any PA's on here?

 

[youngdoc]

To the radiologists (both attending and residents), what made you decide on that specialty?

Got initially drawn to it by IR (but now probably not doing that) but fell in love with it due to the technology, the challenging nature, the anatomy, the variety, less BS with social issues, the ability to do procedures and still interact with patients

 

[mr marcus]

I heard surgeons get all the nurse yambs

Anybody in the hospital can pull a nurse except housekeeping lol...single nurses be loose

Asian ones be aiming for docs tho

White/Blk/Latina anything goes

 

[Peep Game]

For real, nurses start tossing out the yambs in college before they even fully get into their profession you can snatch them up genetics or microbiology class

 

[ddell2345]

Midlevels do have the education, training and knowledge-base.  Sounds like you've been working with some weak providers.  I'm a ortho pa for 3+ years and am confident I would've known to order a liver panel.

 

[ksteezy]

Healthcare is going to **** I barely see doctors, unfortunately I suffer from psoriasis which there is no cure for so I need to see a dermatologist....I had to drop the last dude because this idiot must have been maybe a year younger than me, fresh out of residency with his arrogant attitude and can't even spare more than 4 minutes per visit, dude prescribed me a chemo therapy pill to combat my psoriasis and when I asked him of side effects, my man pull out his iPhone and googled this **** I looked at dude like he was a moron and I don't think he liked it much...but can I blame him?...is this his fault?...not really...he's just a youngin 1 out of 1000's who got through med school, got a gig at some BS clinic for the minimum they can pay a "Doctor" and loaded dude with a ridiculous amount of patients and dude out here with a liscence to kill practically.

 

[girlslovewaffles]

Healthcare is going to **** I barely see doctors, unfortunately I suffer from psoriasis which there is no cure for so I need to see a dermatologist....I had to drop the last dude because this idiot must have been maybe a year younger than me, fresh out of residency with his arrogant attitude and can't even spare more than 4 minutes per visit, dude prescribed me a chemo therapy pill to combat my psoriasis and when I asked him of side effects, my man pull out his iPhone and googled this **** I looked at dude like he was a moron and I don't think he liked it much...but can I blame him?...is this his fault?...not really...he's just a youngin 1 out of 1000's who got through med school, got a gig at some BS clinic for the minimum they can pay a "Doctor" and loaded dude with a ridiculous amount of patients and dude out here with a liscence to kill practically.

Not really.

You just met an inexperienced physician, who are usually young.

It is idiotic to say that a dermatologist is out to kill you.

 

[ksteezy]

Not really.

You just met an inexperienced physician, who are usually young.

It is idiotic to say that a dermatologist is out to kill you.

G you know I work in the medical field, I think I'm more than qualified to make the statement I made based on almost 10 years experience dealing with MANY good and bad physicians, you were prolly still in elementary school when I started working fam...lol

And I was obviously exagerating a bit, but yes there is a surplus of physicians who either don't care or don't have time to care enough to prescribe proper meds or every provide a correct diagnose and that's a fact.