Is not seeing patients the answer for many doctors?

We’ve come to a sorry pass in American medicine when physicians are willing to spend a lot of money to attend conferences—not to learn how to become better physicians, but to find a way out of the pit of clinical practice.

Few of us have the charisma (or chutzpah) to make a living in medical show business, like Sanjay Gupta or Mehmet Oz.  But apparently any physician today can be clever enough to secure a comfortable nonclinical niche where the specter of The Joint Commission never lurks.

I came home recently to find a glossy brochure in my mailbox, inviting me (for a mere $1,295) to attend a two-day meeting with the principal aim to help me stop taking care of patients.  This conference promised contact with recruiters and employers who would put me out of my misery as a clinical physician.  In case I didn’t know I was miserable, the brochure pointed out that switching to a nonclinical career has “more financial potential” than clinical medicine.  It suggested sympathetically that I might be among the many physicians who don’t enjoy going to work any more, and want to eliminate the “stress and time commitments” of patient care.

People in Washington DC would do well to take a good look at this brochure, in case they were wondering why Medicare patients have trouble finding doctors. The panel of experts includes a host of former internists and family physicians, all happy to explain how they fled the tiresome business of seeing patients for their new careers as consultants, entrepreneurs, business executives, motivational speakers, and expert witnesses. One emergency physician on the expert panel left the ER to become a “Master Sherpa Coach”, whatever that is.

It’s no wonder why so many physicians are unhappy. In the past ten years, inflation-adjusted physician fees have declined by 25%, and now aren’t even keeping pace with inflation. The non-elected Independent Payment Advisory Board, created by the Affordable Care Act, has the sweeping power to mandate even more pay cuts to physicians. The overhead costs of running a medical practice continue to rise, and there is no relief in sight to reduce the crippling cost of malpractice insurance in many states.  The documentation requirements (thanks to the Centers for Medicare and Medicaid Services and The Joint Commission) and the penalties for noncompliance grow more threatening every year.

Why wouldn’t an enterprising physician look for a way out of this trap?

Is not seeing patients the answer for many doctors?

A few minutes of browsing the Internet will convince you that many physicians are looking for a lucrative exit from clinical medicine via social media.  Some keep a foot in the door of clinical practice.  Other physicians leave patient care entirely to give social media their full attention. Daniel Palestrant quit surgical residency in Boston after three years to found Sermo, an online forum for physician-only chat and opinion exchange.

Many physicians are going back to school for MBA degrees, hoping to land better jobs as pharmaceutical executives, department chairs, or government regulators.  Even medical students are flocking to nonclinical careers. The number of joint MD/MBA programs has mushroomed from 33 in 2001 to over 60 today, and they graduate at least 500 students each year.  Many medical schools are offering dual programs in medical informatics, biomedical engineering, or public health.

If you’re a graduating resident in anesthesiology and don’t have an MBA already, the University of Washington’s anesthesiology department will be happy to help you.  Their new “faculty fellowships” will allow you to work part-time as a clinical attending while you pursue that MBA, or perhaps a certificate in “Quality and Safety.”  The department’s avowed goal is for a trainee to become “both a content expert and a thought leader.”

A “thought leader”?  That’s just what we need:  more people with scant experience outside the academic bubble telling the rest of us what to do and how to do it.  Even the term “thought leader” sounds as though it originated in a propaganda bureau whose purpose is to tell a docile (or downtrodden) public what to think.

I’m quite sure that the new “thought leaders” will be well versed in the jargon of accountable care organizations, SCIP guidelines, evidence-based medicine, and the rest of the buzzwords that dominate the conversation about health care.  But while they’re sitting around talking about health care and figuring out where to lead our thoughts next, who’s going to be left to take care of the patients?

It’s easy to see how nonclinical careers can be tempting.  If someone offered me a decent salary tomorrow to become a columnist, or a substantial advance to write a book, would I keep on practicing medicine?   Would I continue to risk malpractice litigation from a poor outcome on a high-risk patient?  Would any of us choose to face exposure to VRE, MRSA, tuberculosis, and HIV?  Or deal with the payment denials from Medicare and insurance companies?  Or read the memos from administrators and bureaucrats who create senseless new rules all the time?

If there is a sure indicator that American health care is heading down the wrong track, it’s the fact that current policies are driving physicians out of patient care.  When physicians are willing to pay real money to attend seminars on how to land nonclinical jobs, then I think we can all agree that Washington’s health care policies are incentivizing physicians in exactly the wrong way—to abandon patient care.  I doubt that’s what Americans really want, and I’m certain that when children dream of becoming doctors they’re not imagining a desk job, even in a corner office.

Karen S. Sibert is an Associate Professor of Anesthesiology, Cedars-Sinai Medical Center.  She blogs at A Penned Point.

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  • http://www.facebook.com/kenan.omurtag Kenan Omurtag

    I am 30 years old, a board certified OBGYN and fellow in reproductive endocrinology and infertility. I have always wondered whether we as physicians relinquished control of the healthcare industry as technology and treatments improved and more money was to be made. Business savvy folks took over so many elements of healthcare and made it their own.

    Becuase physicians lost control of healthcare delivery, helping to make it better requires a better understanding of the system. Being just a “good doctor” who “takes care of patients” is not enough anymore and the system is responding.

  • http://twitter.com/Skepticscalpel Skeptical Scalpel

    Dr. Sibert, I loved your post. I wish I had written it. I still might. For an anesthesiologist, you make a lot of sense. Can you please forward me the brochure you mentioned? I have given up my dream of being a Black Belt in Six Sigma and now am focusing on becoming a thought leader or a Master Sherpa Coach.

  • glasshospital

    With all this seeming abandonment of practice by clinical docs, doesn’t make sense to encourage more female doctors into the fold–those that want part-time work to try better work/life (family) balance?

    After all, it seems that full time docs with big clinical loads are the ones most likely to burn out and seek these alternative careers.

    I seem to recall your being somewhat negative about that idea.

    • http://twitter.com/KarenSibertMD Karen Sibert MD

      Sorry! Still can’t agree. If medical education were a limitless resource, then it would make sense to train as many physicians as possible. But, given that medical education is both limited in quantity and expensive, how can it make sense to use twice the resource to train two people to do the work of one? Better instead to try harder to identify in advance those who are truly dedicated to clinical practice, and interested in staying the course. See also my column in KevinMD about the shortage of physicians: http://www.kevinmd.com/blog/2012/04/physician-shortage-worse.html

  • http://twitter.com/zdoggmd ZDoggMD

    Sometimes you have to unplug from The Matrix to actually have any chance of disrupting it. After 10 years of clinical practice I took the red pill and found myself in downtown Las Vegas, working with people much smarter than myself, hoping to rethink how employer-based health care can restore the primacy of the doctor-patient relationship while improving quality and cutting costs.

    And when we succeed, I’ll be right back in the trenches practicing this new medicine because that’s why I became a doctor in the first place. But I refuse to continue struggling along as a passive participant in a morally bankrupt and broken system without at least TRYING to fix it.
    Now where’s that Master Sherpa Coach? We’ve got some seriously climbing to do…

    • glasshospital

      kudos to you, ZDogg, for taking a risk and trying to make a difference in a big way. good opportunities are pretty rare.

      • http://twitter.com/zdoggmd ZDoggMD

        You are too kind. Keep rockin’ it Glass!

  • Janice Mancuso

    Great post! I think about this subject every day. In fact, right now I’m staring at the brochure Dr. Sibert mentioned!

    We have created a conference whose mission is the exact opposite of that one, i.e. providing tools and inspiration that will help keep doctors IN clinical medicine. (Doctoring
    in the 21st Century: Embracing the Challenge) Doctors need to unite forces and take back their profession. There are signs this may be happening or, at the very least, that the time is near for them to do so.

    Edwin Leap, MD, a frequent KevinMD writer, will be speaking on this subject at our conference in October: “Critical Mass and the Reformation of Medicine – It’s Time.”
    And the esteemed Bernard Lown, MD recently wrote an essay that addresses this subject – Doctor as scientist, healer, magician,
    business entrepreneur, small shopkeeper, or assembly line worker — which is it?
    I believe there is reason to have hope.
    janiceCreator, The Osler Symposiawww.OslerSymposia.org

  • Janice Mancuso

    Great post! I think about this subject every day. In fact,
    right now I’m staring at the brochure Dr. Sibert mentioned!

    We, on the other hand, have created a CME conference whose mission is the exact
    opposite of that one, i.e. providing tools and inspiration that will help keep
    doctors IN clinical medicine. (www.OslerSymposia.org)
    Doctors need to unite forces and take
    back the profession. There are signs this may be happening or, at the very
    least, that the time is near.

    Edwin Leap, MD, a frequent KevinMD writer, will be speaking
    on this subject at our conference in October: “Critical Mass and the
    Reformation of Medicine – It’s Time.”

    And the esteemed Bernard Lown, MD recently wrote an essay
    that addresses this subject – “Doctor as scientist, healer, magician, business
    entrepreneur, small shopkeeper, or assembly line worker — which is it?”

    (http://bernardlown.wordpress.com/2012/06/26/doctor-as-scien/)

    I believe there is reason to have hope.

    janice
    http://www.OslerSymposia.org

  • http://www.facebook.com/drjoe.kosterich DrJoe Kosterich

    This is true in other countries too. In Australia surveys suggest 50% of Family Physicians would get out if they could! The reasons as essentially the same notwithstanding a different system

  • http://twitter.com/stevenferguson Steven Ferguson

    Staying in business is a big concern for a lot of doctors we speak with, so I can understand how some might be tempted to leave the practice of medicine. We don’t have to look any further than this recent WSJ article (http://online.wsj.com/article/SB10001424052970204603004577271340816194320.html) proclaiming 144k doctors are struggling to make ends meet. Although most of the doctors we speak to are in primary care, by the looks of it, specialists are being wooed away from clinical practice as well. Dr. Sibert, you are absolutely right – current policies ARE driving physicians out of patient care.

    Luckily some are seeking out innovate ways to stay in the game.

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