Tray Dunaway: “So factor in the percentage change of doctors who used to work 24/7 lives, or any physician reasonably choosing a lifestyle that works more than 12 hours a day, and try replacing them by physicians who only will work 12 hours a day, for five to seven days a week.
Do the math.
What do you get?
Instant physician shortage to meet the 24/7 needs of patients.
Simple math. Scary results.”
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I used to have a prof that would tell us to stop bitching about our pagers. When he was a resident they didn’t have them and they would have to leave the phone number (whereever they were) with the answering service. They’d get home, only to have to drive back in. There is a shortage but the velocity of care has changed too. I access radiographs from home, do a bunch of stuff by email, etc… Physicians are able to give more care now than they could 20 years ago. It’s not so simple an equation but it’s still a massive problem. http://www.waittimes.blogspot.com
Disclaimer first: I am one of a 3 person family practice, we do call 1/3, including weekends. We also cover our own admissions and do not rely on hospitalist. Why? Because it is our philosophy that there is no substitute for continuity of care. In otherwords, it comes with the job.
So how come we feel like dinosaurs?
Just a few of many explanations:
1. Insurance companies pay exactly zero dollars for phone calls. Most also do not recognize code 99050, for care provided outside of regular hours.
2. Young doctors potentially choosing primary care (are there any left?) are bombarded with the message that they cannot do it all, in the name of quality. For example, the myth that hospitalists improve quality and decrease costs is perpetuated without thought, as if it were a mantra.
3. Some patients abuse access to their physicians, calling for anything, ie is it ok if I take tylenol? Or do I really need to come in? Or can you call something in? This sense of entitlement is perpetuated by another invention of modern times: urgicare, which underscores a consumer-oriented notion that the patient has a right to access healthcare wherever and whenever they want, despite the reason. The days of saying “take two aspirin and call me in the morning are over.” Continuity is sacrificed for convenience.
So what’s the solution? Either we accept the extinction of primary care as we once knew it or we, as a medical profession, fight for it.
Comrade Underpaid in Upstate New York
I’m a 4th year med student going into primary care (peds). I have absolutely no desire to work even 12 hour days post-residency. Nor do I intend to be on q3 call. If that’s what a practice is offering, then no thanks, I’ll keep looking. My wife is continually pestered by comments from doctor’s ex-wives about how their spouses were slaves to their beepers, to the detriment of their families, eventually leading to a divorce. I’ve heard this so many times it’s beginning to get nauseating. All I want is to pay my loans off and live comfortably – as well as being a part of my children’s life. I don’t care if anyone thinks I’m a mediocre doctor because I put my family first.
There is a real swaggering attitude regarding work hours that I’ve noticed over the past 4 years. Kind of the “I suffered, so you need to as well” Those days are done, and they’re not coming back, not when 65% of my class is fertile-aged females.
If you want to pay off your loans, live comfortably, and work limited hours, you’re in for a big disappointment when you get into primary care. You should start condisering which pediatric specialty you’re going to now.
If I’m wrong, let us know here so I can apply for a job there too.
Add to that the “early” retirement of doctors. “Early” defined as what would be a normal retirement age for most other people. You don’t find the docs willing to work the part-time jobs, the free clinics, filling in all the volunteer stuff they used to do, just to stay busy. It’s not worth it to risk your family’s inheritance to a malpractice suit.
Again, instant physician shortage, and good luck filling those spots with docs who still have to worry about paying off debt.
Retirement? Family’s inheritance? As a physician today all I can look forward to is having my kids inherit my bills when I die at work.
Society has decided that our services are not valuable to them.
We should work less – it’s what everyone else who gets a pay cut does.
Increase the wage we are paid and more people will want to do the work.
Simple math, simple economics, simple reality. It’s just not worth it any more for most people.
“3. Some patients abuse access to their physicians, calling for anything, ie is it ok if I take tylenol? Or do I really need to come in? Or can you call something in? This sense of entitlement is perpetuated by another invention of modern times: urgicare, which underscores a consumer-oriented notion that the patient has a right to access healthcare wherever and whenever they want, despite the reason.”
Then again, patients are often subjected to incredible amounts of bureaucracy at a clinic that wastes THEIR time, but I don’t hear anyone suggesting that a patient should be reimbursed for that.
Case and point, I’ve made six phone calls this week to my doctor’s office trying to get a simple Lipitor prescription renewed (as my doctor told me to do following my annual physical and blood workup last month). One of his nurses erroneously recorded that I was “due” for a physical after my first call to request the renewal, and God forbid anyone should take a minute to correct that mistake so the prescription can be renewed and we can all go on happily with our lives.
I’m suggesting that maybe some of the calls you’re complaining about here wouldn’t be coming with better office procedures, better trained staff, and better communication with patients during actual visits. Just a thought.
“Then again, patients are often subjected to incredible amounts of bureaucracy at a clinic that wastes THEIR time, but I don’t hear anyone suggesting that a patient should be reimbursed for that.”
You can thank the federal government, insurance companies, and patients who don’t pay their bills for this. I despise having to ask patients for their picture ID, phone number, address, and insurance card at every visit (even if it was just a week ago) followed by myriad mandated forms to sign, but that is what we are forced to do. This adds absolutely nothing to your care. Don’t be surprised when some government agency insists we fingerprint you. After all, criminals and terrorists need medical care too and that may be one of the few opportunities to apprehend such individuals.
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