It’s no secret that training a doctor takes a tremendous amount of time and money, both from the physician and the government, who subsidizes a substantial amount of the cost of training.
So, in the midst of a physician shortage, internist Toni Brayer wonders about doctors who simply decide to stop seeing patients.
After talking to a young physician who made such a decision, and instead, is starting a a pharmaceutical business, she asks, how many “parlay their medical degree into some type of business venture?”
Furthermore, is the medical degree is going the way of law degrees, especially when you consider that “few attorneys actually see the inside of a court room or defend people against injustice.” Indeed, “are fewer young doctors actually seeing sick patients?”
With the amount of bureaucracy that doctors face today, it’s not surprise that more are transitioning their career out of patient care, into perhaps a more rewarding area of medicine.
And with universal coverage on the horizon, which demands every physician hand on deck, there couldn’t be a worse time to do so.
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{ 35 comments }
It may be because of the increasing bureaucratization of medicine that “nonmedical” medical careers are becoming more important and more lucrative.
John
Even within patient care medicine, the doctors are in a way getting out of patient care. Think of the dermatology journal article a while ago, where someone with a skin lesion suspicious for cancer had to wait to see the derm, but the same patient wanting Botox got seen that day.
The government should pass legislation that forces physicians to work to address access issues.
Given the number of individuals who want to become doctors (and are fully qualified to complete the rigorous training) the idea that someone would take a spot in med school, have his/her residency training paid for by tax dollars and then choose not to practice is horrible.
Is there a business/science degree that can be created for these individuals and leave the med school spots for those who actually want to see patients or do research?
How much money is enough money for a physician to earn? If the training were better subsidized and physicians did not have to carry such a large debt load upon completion of training would they be willing to earn slightly less (but still considerably more than most)? How much higher in the class system do doctors need to be? When I was growing up the doctor had a little better car than most, took vacations at more exotic locales occasionally, lived in the better part of town, but didn’t put himself above those whom he treated.
There is often a refrain in the blogs from some docs about “p.a.’s making almost as much,” or “nurses being paid too much,” or “the plumber drives a better care than I do,” and the subtext of those statements is often outrage that such individuals should have an income that affords them a lifestyle only a rung or two lower than the doctors. It’s as if these docs want to ensure that however much they themselves are paid – everyone else should make enough less so as to keep the class distinction obvious.
I am one of those getting out. It’s not just younger docs. I have worked on average 60+ hours a week for 30 years and earned in 6 figures just once during that time. It isn’t the money, people! I still love talking with and seeing patients but that consumed so little of my day in recent years that the joy was gone. And, there is a tremendous decline in simple respect given to primary care physicians. As someone who is academically capable, I took night classes and taught myself in software and computer hardware and now work doing primarily on call repair work (Geeks on Call type business). Hours are less. Income is more. Happiness quotient much better. I didn’t “parlay my medical degree” into a related job but I did parlay the human skills that I used in medicine to inprove the value of my new skills to the business and still work directly with people (and technology) each day but with no prior auths required. I cannot see going back to medicine and “NO”, there cannot be “legislation” that forces me to work in clinical care.
“And with universal coverage on the horizon, which demands every physician hand on deck, there couldn’t be a worse time to do so.”
Correction: “And with universal coverage on the horizon, which demands every physician be enslaved, there couldn’t be a better time to do so.”
Norman said: “The government should pass legislation that forces physicians to work to address access issues.”
‘Cause the government forcing people to work went so well the first time….
What about doctors that work part time. Should we fund their training with tax payer dollars?
hey “fedup” I understand what you’re saying. With the current government in control, I wouldn’t put it past them to find a way to force doctors to work.
Not long ago, Quebec tried to force their primary care doctors to cover provincial ER’s. I don’t mean follow-up coverage, I mean force them to go to that ER and work there, even if they didn’t do ER work.
Very succinct and well said Smart Doc. Any person with self respect and a belief in freedom of thought, ideas and expression would not work under compulsion as suggested by Norman. Most patients would not want a physician that did not possess those qualities. See this link for Ayn Rand’s eloquent take on the situation.
“There is often a refrain in the blogs from some docs about “p.a.’s making almost as much,” or “nurses being paid too much,” or “the plumber drives a better care than I do,” and the subtext of those statements is often outrage that such individuals should have an income that affords them a lifestyle only a rung or two lower than the doctors. It’s as if these docs want to ensure that however much they themselves are paid – everyone else should make enough less so as to keep the class distinction obvious.”
This is a great point. I cringe when I hear physicians speak this way particularly when grumbling about how much admin and support staff make. It’s offensive.
‘every physician hand on deck’
Ah, a doc’s synecdoche.
There’s no way to force physicians to see patients (outside of the military)… but we could reduce the financial pressures that tip the balance for some docs.
Make medical education free… with the condition the tuition (the actual full cost, not just the sticker price) and other support (plus interest and perhaps some ‘early termination fee’) has to be paid back if the individual opts not to go into clinical practice (or research or teaching) for a certain number of years. The “debt” would decline with each year of practice… accelerated for working with underserved populations/communities.
This system would end the way career decisions are warped by heavy debt loads faced by young physicians… and it would provide a lasting bit of incentive to stay in practice. Sure, some non-clinical jobs would pay enough more (and offer other benefits) to draw away some docs… but at least they would then pay back into the pot to support training their replacements.
All of you who are not docs posting on here have no clue. I mean you Janice, E and Norman.
The fact is there is not a large amount of people “qualified” to be doctors that don’t have the chance, unless you lower the standards for qualified. And considering the level of training I went through, and the fact that I am held to a much higher standard than a PA or NP, I do deserve to make significantly more than them, period.
Lets see what happens to quality if all the doctors leave practice. Lets see how well your plumber performs that AAA repair, or even a PA for that matter. Physicians are able to do much more, are better trained, and have a much higher skill set on average than PAs and NPs. That is a fact.
I have yet to meet an extender that can keep up with me on abilities and efficiency.
It’s not PAs and NPs that get sued when something goes wrong, it is the physician who oversees them.
As soon as NPs and PAs are willing to accept the same risk and expectations that I do, they should be paid well less than a physician.
Quite frankly it is sad that people value the job done by a plumber who fixes a leak, than that done by a physician who saves their life.
Primary Care docs are extremely underpaid for what they do, and deserve to have a better income than most. I do not begrudge anyones ability to make a good living, but considering what I do, I deserve to be paid better by Medicare/Medicaid than I currently am. Those who wish to compel us to labor, or begrudge our desire to be paid well are Communists, pure and simple. Maybe you should go to North Korea where life is so great under Communism.
Remember that Cuba and China are internally Communist, but they would not survive if they did not participate in Capitalism on a global scale.
Why is the turnover among nurses in hospital’s so high? Why do I see nurses, PAs, and NPs taking jobs outside of patient care?
I want to know if nurses, extenders, admin and other support staff are willing to accept a pay cut of the same proportion that doctors will see under a government plan? If they care so much about universal coverage, they should be willing to sacrifice as much as the docs to make it happen. My suspicion is that while they would support a physician pay cut, they would oppose a pay cut of their own. That is why they go on strike to protect their benefits, while docs are not afforded the same right to collectively bargain. How is that just and fair?
So until all of you complaining about doctors are willing to make the same level of sacrifice in compensation and benefits, no longer request pay increases, and completely abandon the strike option, you have no place criticize doctors for their desire to be paid well.
BTW, why don’t all of these nurses, PAs, NPs, admin, and support staff become doctors themselves? Almost all of the ones I talk to say that it takes too much school, time, and debt. If you don’t want to put in the effort and risk, don’t expect the benefits. Plus, most are not qualified or capable of the rigorous training required.
We have an option for physicians to get their tuition covered completely. The military and NHSC scholarships. Despite these options, few physicians will consider them because the pay is significantly lower during the payoff period. Under-served areas that offer large loan repayment amounts struggle to get docs as well. If the area is undesirable, or the pay is low, you will struggle to get docs even if you do pay off the student debt.
The fact is doctors are not willing to sacrifice >$1 million worth of income in exchange for paying off $200,000 worth of student loans. It is simple economics. Who would make that tradeoff in any career? Would a plumber or lawyer? No. Neither would nurses, PAs or NPs. The fact is these professionals do not have any higher rate of working in under-served areas than doctors do, except when they get a premium in pay for doing so. They certainly wouldn’t take a pay cut to do it.
Why do you think docs from other countries where medical education is cheap or free still come to the US to practice?
Physician access may improve as Obama and the democrat party’s massive economic mismanagement annihilate the savings of many physicians, forcing many to work past their planned retirements.
People leave clinical medicine for so many different reasons. I’ve met so many individuals who have discovered that clinical medicine simply isn’t the “right fit” for them. So what do they do? They search for non-clinical jobs on Google and quickly discover that there are so many options out there.
The discussion from this post is very interesting.
I recently wrote a series of posts on my Medical Fusion Blog about physician dissatisfaction and my inkling that many physicians were looking to leave clinical medicine. What I find most interesting is the same people who argue that physicians should be forced to perform clinical medicine are the same people who argue that clinical physicians should have mediocre wages.
I would be much more impressed by the person who says clinical medicine is so important that we should subsidize the salaries of clinical physicians and do whatever it takes to increase their numbers and quality. However, it appears that a certain segment of the US population wants excellent (and instant) care from intelligent and honorable physicians who make average salaries yet work 100+ hours a week with smiles on their faces for the privilege of taking care of their local communities (at all hours, day or night).
Emergency Medicine is a an example of what might be down the road for the entire healthcare system. What many non-medical people might not realize is that emergency healthcare in the US is universal in the sense that anyone can be seen and treated by a physician in an Emergency Department at any time for any reason. By federal law, an Emergency Department cannot turn away anyone and ambulances are required to transport patients for any reason. The result is an unbelievable crush of patients flooding our Emergency Departments all over the country, and many patients are presenting for very minor conditions. Some patients visit their local EDs 2 or 3 times a month. In extreme cases that I have read (and seen in EDs where I have worked), some patients visit every other day “just to get checked out.”
Physicians are frustrated and they are tired of society at large asking them to do more and more, and then being lectured that they are unpatriotic or lacking in compassion when they vent their frustrations. Maybe not all physicians are geniuses, but they are mostly bright individuals with lots of options. As a physician myself, I am seeing more and more of my peers exercising their option to leave clinical medicine behind. It’s a shame, but honestly, I don’t blame them.
if a physician’s goal is to help people, then they should do anything and everything they are able to do to achieve that goal. an MD degree carries alot of respect and weight and physicians are leaders in their communities, i think it would be a shame that a doctor who can better serve by leaving clinical care for some other aspect of healthcare should choose to remain in clinical care instead. the shortage of primary care physicians, the costs of a medical education, and the pay of doctors should not compose the perspective for looking at this issue.
It is interesting how non-physicians are so quick to imply that some sort of “debt” is owed in repayment for physician residency training. That’s laughable. The government gets a lot of hours of skilled, educated and low-cost labor off the backs of residents for its payments in support to training hospitals. Show me any line of work where you can get someone with eight years of university education and two degrees–usually earned with honors–to work eighty hours a week for under $45K yearly and without retirement plans and usually with fairly crappy benefits. You can’t. Not lawyers, not dentists, not engineers or architects, not podiatrists or even clergy. So to all those who think they are owed something extra off the backs of doctors because they once were residents, please take your ideas out to the bin, because they’re rotten and are beginning to stink.
And the idea that “free” education is somehow the answer is equally risible. Sorry, but there is more to this than paying off a tuition bill. You do have to be a cut above the average university graduate to get a slot in medical school, and there is more to the process than simply writing a check. As another poster noted, the er are already programs offering to cover tuition–the HPSP and others, and they still go begging. Low-paying government medical jobs are only part of the reason that is true, the other part is that there are lots of strings attached to these programs that delay and limit your choices in obtaining specialty training. So making education “free” if you give no accounting for the opportunity costs as well as the real tuition costs, and then place obstacles to obtaining residency training is just a non-starter.
Norman, good luck with your care under the “legislated access” you seem to want. That has the whiff of expropriated labor to it and it smells kinda bad. But to each his own, Komrade (or is that from each according to his ability and to each according to his need? No matter.)
And Janice, so sorry you are shaking with outrage that someone who has invested significantly in their skills and knowledge might want a return on that that reflects their efforts. Your reasoning is curious. I take from your objection that somehow you think all compensation should be similar, that it is somehow wrong to want compensation proportional to one’s investment (real investments now, money out, effort and opportunity costs.) I can safely assume you are not a physician and have not made the investment of yourself and your money in qualifying. Still, appreciating why someone else who has made that effort might want a return that seemed fair and was acceptable to them shouldn’t be all that had to grasp, unless you are indifferent to that, as would be a communist, or you are just fond of irrationality.
I don’t blame doctors for quitting. It is their right to do so if they are unhappy, and nobody has a right to their work on any terms other than what those delivering the service think is free and fair.
So until all of you complaining about doctors are willing to make the same level of sacrifice in compensation and benefits, no longer request pay increases, and completely abandon the strike option, you have no place criticize doctors for their desire to be paid well.
BTW, why don’t all of these nurses, PAs, NPs, admin, and support staff become doctors themselves? Almost all of the ones I talk to say that it takes too much school, time, and debt. If you don’t want to put in the effort and risk, don’t expect the benefits. Plus, most are not qualified or capable of the rigorous training required
I think her point was that one shouldn’t denigrate the work of others to elevate their own. Maybe you’re right. Maybe admin and other clinical support staff should get out of medicine and doctors can take on both their salaries and their workload.
I have a chronic condition and while my condition is managed extremely well by my physician, I am very aware of how much the rest of his staff contributes to the coordination of care. Without the nurses, there is no one to track my vitals for the physician, who has never taken them. Without the nurses, I wouldn’t have all my medication dosing questions answered when my doctor doesn’t have time. Without the support staff making sure my scripts are written and called in a timely manner, I have no meds. Without the support staff staying on top of scheduling, medical records and insurance billing (I have Blue Cross and not medicaid) I might slip through the cracks.
Everyone has a role in my care, I am a grateful to all them. From the lowest environmental services person who knows his OSHA to the most “important” specialist.
I do believe the point of residency is to further train physicians. They are apprentices, in a very true sense, and unlike most apprentices in other fields, are paid a stipend to cover living expenses while continuing their educations. That they must work hard to do so is, of course, part of the deal.
These physicians are not qualified to practice when they first graduate with their m.d. degrees, and cannot get a full license until they have completed at least a one year internship and a final licensure exam.
The attitude that residency is only free slave labor for the hospitals is a false statement. Is the training done in a malignant environment? Yes – quite often. Are the residents abused and worked in ways that do not contribute to the training? Yes – quite often. This is a problem with the system and requires remedy. Hospitals should not be permitted to use residents to do work that does not contribute to their training.
It is also true that the physicians in training are receiving an education at the expense of taxpayers. That they owe some sort of compulsory service after their training is complete is not a position I advocate. That they understand that they were among the privileged few permitted to receive this education is something I would hope that they realize and for which they continue to be grateful their entire careers.
I believe in the carrot not the stick, and providing incentives in the form of loan forgiveness or full payment of medical school training in exchange for service in an underserved area (geographically or medically) seems an idea worthy of implementation.
That medical school admission committees find a better way to screen applicants and award the finite spots in their schools to those individuals who will be able, their entire careers, to contribute to medical science in a meaningful way – for themselves and those they serve is my fervent wish.
To E:
Residents are not students in the training process the way medical students are. They are professionals, although not fully trained, and they are employees. The pay they receive is a contracted salary, usually renewable on an annual basis. It is not a gift bestowed by the government for which anyone doing the work–which is a lot of work for relatively very little money–should have any moral obligation to repay or any sense of gratitude. It is not a gift received from the taxpayers any more than pay received by anyone else working as a contract laborer for an institution that has a government contract would be. The residents’ pay is money earned for work done, not a present. Just because the resident does not bill independently for his labor, or because the residents require attending supervision, or because they don’t yet have an unrestricted license (not true either, 38 states allow doctors who have completed internship the privilege of unrestricted licenses; this writer had one as a resident.) does not diminish the value of their labor.
The numbers of training spots are finite because the residency patient care experience requires a certain distribution of cases to have a residency be thought sufficient for training. There is a reason they are limited in number, and it is not for the sake of preciousness.
Medicare benefits greatly by having physicians available at the rates they are paid as residents, and while they are not board-certified, their work frequently substitutes for far more costly attending physicians’ services. Medicare and other payers (and not just the hospitals) realize substantial benefits from a resident physician workforce. That the resident isn’t fully trained is irrelevant. Their work is still valuable, irrespective of their licensing status.
To Patient X
You are correct in saying the doctors support staff is equally important in your care. But who do you think pays for that support. Your doctor has to pay, supervise and is ultimately responsible for the performance of that staff. That staff support consumes 50 percent of his gross income. Everytime you call his office for an antibiotic for your “cold” you are getting free care because he can’t bill you for a telephone call. Try doing that with your lawyer.
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