How Being a Doctor Became the Most
Miserable Profession
Nine of 10 doctors discourage others from joining
the profession, and 300 physicians commit
suicide every year. When did it get this bad?
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
healthcare 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 dollars 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.”
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 just decided that doctors
should be tested not every ten years, but every
two years. If a physician doesn’t comply by the
end of this month, the ABIM will strip away the
doctor’s board certification status.
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.
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