What future physicians have to look forward to

Adding fuel to why there is/will be a physician shortage:

“In medical school I spent easily 80 hours/wk in classes or studying. I completed a preliminary year in general surgery the year before the 80 hour/wk work rule took effect. Not one week had less than 120 hours of hospital responsibilities; most were between 125 and 135 hours. Our general surgery residency program boasted a 100 percent divorce rate among its residents before graduation. The three years of my anesthesiology residency has required approximately 80 hours a week of hospital and homework.
“As I graduate, I have approximately $170,000 in student debt from my medical school training alone . . .
. . . “Many other trades and professions provide more income per hour of work than many medical specialtiesÃ‚Â—including pediatrics, family medicine, internal medicine, and general surgery. Without the fear of being sued for an outcome beyond their control. And the day that Medicare/Medicaid reimbursement became less than the cost of treating those patients was a day of darkness for the healthcare profession. Physicians are voluntarily one of the most philanthropic professions, but our philanthropy should not be mandated by the lack of government reimbursement.

Comments

Anonymous
With no disrespect intended, the long hours described here are an issue for the medical profession to address internally — it’s certainly no benefit to patients to be cared for by someone who has been on the job for 80 hours straight. If you don’t like it, why don’t you change it?
Anonymous
According to at least one poster here, there are 30 new MD and DO schools that have either recently openeed or are opening and there is no shortage!
Anonymous
If there are too few docs, why do they get paid less and less? Who needs a doc if an NP and a computer will do just fine thank you? Or a radiologist sitting in Mumbai?
Ask Medicare if they think there is a doctor shortage! Docs are a dime a dozen. Quality is not the issue. Most countries medical systems run on significantly fewer MDs per population than the US and yet their health statistics are as good or better than ours. If you want money, go into banking.
Anonymous
We make enough money. Compared to the rest of you losers we are goddamn rockefellers! We are just trying to avoid being dragged into litigation because it wastes time we could be spending enjoying ourselves or doing other things…thanks to this site, we can read about how and when (all the time!)to practice defensive medicine and protect ourselves from you American a-holes while at the same time screwing you with unnecessary testing…enjoy, animals!
Anonymous
The plebeians need to read more statements akin to that of anon 10:41. To the plebeians that read this blog… do you have a clue yet? The MDs are not “being killed” by only making 100K a year, they are not being “driven out of practice” (they are abandoning you unless you give them special legal privileges available to no one else)and they consider you, based on your idolatrous actions, to be simple minded sheep.
Anonymous
Ever get the idea that “crazy doc” (anon 10:41) and “doc hater” (anon 11:52) are sharing the same crack pipe?
just my observation.
Anonymous
Yeah, they take turns pleasuring each other. What they say shouldn’t upset anyone for even a nanosecond.
TXMed
Anonymity leads to such poignant animosity. In anycase, there’s certainly a lot of misinformation being used in the service of name calling.
anon 9:03
“If there are too few docs, why do they get paid less and less? “
“Most countries medical systems run on significantly fewer MDs per population than the US and yet their health statistics are as good or better than ours.”
Because the vast majority of reimbursement are centered under the control of a relatively small group of payees, it stifles the basic law of supply and demand. For instance, the government paid 44% of personal healthcare expenses in 2002 (Health Affairs 2004;23(1):147). I really don’t mean to be rude but drawing the conclusion that physicians are paid less and less because of an overabundance is just baloney reasoning.
We’re viewing monopolistic tendencies at work here.
There are plenty of articulate, well informed, well reasoned people who might think that physicians are overpaid, and I really think you should spend some time studying the situation, and aspire to those compliments, if you truly want to provide real critique here.
As for the claim that “most countries” have lower per capita physician populations and yet have better healthcare. Well, at least the first part is just not true. It is just false. I think I typed in “physicians per capita” on Google to find this, so I don’t know why you couldn’t research this:
http://www.who.int/entity/whr/2006/annex/annex4.xls
The claim is two parts: 1) the majority of countries have fewer physicians per capita and 2) most countries have better healthcare.
The only countries with significantly lower per capita physician populations exist in the 3rd world according to the World Health Organization. Obviously, they do not enjoy better healthcare than the U.S.
anon 11:52
“[T]he MDs are not “being killed” by only making 100K a year, they are not being “driven out of practice”"
I don’t know what your experiences are or how you precieve that the healthcare system did you wrong, but this comment is just vengeful. Yes, even with the debt I have and continue to incur, I could live off $100,000 a year. There’s a good chance I could do better not practicing medicine.
As this post says, as I’ve said before, $170,000 in debt, more than $300,000 probably when paid in full is a major pressure. The vast majority of this country their most significant debt is their mortage. In fact it is remarkable to think that my most signifcant investment for a good chunk of my life will not be something transferable or physical. It will be the comparative strengthing and weakening of nerve synapses in my brain, acquired over years and years.
The earnings of a primary care physician shrink when put up against these hundreds of thousands of dollars in debt (on top of all other normal living debt).
Finally, I know the error in lumping you in the same boat but look at the arguments put forth by some of the antagonists who comment on Kevin’s site? Your basic attitude comes across as physicians are overpaid and they greedily want more. Up above anon 9:03 argues that the free market sets physician reimbursement. But really, imagine the service some physicians provide. What if we really let the physicians freely dictate their price? What would it be worth to you to excavate a hematoma, with no other neurosurgeon on trauma call within a hundred miles? What would it be worth you to live the rest of your life? I’m not trying to be greedy here, this is just a rhetorical question to get everyone thinking. I am going to have given, with my years working hard in undergrad, maybe as many as 16 years training for the privilige of caring for patients. If I’m truly a good physician, if I’m truly helping people, if I truly put my patient’s health before all, if I’m truly working like a dog, you don’t think it’s worth $100,000? $200,000? $300,000?
There’s no other profession with this level of training, there’s very few professions with this level of stress and this much on the line (albeit many of those other professions earn significantly less). I really don’t understand why physician complaints that their income went down 7% against inflation last year come across as greedy to some people.
Anonymous
There is no physician shortage, and there will be no crunch.
The system is changing, which was inevitable when the boomers, the largest, wealthiest and most powerful voting bloc in the history of our country, retired. Medicine will change to adapt with it.
We’ll have plenty of physicians and they’ll all continued to be paid very well.
Anonymous
“We’ll have plenty of physicians and they’ll all continued to be paid very well.”
Yeah, right. There are less and less physicians going into primary care, medical subspecialties such as renal and pulmonary, surgery and ObGyn. Once there arent enough of us, maybe we’ll get paid better when we all have the courage and balls to tell Medicare and other insurers to go f— themselves. Until then, we’ll be paid less and there won’t be anywhere near enough of us.
Michael Rack, MD
“There is no physician shortage, and there will be no crunch.
We’ll have plenty of physicians and they’ll all continued to be paid very well.”
The anonymous poster is correct in that there is no overall physician shortage. However, as mentioned by txmed, there are shortages of key specialties in some areas. What good does it do to have 10 internists in a city if you have a ruptured cerebral aneurysm and the nearest neurosurgeon is 75 miles away? Many specialists are not accepting Medicare, or they do not accept assignment (meaning that the patient has to pay up front and wait to be reimbursed by Medicare). In Jackson MS, there is a 3 month wait for a Medicare patient to see a dermatologist, unless they are willing and able to pay up front.
Anonymous
Dr. Rack, you are exactly right. Which is why, instead of spending all your reform dollars and anger agitating on behalf of your liability carriers, you ought to be spending your time and energy agitating on behalf of yourselves in terms of your reimbursements and developing alternatives to our present reimbursement system.
Alas, every day that goes by we move closer to universal care, and you guys being just another civil service branch.
CJD
Anonymous
Tx Med:
I wish to commend you on an excellent post. Unlike the typical self-serving crack pipe arrogant rot that passes for “informed” commentary, your manner of response and more importantly, the content contained therein are worthy of a cogent response. As I have a moment this day I will respond accordingly.
anon 11:52
WilliamManginoMD
Some issues have not been squarely addressed in these comments.
Residency [ specialty ] training programs are closely tied into hospital economic policy. During the 1950-1985 period, and perhaps even today, training programs, even in some university hospitals, were run by private practice groups.
It was the philosophy of chairmen of many programs that during a three to four year intensive training stint-being on call every other night meant that you still “Missed half of the good cases.”
There is much truth to this philosophy. Medicine is one field where much of what the doctor learns comes ‘after hours’ and much of what I learned during my training years 1977-1983 in internship and residency could not have been learned 9 to 5.Nor can it be condensed into one or two years, especially now, where much of the ‘pathology’ has “Dried up.”
As an example of this statement ask yourselves how many chief surgical residents do 700-1000 cases a year-as it was in the ‘old days’? How many ENT trainees get to drill out an infected mastoid or actually see cholesteatoma’s? Not many-and these examples can be applied across all specialties-by way of illustration.
By the same token, a fair amount of the residents time in training is ‘wasted’ with non-medical duties. However; one could argue strongly that these duties do help to contour the learning experience.
Ultimately, doctors ‘age’ like fine wines. Learning is a plateau-like step wise process. We know that.
How much do we ‘deserve’ to make? I don’t know. Is Alex Rodriguez really worth 100 million dollars?
The answer is that people will pay big bucks for what they deem to be of value to them. Does this mean we should treat people on retainer fees?
I still read two hours daily, three or four times a week, all the literature I can get hold of pertaining to my specialty interests. I do it for two reasons. First of all, I love it. Second of all, it helps me to make better clinical judgements.
It doesn’t, never did, or ever will, translate out to salary equivalents-and it should not.
We are doctors-not businessmen. We probably should never have originally accepted assignment. We got tired of people paying what they could afford so we made sure we got a check from Uncle Sam.
Now they control the purse-string and dictate to us how to do our jobs.
You can’t even opt out without going through a myriad of ‘hoop jumping.’
The profession has, in some ways, been selfish. We are a service profession and most of us enjoy our work enough to keep doing it regardless of how much money we make.
Thats the way it should be-and when we show the public that we are in it for them-not ourselves- we’ll get back the measure of respect we do deserve.
Anonymous
Listen, jackass, these animals are out for the quick buck. If something goes wrong, they will sue and get you entangled in a quagmire of litigation. Instead of waxing philosophical during the twilight of you career, you should be focussing on defensive medicine and how to protect yourself…
when one of these animals walks into your office and presents a complaint, think about how the animal can possibly sue you and then go from there…refer, order all necessary tests, don’t think about an animal, think about yourself..
Anonymous
I would imagine one thought accomplishes both with you.
Anonymous
Unfortunately, I agree with Anon 531pm, but I got out of medicine for just that reason. I’d rather make $25,000 a year and not have to deal with CYA medicine and the malpractice mess the lawyers are getting away with. Fix the malpractice mess, I’ll come back and a bunch of patients who now have no doctor will have one again. Otherwise, the hell with you people.
Anonymous
You clearly weren’t making very much more before, which probably speaks to your skills as a physician.
Anyone who truly has lived on $25K a year, and has a choice to endure a few more headaches and some more work and make on average 6 times that would never elect the former.
Anonymous
Why don’t you tel us what’s it’s like to live on $25K, you uneducated loser…then go back to commenting on how physicians should so their jobs…
Anonymous
So wait – it’s noble when a physician lives on that, but anyone else is just an uneducated loser?
Physician logic never ceases to amaze.
Anonymous
Why don’t you all just go to work for Proctor & Gamble…Work for 20 years and retire with a miliion dollars in profit sharing.
Anonymous
Kevin,
The general public has no sympathy for physicians with regard to their finances or hours. Most people would be willing to see a gorilla with a white lab coat on if there was no co-pay and the care was free. Until Americans start waiting in line to see physicians or start dropping dead from waiting so long, the American public and the federal government(Medicare) will not pay attention to our woes.
An Anonymous MD

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