How the silent exodus will worsen the doctor shortage

American Medical News has an important article - Will a “silent exodus” from medicine worsen doctor shortage?

Frustrated by mounting regulation, declining pay, loss of autonomy and uncertainty about the effect of health system reform, doctors are cutting back the number of hours they work and how many patients they see.

Between 2008 and 2012, the average number of hours physicians worked fell by 5.9%, from 57 hours a week to 53, and doctors saw 16.6% fewer patients, according to a survey of nearly 14,000 doctors released in September. If the trend continues through 2016, it would equate to the loss of 44,250 full-time physicians, said the report, conducted by the doctor-recruiting firm Merritt Hawkins & Associates for the Physicians Foundation. The foundation was started in 2003 with more than $30 million from class-action settlements that 22 state and county  medical societies made with health plans.

“This is a silent exodus,” said Mark Smith, president of Merritt Hawkins. “Physicians are feeling extremely overtaxed, overrun and overburdened.”

As I round these day in a community teaching hospital, I have many colleagues in private practice.  These physicians are warriors.  Our hospital has, in my opinion, too few physicians in several specialties.  Thus, those physicians work very long hours.

When one first starts out, fresh out of residency or fellowship, long hours seem reasonable.  Medicine is exciting, and the excitement and the intellectual and emotional challenge spur one to work very hard.

But as we get older, this lifestyle starts to get old also.  Common wisdom says that critical care docs become sleep docs around age 50.  That example tells the beginning of the story.

With the new work hour restrictions, the newly minted specialists and subspecialists will less likely accept very long hours.  Women (now around 50% of graduates) are less likely to work very long hours.

Oh, and we are producing no more specialists and subspecialists while the population increases and we need more physicians per patient because we have improved the care of chronic disease, so we have patients living longer and thus needing more care.

Many physicians have made enough money, and handled that money well enough that retiring will have no impact on their quality of life.  Many physicians are willing to make less money as a trade off for improved lifestyle.

And then we must mention electronic health records.  Many physicians hate learning EHRs.  As much as I like the idea of EHRs, and understand the advantages that they can bring to health care, any object observer will tell you that current programs are counter intuitive and time  consuming.  Meaningful use has made the physicians’ job more difficult and added time per patient for record keeping.  So some physicians just retire rather than dealing with computers.

We have a disconnect between those who make the rules (usually Congress or CMS or insurance companies) and an understanding of the moving parts required for successful health care.  We need more physicians and particularly well trained, fairly compensated primary care physicians.  Too many of our laws and regulations act to hamper health care.

This is a smoldering crisis, and our policy wonks, CMS regulators and Congress are all asleep at the wheel.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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