Posted on 04/16/2014 5:31:27 AM PDT by SJackson
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.
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.”
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.
HeathCARE was between trained, caring docs and nurses
and patients and their families.
NOW, EXEMPT politicians, their EXEMPT staff,
EXEMPT “judges”, EXEMPT felons, EXEMPT lawyers
and EXEMPT criminal illegals now run
ObamaCARE, with the whips and guns held by the IRS.
It's time to turn the tables.
I hardly think medicine has become "The Most Miserable Profession", although the part about working for government bureaucrats and for insurance company clerks might be among the most miserable of jobs.
Yes, it has become miserable due to electronic medical records forced on unwilling physicians by the watchers not the doers.
EMRs are a distraction and makes me glad I am in the twilight and not the dawn of my medical career.
Now where did I put that bullet?
Dentist have always had the Highest suicide rate of Professionals has that changed?
Which ones are doing it, proctologists?
I remember the old Rodney Dangerfield joke. “Proctologist, they start at the bottom and they stay there.”
bookmark
I can’t believe it is more miserable than being a reporter for The Daily Beast.
Being the official NFL Cheerleader gynecologist wouldn’t be a miserable way to make a living.
I had always heard that the highest number of suicides among M.D.’s were psychiatrists.
Oh cry me a river.
While I’m not denying that primary care is in shambles, the author suggests plastic surgeons, radiologists, and ophthalmologists have it so much better. As a nurse anesthetist, I can tell you NO physician is exempt from the mess that is our healthcare system. Most are grossly underpaid for the responsibility they carry as well as the student loan debt they’ve acquired. And all are subject to beaurocrats who dictate how they practice.
I will agree that physicians are demonized both both DC politicians and the lame stream media, and our low-information electorate has bought into that class-warfare narrative. Sad.
But lets not forget that the American Medical Association, made up largely of these primary care docs, championed the affordable care act. Part of me feels like this piece reads as a case for a single payor system. Caution.
The government and insurance companies have ruined medicine. I advocate concierge medicine, with no insurance taken. Its cash on the barrelhead. Prices will be reduced, and the leeches are out of the picture.
However, this market wouldn’t be allowed to stand, and the feds would eventually outlaw it.
There was an unannounced “war” between the independent-minded physicians (largely Republican) and the trial liars (largely Democrat) and the trial liars won. Their buds control the courts and the legislatures and have put the squeeze on doctors until ObamaCare was passed to suck the life and power out of any doctor who didn’t marge in goosestep with FedGov.
I think the smart ones are starting to leave for countries where free enterprise still reigns and “medical vacations” are ramping up knowing they may not have the crunching churn of American patient care offices but they can live a good third-world existence and maintain some freedom.
True story: A good friend of mine has a daughter who married a French doctor. The doctor sees his number of patients in the socialist French health care system where he can’t make a decent wage then travels on the weekends to Switzerland and northern Italy where he actually makes his income seeing patients outside the system. Not sure why one doesn’t just move to Switzerland (probably tough to immigrate) but it leaves him no time for a social life or any downtime.
They are among the highest, along with policemen. The Dentist puts himself through the same rigors of a med student, goes into debt to build up his practice and, if he survives, finds that by age 40 he is a dentist with no place to advance for the rest of his life. He has to spend his days with his fists in people's mouths and among patients who would rather not spend a second more with him than is absolutely necessary. Policemen, like soldiers, are forced to watch the most hideous of things and the dregs of existence. They are there because somebody has to be and while much of their time is spent with boredom and paperwork, the times they have to involve themselves with death and disasters makes it a high-stress occupation.
All three (doctors, dentists and cops) deserve some sympathy despite all the negatives said about them. They really do have lives I wouldn't wish on most people. How would you like to spend five-to-seven days a week seeing unhappy people in pain and misery all day? It really is depressing if you don't have a firm personal foundation.
Primary care physicians are actually faring better than specialists at this time, in light of Medicare cuts and ACA inducements to more generalized health promotion activities. The trend is toward lowering the professional level of the care provider, for example, moving care from a physician to a PA or from a physician to a NP. It seems as though the “affordable” in ACA refers to gov’t payouts and large business’s shift away from providing health insurance, not patient’s costs and certainly not for a high quality of care.
You all haven’t seen ANYTHING yet. Wait until ICD10 kicks in Oct 2015.
Doubles the DRs documentation time per patient.
Currently ICD9 is a 5 digit code with 17,000 possibilities. 30 yrs used. ICD10 is a 7 digit alpha-numeric code with 155,000 possibilities. One wrong character, you don’t get reimbursed. Kills the small offices who don’t have an army of coders.
http://www.weeklystandard.com/keyword/ICD_10
I was many moons ago a Personal accident & Life Underwriter early in my career. We did a lot of ASSOCIATION business Group Underwriter. This was before MET’s were Popular (Multiple Employer Trust) Cops were High in Alcoholism and early aged Heart attacks. Dentist were #1 in suicide..always could schedule wednesday’s off for Golf. never midnight visits. But Like you noted People hated them from an early age.. Your Barber gave you Lollipops or bubble gum. Dentist gave kids PAIN!
I always took Psychiatrist as becoming depressed. Never underwrote US Psychiatrist association. Thanks for sharing always good to learn..
The AMA has never represented physicians well and even less so now. Phylis Schafly wrote an article on the AMA years ago. Read it and realize how much worse things are. The AMA has been in bed with the corrutocrats for decades.
I know that. My point was less than 30% of physicians belong to the AMA and the majority of those ate primary care docs
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