American doctors are increasingly unhappy with their once- vaunted calling, and its hurting patients. But the medical profession can help heal itself. My profession is in a midlife crisis. In the past four decades, American doctors have lost the status they used to enjoy. In the mid-20th century, physicians were the pillars of any community. If you were smart and sincere and ambitious, at the top of your class, there was nothing nobler or more rewarding that you could aspire to become. Today medicine is just another profession, and doctors have become like everybody else: insecure, discontented and anxious about the future. In surveys, a majority of doctors express diminished enthusiasm for medicine and say they would discourage a friend or family member from entering the profession. In a 2008 survey, 84% said that their incomes were constant or decreasing. Most said they didnt have enough time to spend with patients because of paperwork, and nearly half said they planned to reduce the number of patients they would see in the next three years or stop practicing altogether. We strove, made sacrifices -- and for what? For many of us, the job has become only that -- a job. Consider what one doctor had to say on Sermo, the online community of more than 270,000 physicians: I wouldnt do it again, and it has nothing to do with the money. I get too little respect from patients, physician colleagues, and administrators, despite good clinical judgment, hard work, and compassion for my patients. Working up patients in the ER these days involves shotgunning multiple unnecessary tests (everybody gets a CT!) despite the fact that we know they dont need them, and being aware of the wastefulness of it all really sucks the love out of what you do. I feel like a pawn in a moneymaking game for hospital administrators. There are so many other ways I could have made my living and been more fulfilled. The sad part is we chose medicine because we thought it was worthwhile and noble, but from what I have seen in my short career, it is a charade. In the halcyon days of the mid-20th century, American medicine was in a golden age. Doctors largely set their own hours and determined their own fees. Popular depictions of physicians (Marcus Welby, General Hospital) were overwhelmingly positive, almost heroic. They could regulate fees based on a patients ability to pay and look like benefactors. They werent subordinated to bureaucratic hierarchy. After Medicare was introduced in 1965 as a social safety net for the elderly, doctors salaries actually increased as more people sought medical care. In 1940, in inflation-adjusted 2010 dollars, the mean income for US physicians was about $50,000. By 1970, it was close to $250,000 -- nearly six times the median household income. But as doctors profited, they were increasingly perceived as bilking the system. If doctors were mismanaging their patients care, someone else would have to manage that care for them. Beginning in 1970, health maintenance organizations, or HMOs, were championed to promote a new kind of health-care delivery built around price controls and fixed payments. Unlike with Medicare or private insurance, doctors themselves would be held responsible for excess spending. That ushered in the era of HMOs. In 1973, fewer than 15% of physicians reported any doubts that they had made the right career choice. By 1981, half said they would not recommend the practice of medicine as highly as they would have a decade earlier. Public opinion of doctors shifted distinctly downward too. Doctors were no longer unquestioningly exalted. As managed care grew (by the early 2000s, 95% of insured workers were in some sort of managed-care plan), physicians confidence plummeted. More recent surveys have shown that 30% to 40% of practicing physicians wouldnt choose to enter the medical profession if they were deciding on a career again -- and an even higher percentage wouldnt encourage their children to pursue a medical career. Physicians increasingly say they dont have enough time to spend with patients. Salaries havent kept pace with doctors expectations. In 1970, the average inflation-adjusted income of general practitioners was $185,000. In 2010, it was $161,000, despite a near doubling of the number of patients that doctors see a day. While patients today are undoubtedly paying more for medical care, less of that money is actually going to the people who provide the care. Some doctors are limiting their practices to patients who can pay out of pocket without insurance company discounting. Other woes include payer bureaucracy. US doctors spend almost an hour on average each day, and $83,000 a year -- four times their Canadian counterparts -- dealing with the paperwork of insurance companies. Their office staffs spend more than seven hours a day. And dont forget the fear of lawsuits; runaway malpractice- liability premiums; and finally the loss of professional autonomy that has led many physicians to view themselves as pawns in a battle between insurers and the government. The growing discontent has serious consequences for patients. One is a looming shortage of doctors, especially in primary care, which has the lowest reimbursement of all the medical specialties and probably has the most dissatisfied practitioners. Try getting a timely appointment with your family doctor; in some parts of the country, it is next to impossible. Interest in primary care is at an all-time low. People used to talk about my doctor. Now, in a given year, Medicare patients see on average two different primary care physicians and five specialists working in four separate practices. It is rare to find a primary physician who can remember us from visit to visit, let alone come to know us in depth or with any meaning or relevancy. Many professions, including law and teaching, have become constrained by corporate structures, resulting in loss of autonomy, status, and respect. Sandeep Jauhar, Wall Street Journal, 31 Aug 14 © 2014 Microsoft Terms Privacy & cookies Developers English (United States)
Posted on: Wed, 22 Oct 2014 14:03:57 +0000
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