Top 10 ways to know it’s time to quit your job as a doctor

Top 10 ways to know its time to quit your job as a doctor

Attention all doctors: The first three are mine. The rest are from miserable colleagues. All true. And common. If you’re a doctor and you recognize anything on this list, please quit your job.

10. You feel nauseated when you see your clinic logo; you alter your commute to avoid streets with your clinic’s billboard.

9. Discouraged by the general despair among staff, you try to be joyful. Then you’re reprimanded by the clinic manager for being “excessively happy.”

8. You dream of leaving medicine to work as a waitress.

7. You envy your sickest patients and/or you develop a perverse pleasure in your patients’ pain.

6. You pray you will be diagnosed with cancer so you can get some time to sleep.

5. You spend your nights trying to keep patients alive while you imagine ways to die by suicide.

4. You work 16 to 24-hour shifts and have not had sex with your spouse in months.

3. You’re a top-rated doctor, yet you daydream about walking into traffic, jumping through the window, or just dying in the course of a normal day.

2. You are counting down the days until retirement during patient appointments.

1. You change your computer password to “f*ck [name of hospital where you work]!!!”

If you’re a doctor, join the physician teleseminar and learn how you can stop suffering and start practicing real medicine.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears. Watch her TEDx talk, How to Get Naked with Your Doctor

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  • SteveCaley

    It stops being a means of expressing joy, and just feels nasty. It depersonalizes; it disrespects. It stops being a nice way to interact with your fellow humans, and feels like being the Store Greeter at a Concentration Camp.

    • Patient Kit

      Feels like being a store greeter at a concentration camp? I’m really sorry that it has gotten that bad for you. I hope you find a way back to being happy.

    • guest

      For me the analogy is work at a slaughterhouse. You develop a certain numbness of the heart. It is the only way that I can see surviving in medicine. It is not for those who like to help people, contribute to humanity and give back. Medicine is for those who like following the strict protocol, do not care about others and like to make money for which most subspecialize. Primary care is pretty sad, no money, no respect, no reason to do it unless one is delusional or brave to leave the mainstream system.

      • Patient Kit

        This is beyond sad. “Numbness of heart….not for those who like to help people…medicine is for those who do not care about others….” If things are really this bad for so many doctors, perhaps meaning and passion can be re-found in forming a movement to try to change our dysfunctional, demoralizing healthcare system? Freedom’s just another word for nothing left to lose!

        • http://www.idealmedicalcare.org PamelaWibleMD

          The movement we need is like the civil rights movement. Docs need an awakening of their souls, They must be true to their personal statements that they wrote on their med school applications. Nobody can do this for us.

        • guest

          I often wonder why do people who work for min wage continue to be abused and underpaid and why do not they just quit. Min wage has substantially decreased over the last decades, they can not even support their families any more with that kind of pay. Why do not they just quit? Perhaps they have no choice. What options do I have as a physician outside medicine without an MBA and management aspirations. Perhaps a job in the lab close to min wage. There is no choice for now, but I continue to look for ways out.

          • Patient Kit

            I’m sorry that you are so unhappy being a doctor. I really am. And I hope you find a way to be happy, in or out of medicine. But the fact that, with all your education, you feel like you have no options and that you wonder why people working and trying to survive on minimum wage don’t “just quit” when you feel like you can’t just quit your job yourself — well, that’s a bit of a disconnect from what millions and millions of Americans lives are like, including presumably some of your patients.

            Federal minimum wage is $7.25/hr or $2.15/hr if the job allows tips (think about that when you’re in a tipping situation). Some states and cities have higher local minimum wages. Here in NY it’s a whopping $8/hr. Try living in NYC on $8/hr. Something like 60% of the people working in low-wage jobs are adults between the ages of 26 and 64, not kids working for extra money. They don’t “just quit” because $7.25/hr is better than nothing and they do need to try to feed their families and keep a roof over their heads. So, many people work three minimum wage jobs, which adds up to working a lot of hours a week — just to survive. If they quit, what do you suggest they do instead? Apply for welfare? Go into a lucrative but risky life of crime?

            You can’t compare yourself to people who work for minimum wage who truly have few options. You do have options.

          • http://www.idealmedicalcare.org PamelaWibleMD

            But with PTSD, depression, despair—options look bleak no matter what your wage—whether you are Robin Williams or the cashier down the street at 7-11.

          • guest

            I can work for a minimum wage which is not a livable wage. Things have gotten so bad for Americans that middle class jobs are non existent. I am looking for other options, but all other jobs that I could do pay less than a livable wage which in my opinion is around $25/hr at least. So I was just voicing my frustration with how bad it had gotten for us and how little options people have not just for everyone else but also for those who want to get out of soul sucking but better paying jobs like medicine.

          • buzzkillerjsmith

            Minimum wage>starvation and homelessness

        • buzzkillerjsmith

          A movement to change?

          Kind of like the ghost dance. That didn’t help much at Wounded Knee.

          Please, Kit, embrace the futility. It is the only sensible thing to do.

          The best change is change from a doc to a retired doc. 11 years for me. Actually 10 years and 10 months but who’s counting.

          Of course all those lottery tickets could speed things up a bit.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Totally disagree. The ideal medical care movement is changing hearts and minds—and saving doctors.

          • http://www.idealmedicalcare.org PamelaWibleMD

            It’s the lack of positive mentors in an apprenticeship profession that is killing medicine.
            Medical students who shadow me tell me that I’m the first happy doctor they’ve ever met. They tell me I’m the only solo doc they’ve ever met. They tell me that in medical school they are told it’s not possible to be a solo doc anymore (from a bunch of cynical burned out teachers I suppose). If you are a burned out cynical doc, please get therapy or retire early. You are not helping these young doctors-to-be.

          • buzzkillerjsmith

            You misjudge me. I’m doing fine. I like going to work almost every day I work.

            And I am helping those one or two young docs who might have ever read anything I have every written. I am trying to keep them from making one of the stupidest decisions they will ever make.

            Because, unlike some, I see things clearly and am willing to share that clarity.

            Teaching is indeed fun. University of Washington med students that shadow me are never subjected to my thoughts on these matters. They are subjected to instruction of how to read X-rays and suchlike.

            Docs who attend my talks on tuberculosis are never subjected to this either. They are subjected to a discussion of the antigens tested for by IGRAs and TSTs as well as an estimated Bayesian analysis of each test.

            They are also not subjected to discussions about loving their patients.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Medicine is an apprenticeship profession so it’s not what you say, it’s how you do it. Students are watching your every move, gesture, sigh. They know if you are enjoying your work or not and that will impact the way they practice later—for good or worse.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Unless you go into private practice.

      • SarahJ89

        Or, as I once said to my psychologist colleague, “We’re being paid to give the illusion of services.” There was no way we would ever be allowed to actually be helpful, useful or effective.

    • http://www.idealmedicalcare.org PamelaWibleMD

      —-> the Store Greeter at a Concentration Camp.

      Well stated!

  • Thomas D Guastavino

    One of my basic rules of life is “never take responsibility over that which you have no control”. If you are in medical practice (or any job for that matter) you realize that the greatest source of stress is not your work load, but the amount of control you have and the obstacles that are put in way. As a surgeon I have found that I am under the least amount of stress when I am actually operating because thats when I have the most control. The reality is that if physicians wish to obtain a more balanced life they are going to have to start saying no to those work conditions that create that disconnect.

    • southerndoc1

      Well said.

      When you sell your soul and go to work for Corp Med, you have to accept responsibility for the consequences of your decision.

      • Patient Kit

        So, is private practice the only way to be happy practicing medicine? Should I assume that every doctor who treats me at the hospital is miserable? Even considering all the bad things about Corp Med, there must be both good employers and bad employers, I would hope.

        • southerndoc1

          “So, is private practice the only way to be happy practicing medicine?”

          No, not at all. Different strokes for different folks.

          But there are a lot of docs, tempermentally unsuited to beings employees, who don’t seem to look at the fine print of their contracts before they sign on.

          • http://www.idealmedicalcare.org PamelaWibleMD

            The part of the contract that says “we own you.”

          • kidmodel

            Fear the ubiquitously frightening, ‘other duties as assigned’. Also the non-compete clause CAN be modified in some cases which can afford one a sense of freedom.

          • Patient Kit

            I can certainly understand many docs not having the temperament for being employees. I think it must be especially hard for docs who spent the first part of their career in private practice and are now grappling with a changing healthcare system in which it is harder to stay in private practice. I truly get and empathize with that. We are all living in a very rapidly changing world.

            I hope docs coming of age now and opting for hospital employment can be happy being doctors. I’m getting some terrific care from them and I hate to think of them as being unhappy.

            Re the not reading their contracts before they sign them, I’m not surprised. Nobody seems to want to read anything anymore. A lot of patients sign consent forms without reading them too. At the YMCA where I swim regularly, there is a constant stream of new members who say once they have joined “Why do they let kids in here?” Hello. Did you not know what a Y was when you joined? Did you not read the agreement you signed? Not the same thing, I know. But there is an epidemic of not reading before signing, probably because any contract or agreement is longer than one text message. Part of my last job as a research analyst was reading the fine print of official documents like companies’ annual reports. The secrets are hidden in that fine print.

          • buzzkillerjsmith

            Hospital employment is not good. A better model is working for a large physician-owned group so that admin types work for the docs and not vice versa.

            Kaiser has this setup. It’s a lousy place to work, but it could be even more humiliating.

          • http://www.idealmedicalcare.org PamelaWibleMD

            What about admin physicians who prey on other physicians? That’s like cannibalism. Right?

            Here’s an example of predatory physicians: http://www.idealmedicalcare.org/blog/doctors-not-allowed-to-ask-patients-how-are-you/

          • NPPCP

            I agree. If I didn’t own my own place I would be a hired gun. Would never be full time again. The health care system is abusive to employed brains. I would work where they were most grateful and leave when they weren’t anymore. I could switch jobs about 30 more times and then retire, wreaking administrative havoc all along the way. It would be a hobby.

          • SteveCaley

            It’s a sweet job for a predator, a psychopath. Many of them gravitate to residency programs. There’s sweet meat out there.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Very disturbing. I am studying medical student mental health now. Difficult to take it all in. And I can usually handle quite a bit of pain.

          • jpsoule@hotmail.com

            Reminds me of one of my resident instructors as a 3rd year medical student just starting clinicals. Our 1st course was physical diagnosis at the university VA. As he assigned patients to us for a head to toe physical exam, to be reported back to him in detail, he told me he was assigning me Mr X.
            I asked him what Mr X was in the hospital for.
            He looked at me and said, “Normally I would not tell you, but he is here for Hansen’s Disease.” I said I don’t know what that is. He smiled broadly and said, “Look it up after you do a thorough exam” and just chuckled.
            Of course Hansen’s disease is leprosy… :)

          • jpsoule@hotmail.com

            Your link reminds me of what one of my VA patients told me. These patients pay out of pocket to see me even though the VA sees them at no cost. He has to go to the VA clinic every 6 months to receive his meds for free there.
            As we discussed his concerns, I asked him what his VA doctor told him about his HTN, DM, CAD, etc.
            He said “She told me She is the doctor and She asks the questions, NOT him”. As she filled out the EMR without looking at him and dismissed him when she was done.

          • RenegadeRN

            Sadly, there are many docs who are not comfortable with a patient who can critically think for themselves. Voicing an opinion, thought or asking questions takes too much time and just generates irritation in docs, such as the one you mentioned.

          • http://www.idealmedicalcare.org PamelaWibleMD

            That is not how any of these docs imagined practicing when they were in medical school. Assembly-line medicine is an assault of the soul of doctors—and patients.

          • RenegadeRN

            Agreed!

          • Robert Steed

            Reminds me of when I was rotating through the VA endocrine clinic as a fellow. As I started talking to a guy and taking his history, he interrupted, “Doc, thanks for you interest, but I have a regular doc on the outside. If you could just sign off on my prescriptions, I’d appreciate it.”

          • jpsoule@hotmail.com

            Many vets who can afford it or have other insurance such as medicare and a secondary use the VA only for services like meds and other things not well covered by the private insurance. But also the VA promotes this, intentionally or not, by making it very difficult to receive care on a timely basis, as seen in the recent scandal.
            Many times I have admitted these patients directly to local private hospitals for acute problems because the VA system could not see them for MONTHS, not days or weeks.
            Even the chronic patients tell me they often show up at the regional VA medical center (2hrs away) only to be told their appt. had been cancelled and rescheduled, with no explanation. Maybe things will improve now.

          • buzzkillerjsmith

            Well said. Kaiser in a nutshell.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Scary.

          • SteveCaley

            The problem is that medical school once taught people to be responsible for making decisions, based on incomplete information, to trust in themselves more than they feel like it at the time.
            There is no second chance, sometimes. Get it right. If it’s not you – it’s nobody making the decision. You can’t skip any questions as ‘too-hard.’
            Most doctors have gone to bed and couldn’t sleep, praying that their decision was right. I have.
            Nowadays, the culture is one of the Monday-Morning-Quarterback. Decide nothing, criticize everything, and shift the blame. In this world, the doctor is a doubleplusungood loose-cannon in need of re-education.

          • DeceasedMD

            There is less to struggle with. Increasingly decisions are made with abnormal testing, not with clinical acumen. And numbers and cutoffs are decided for you. If a pt has clinical signs and a Hg of 7.1 then it’s easy. No blood transfusion. Drop your Hg to 7.0, then you qualify. Simple.

        • Eric Strong

          I work for a VA hospital. Despite the largely undeserved bad press about the VA, most of my colleagues are quite happy with their jobs. Of course there are minor complaints (usually about issues removed from patient care), but overall happy.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Awesome! Congrats! Which VA are you at?

          • Eric Strong

            Palo Alto.

          • QQQ

            Nice place!!! I have friends there in CA! Great computer companies are in that location and its a nice to place to live! Expensive, but nice!!

          • Eric Strong

            Very expensive, particularly when buying a home. (I’ve been out of residency 8 years, and I’m still renting…)

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes. Impossible cost of living AND Medical reimburses $11 per visit. Do the math on that one ninguem.

          • querywoman

            You may do better to rent. Texas “strong arm” attorney Brian Loncar has his home in his wife’s name. This is public info.

          • buzzkillerjsmith

            Nice place? Not hardly. Too many two-legged locusts. I prefer moose, elk, and deer. Plus the wolves are back.

          • QQQ

            Everybody has their own opinion and I respect that! But for me, its nice!

          • buzzkillerjsmith

            Most people would not want to live out here. Despair in the wilderness for those folks. No despair for me.

          • SarahJ89

            I live next to 450 acres of forest. Across the road is another 300. I love to be in the woods, it’s my safe place. I’ll take my chances with the local bear any day of the week.

          • Eric Strong

            Palo Alto is actually immediately adjacent to the Santa Cruz Mts, a minimally developed coastal mountain range similar in size to the White Mts of New Hampshire. We lived in a cabin there for a year, where we were surrounded by redwood trees and literally fed wild deer in our backyard, yet still managed to commute to Stanford in 25 min. Maybe you’re thinking of LA?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Wow! That’s still possible in California???

          • Lisa

            I live in Santa Cruz and the Santa Cruz Mts. are pretty nice! I hike there there a lot.

          • Patient Kit

            Some — okay most — people think of tech companies and Stanford University when they hear Palo Alto. I think of James Franco. :-p

          • Patient Kit

            I’m happy to hear that you and your colleagues are happy working for the VA. My sister, an MSW psychotherapist (not a doc), is very happy working for HHC, NYC’s public hospital system, also the subject of much undeserved bad press. People think “Bellevue!”, yet Bellevue’s ER is where any NYPD who is shot is taken. And allegedly, Bellevue is where the President of the US would be taken if anything happened to him here. My sis says she has no regrets about working for HHC instead of going into private practice. She seems genuinely happy and fulfilled with her career.

            A lot of people find that unimaginable to be happy working for HHC. She is very good at what she does and has a lot of good long term relationships with her patients (She works out of an outpatient clinic affiliated to one of the other hospitals, not Bellevue). But I don’t think you can work for a bigger bureaucracy than HHC. Well, the VA. ;-)

          • Eric Strong

            That’s wonderful that your sister is happy and fulfilled with the HHC. The world needs great and dedicated MSWs!

            I went to med school at NYU, and spent time in the Bellevue ER. It’s truly a world class department. Other departments in Bellevue were more hit or miss with the care (circa 2000-2002). The care in forensic psychiatry (i.e. psychiatrically ill prisoners) was particularly awful.

          • Patient Kit

            I think all hospitals probably have their strengths and weaknesses. And when we have the time to do the research before choosing, we should. Nobody should choose a hospital based on the great reputation of a specific department when that is not the department they need. I have a tremendous amount of respect for the people who work in the VA and HHC systems. My sister loves being able to treat the population she treats. As I’m sure you know, HHC is not without its problems but is a true safety net hospital system.

            That said, when I found myself in personal crisis last year (layoff>loss of insurance>ovarian cancer dx), I chose to be treated in the NY Presbyterian system rather than the HHC system. I have no regrets. I have had excellent care from an awesome doc. Academic medical centers/teaching hospitals are another great safety net. I’m very lucky to have had good choices during a very difficult time. NYC is not a bad place to need healthcare.

          • SarahJ89

            OT but maybe interesting: I worked in a large hospital in Belfast, NI at the height of the current Troubles in the 1970′s. It was the place the British Army took their soldiers for treatment.

            There were niches in the hallways, the sort of thing in which most places would park a statue. In Belfast there were soldiers lying on the ground, rifles in hand. The rifles stuck out into the hallway. I used to have to watch out not to trip over them on my way to get a cup of tea.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Not my cup o tea.

          • querywoman

            A nice young cardiologist I had just quit to go back to a VA where he trained.
            He had been called in due to fast heartbeat due to my pneumonia.

          • JR DNR

            I know the VA has been under fire… but the VA has been critical to the study of PTSD. The training docs the VA has on how to provide medical care to people with PTSD… it’s pretty much all there is!

            … I wish that doctors didn’t think such things were “someone else’s problem”. I hold out hope to find a PCP trained in trauma informed care someday.

          • SarahJ89

            JR,
            I’ve had better results in training my PCP. I highly recommend this approach. I’ve done better with finding a compassionate person who listens and is willing to learn.

            The fact is, each of us has unique triggers and our typical response can
            be unique. For example, I tend to freeze–the forgotten stepchild of
            flight-fight-freeze–so I have to explain this reaction to anyone likely to trigger a response. And someone who listens usually is willing to learn. My PCP has no special training but has learned to ask before he touches and to make changes slowly. And just knowing he’s willing to listen is healing in itself.

            I’ve run into practitioners who were trained in PTSD and fancied themselves “experts” but who were exceedingly ham handed.

            The bottom line with PTSD is that it’s mostly up to us to figure out how to fly that helicopter–how to identify and manage our symptoms and responses and how to explain them to the people in our lives who need to know.

        • http://www.idealmedicalcare.org PamelaWibleMD

          There are well adjusted, happy, and healthy doctors in all types of practices. Some employers are better than others. The problem is when the number of miserable doctors far exceeds the number of happy doctors. Look around. How many happy docs do you see?

          • Patient Kit

            I don’t think there is any way for me to really know how many docs are happy and how many are unhappy with their work and lives. Even basically happy docs need to vent frustrations, which makes them sound unhappier than they are sometimes.

          • Lisa

            I agree with you; how would a patient know, really know if a doctor is unhappy with their work? I don’t think my doctors are unhappy, in fact they generally seem happy with their work. The doctors I see socially are all pretty happy with their jobs. But I don’t know, not really.

          • http://www.idealmedicalcare.org PamelaWibleMD

            If you call and you discover your doctor has “died suddenly.” Maybe that is an indication, but doctors are masters at hiding depression and suicidal thoughts.

            How you might know that docs are unhappy –> They complain about work, they have a vacant stare, they seem frazzled, appointments are rushed docs are harried and with poor focus and concentration, you get a letter than your doc moved on to another position elsewhere, you find out they died by suicide.

            Sometimes it is easier to tell than others. We had a local multi-specialty group that lost 18 primary care docs in one year. I’d say they weren’t happy.

          • Patient Kit

            I have no doubt that there are plenty of big problems and issues working in our dysfunctional healthcare system and that many docs are good at hiding how they are feeling. But I think that seeing everything through a suicide lense sometimes leads you to overstate things. You make it sound like almost every doctor in the US is suicidal or potentially suicidal. And I simply do not believe that.

          • http://www.idealmedicalcare.org PamelaWibleMD

            A quote from a doctor on my blog:

            Anonymous says:
            April 5, 2014 at 6:27 am

            I suspect that you would be hard-pressed to find one of us that isn’t at least sometimes suicidal. We’re just not allowed to admit it as it would end our careers.

          • Patient Kit

            That is one anonymous depressed doctor’s opinion. It doesn’t make it true. I’d be interested in knowing what other docs here think: Are ALL docs suicidal? I certainly hope not.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Another (non-physician) on my blog felt that it was normal for a person to have contemplated suicide at least once in their life by age 45.

          • Patient Kit

            All people, not just doctors, have seriously contemplated suicide at least once by 45? I don’t believe that. I certainly hope it’s not true. I think we have to differentiate between people who are seriously suicidal and those who just indulge in light fantasy about it but would really never do it. And those who really want to die and those who are crying out for help and attention. You could make a case that many teens indulge in suicidal behavior (like drunk driving) but its offset by their co-existing belief that nothing is really going to happen to them and that they are going to live forever.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I think we all at times have had at least a “light fantasy” of what life would be like if we did not exist. If our pain and problems were to suddenly disappear . . .

          • http://www.idealmedicalcare.org PamelaWibleMD

            If anyone out there is so well adjusted that you have never once had this thought, please come forward. Announce yourself. I want to interview you for my next blog.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Especially if you are a well adjusted doctor who had a happy childhood and a wonderful trauma-free experience in medical school.

          • buzzkillerjsmith

            Not really. Homicide though…, especially in that city traffic.

          • SteveCaley

            Whatever we choose not to see, we thus choose not to believe. Whatever we choose not to believe, we choose to become complicit in.

          • Lisa

            I’ve read that doctor’s rate of suicide is twice that of the population as a whole. But this has been so for a long time. I’ve seen references to studies of the problem in the 1960s.

            Admiting to being suicidal might end many careers, not just doctors careers.

          • Patient Kit

            Doctors and police officers seem to have a lot in common when it comes to suicide. Both have easy access to means (docs to drugs and police officers to guns) and both work in cultures that consider seeking help for depression or PTSD a fatal sign of weakness. And then there is that Blue Wall of Silence and that White Wall of Silence. Those cultures need to change if we want to see suicide rates go down.

          • http://www.idealmedicalcare.org PamelaWibleMD

            As women infiltrate the ranks things “should” change. Right?

          • http://www.idealmedicalcare.org PamelaWibleMD

            High rates of doc suicide written about back to 1858 in England.

          • Lisa

            None of my doctors exhibit any of your signs of being unhappy. I have had two doctors retire, but they were of retirement age. I’ve had one doctor die of cancer. My friends who are doctors seem as happy as any of my other friends. Maybe my area is a good area to practice in.

            If a local muti-specialty group lost 18 primary care docs in one year, I’d wonder if some other group is ‘poaching.’ But yep, something sounds wrong.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Where do you live?

            Don’t move.

          • Lisa

            I live on central coast of California and I have no intention of moving. I like living here!

          • Patient Kit

            My docs don’t seem unhappy either. But, of course, I don’t know that for sure. They live and work in NYC. Maybe there is some geography to where docs are happier practicing medicine.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Beautiful place. I assume these docs do not have high numbers of Medicaid patients. Medical reimburses like $11 per visit so I figure they would be smiling a lot less in that case.

          • Lisa

            I think most people on medical in this area get funneled into HCOs. I do have several friends who were able to get medical under the ACA and I know they are taking care of long neglected medical matters. They are pretty happy with the situation.

          • SarahJ89

            They lose interest. My sweetie went for his annual physical (he still does that) and was alarmed that his doctor seemed listless and uncharacteristically disinterested in the proceedings. Doc is a really fine person so we were concerned for him. Sweetie no longer gets to see the doc except for these annual excursions (hmmm, perhaps the prostate exam calls for the word “incursion”) so it will be interesting to see how Doc’s doing next year. We’re hoping, for his sake, it was a temporary slump. You hate to see a good man down.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Please write him a card or letter. Express your concern—and appreciation. Could be the wake-up call he needs. Hate to think he may have “died suddenly” before your hubby’s next prostate exam.

      • http://www.idealmedicalcare.org PamelaWibleMD

        If you are supporting an infrastructure that does not support you and frankly terrorizes and abuses other physicians, you become part of the problem. By selling your soul you are not providing health care. You perpetuate a toxic health care system that no amount of legislation can correct.

        • SteveCaley

          Has anyone paused to note that the rapid deterioration of compensation, working conditions, respect and esteem tightly follows the “feminization” of the profession? The average female physician is about 30 and the average male is about 50 years old.
          As they say, “Poverty looks prettier in pink.” Medicine will become a pink-collar job, and the iron rule of 70% pay is on the way, I fear.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes. I have noticed that.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I’ve noticed that female primary care physicians get less media airtime than say, east coast white male specialists. The majority of TED talks are given by men. Turn on the news and the solutions to our problems are being debated by taking heads – mostly men.

            I love men, but . . .

            Ummm . . . excuse me. . . some of us gals have some really innovative ideas worthy of discussion.

            Actually sat next to a guy on an airplane who had no idea we were still living in a patriarchy. He was actually shocked.

          • SteveCaley

            The glass ceiling’s just got screwed back down again hard. With the new “Best Practices / Guidelines / Quality” approach to medicine, the lady doctors see the patient, and do it exactly the way the men tell them.
            See? Best practices.
            Did you know that Abraham Flexner discovered in 1910 that there was perfect equality of opportunity for medical training for medicine? Yes, he had a whole chapter on it. Of course, these female doctors couldn’t vote for another ten years, but equality is a subtle thing in some men’s minds.

          • http://www.idealmedicalcare.org PamelaWibleMD

            How did you discover so much about Abraham Flexner? Did you take a course on the history of medicine?

          • SteveCaley

            I think the high-water-mark for gender equity in medicine was perhaps in the early 90′s. Then, as soon as the women got the first-class cabin, the boat started sinking.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Oh no!

          • querywoman

            In the old Soviet Union, medicine was pink collar and the female doctor had the same status as a housewife.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I can see that.

          • querywoman

            When I was a state welfare worker, my gentleman friend/male coworker blamed us women for the low pay and working conditions. He said it was women’s work and that’s why he got cruddy pay.
            He had a point.
            My one teaching doctor, my derm, recently drilled a female int med resident about the percentage of females in her graduating class. It was slightly more female than male.
            I gripe to him a lot of about sorry female ob/gyns that I have seen. I am okay with most female FP’s and internists.
            That’s how the subject came up. His father was an ob/gyn.
            In the early 1990s, a female internist told me that ob/gyn is highly male dominated.
            Now so many ob/gyns are female, that maybe the attitude has changed. I won’t be testing them.
            I recently went to an older, kindly male ob/gyn whom my derm knew. I had called the medical school because an older/kinder male was on the staff there. He’s just teaching, so they gave me an appointment with the doc most like him. My derm used to office next door to him.

          • querywoman

            As the female doc child of a male doc and a female doc, do you feel things have changed much for women doctors?

            You are not on staff anywhere, a real solo practitioner, but you correspond with a lot of docs.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Things have definitely improved. Though I was trained at the same good-old-boys medical school as my mom, my experience—though traumatic—was not anywhere close to the sexist trauma my mom sustained:

            “In 1965 my mother, Judith Wible, received her medical degree from the University of Texas Medical Branch at Galveston. Of 160 graduates, eight were female. The dean and fellow students reminded the ‘girls’ in the class that they were ‘taking a man’s seat’ and they would never use
            their degrees. Even the anatomy professor refused to accept female anatomy and persisted in addressing women as men. Despite her protests, my mother remained ‘Mr. Wible.’ Women were excluded from urology—from palpating
            penises and prostates—while men dominated obstetrics and gynecology. Daily, the women were exposed to filthy jokes that demeaned female patients, and in the evenings they slept in cramped nursing quarters while the guys had fraternities complete with maids, cooks, parties, and last
            year’s exams.”

            ~ Goddess Shift: Women Leading for a Change, Elite Books, 2011 (anthology in which I contributed a chapter alongside Oprah, Michelle Obama, and other visionary women) – My big claim to fame. :))

          • querywoman

            Wow! The internist who told me in the early 1990s that ob/gyn was male dominated probably saw the tail end of the old ways. She died early due to cancer.
            She also told me that she had volunteered at a large public hospital where some doc administraor didn’t want to feed the patients for some bizarre reason and said the women doctors watned to feed them because they have big boobs.
            Other female doctors have written about medical schools reminding them they were takng a man’s seat.
            The kindly older teaching ob/gyn I saw recently (he didn’t like it when I declined a mammogram), said he was sorry to hear what I said about female ob/gyns since he trained some of them.

          • querywoman

            If I should test out a younger female ob/gyn, and I don’t plan on doing this, to see if the attitude had changed, I could not judge her based on my past experience, now that I no longer menstruate.
            I won’t be getting pregnant, unless I get an Abraham and Sarah miracle, and I have more hope of that than a medical miracle.
            I have been to female ob/gyns who acted like they never had a menstrual cramp in their lives. I have been to ob/gyns who were mothers who had no sympathy for me as a childless woman.
            I went to a female lawyer once who had pictures of her children on her wall and hurt my feelings in the same way female ob/gyns had.

          • SteveCaley

            And being sober enough to stand up, after 6PM, was uncommon.

          • querywoman

            I told a Russian once I heard there was a a shortage of vodka in Russia. He replied, “There is always a shortage of vodka in Russia.”

          • Suzi Q 38

            So True.
            I am thinking about the past again.
            I am thinking about a fleeting comment that a speaker made at a large physician dinner. The topic was : “Chernobyl.”
            It must have been 1986 or so. This doctor had gone to the Ukraine to help treat the victims of the nuclear disaster. He brought a team of doctors, and of course a hefty amount of the drug that my company at the time was promoting.
            There was a picture showing the medical team from the Ukraine. They were all female, and here the doctor from the U.S. was making feeble excuses for the female gender majority there.

            He said something like: “It is interesting that so many of the physicians in the Ukraine are female.
            I think it is because they view being a physician as a “care taking” job, so more women than men want to this job there….”

            I bet it is because they want to pay women less than men for the same job, so more women have gotten hired. I have heard that the pay for women is as much as 50% less.

          • querywoman

            I feel confident your analysis of Soviet “care taking doctors” and pay for women is on target.

          • buzzkillerjsmith

            Good point, infrequently made.

            Educated men go for the money and the power and usually abandon jobs that increasingly become feminized. We know implicitly that those jobs aren’t as good for us as they come with less money and power. Plus you might wind up with a woman boss.

            Damn, am I a sexist. Too late to change.

            Many medical specialties are going that route. I’m not saying that is bad. Good and bad probably.

            Guys who are less educated work with their hands more. I think that have more fun than we do. They certainly have bigger trucks and more boats, which is a very good thing. And no, kayaks and canoes don’t count.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Thanks for the insight. :)

          • NPPCP

            This I really personal…but if I ever deserted my family I would move to Washington and work with/for buzz.

          • buzzkillerjsmith

            There’s a shortage. Come on up. You can even bring the family unless your wife is a shopper.

          • querywoman

            I’ve often thought medicine was downgrading into female physician dominated, low status like housewifery, as in the old Soviet Union.
            The Nazis liked to exploit the highly trained Soviet women for various slave labor in the concentration camps.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Back full circle to the concentration camps.

          • querywoman

            The concentration camps had doctors! A lot of doctors whom I have known are one step away from Mengele.

          • morebuzzkills

            This is exactly why I have a difficult time respecting your comments. Do you have any idea what Josef Mengele actually did to people in Auschwitz? Growing up, my friend’s grandmother used to tell us stories about Auschwitz…many of her stories gave me nightmares that made me wish the Boogie Man would come rescue me. She escaped after several years, living in a barn for over a year where a farmer brought her a potato to eat every other day. The things that Mengele did to other living humans defy even the sickest imagination. Making a blanket statement where you compare physicians whom you have known to being one step away from Mengele is repulsive and utterly disrespectful to those who actually suffered at the hands of this unbelievably cruel person. I think it is pretty safe to say that there are no practicing physicians in the US who even come close to rivaling the atrocities that Mengele committed. And if they were even a step away from Mengele, they would most certainly be in prison. This type of hyperbole also contributes to Dr. Wible’s original topic of why many doctors utterly hate their jobs. Who would want to take a call from a patient at 2 AM only to have the patient subsequently compare him/her to somebody who killed 14 patients in one single night? I am not saying that terrible doctors do not exist in this country, but your measure of them being one step away from Mengele is simply offensive and highly insensitive. I hope that in the future you can better calibrate your barometer of hyperbole.

          • querywoman

            I have researched Mengele plenty! When I am ill and have been left ill, I have often felt many doctors are one step away from Mengele.
            It’s unsufferably cruel to practice preventive medicine like the blood pressure cuff on a patient and leave problems with symptoms ignored.
            The medical profession has not killed me yet, but they could have easily killed me with neglect years ago.
            You need to take into account how repulsive and utterly disrespectful it is to take a person’s money and neglect their illnesses. Do you know what it is like to work sick when you have repeatedly complained to doctors about those illnesses.
            You need to pay more attention to my viewpoint.

          • querywoman

            All of us are capable of great evil and great good. Am I suppose to assume that all doctors are benign? They are not! Why else would I have such an opinion? I did not say all doctors, I said that a lot of doctors I have known are one step away from Mengele. It’s awful that I have seen doctors that bad! Perhaps I should each one let I know how I felt. But many of the bad ones I have seen are no longer practicing and or dad.
            You need to own up to the fact that patients have had no recourse against bad medical advise. If their were some responsibility, many patients wouldn’t be so bitter.

      • SarahJ89

        Fine and dandy, southerndoc. But I have watched PCP after PCP become boxed into selling out to the local voracious so-called nonprofit hospital that now owns every practice but one in a 30-mile radius.

        The required hardware/software for EMR was the nail in many practice’s coffins. It was simply too expensive for a small practice to afford. One doctor I know went bankrupt trying to meet the cost.

        I am quite sure that, however, was merely the tip of a very nasty iceberg. This hospital plays for keeps.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Where are you? And who is the doc who still is on his or her own? What a hero!

    • http://www.idealmedicalcare.org PamelaWibleMD

      Agree 100%. A doc can not be a victim and a healer at the same time. Choose one.

      • Thomas D Guastavino

        Problem is circumstances don’t always allow you the luxury of having that choice.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Please share circumstances.

          • http://www.idealmedicalcare.org PamelaWibleMD

            There are always options.

          • Thomas D Guastavino

            1) You wish to no longer take emergency call but your hospital requires you to do so as a requirement for privileges
            2) You to no longer wish to see a certain patient population due to high malpractice potential but your hospital/practice requires you to do so.
            3) You are at odds with your hospital because they demand you follow a certain protocol that you know is harmful to your patients
            4) You would like to cut back but you still have $200,000 in school loans and just had your third child
            5) You are required by your state to have malpractice insurance but your present carrier canceled and there are no other carriers available
            6) You just got threatened again with a malpractice suit by a patient because your emergency missed yet another fracture
            Enough? I could go on.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Ah! You are a specialist who is required to be on hospital staff.

            Have a few radiologists trying to figure out how to extricate themselves. Not quite as easy as a family doc hanging out a shingle.

          • Thomas D Guastavino

            You got it. Specialty hospitals and narrow focus practices are ways that physicians have tried to extricate themselves from general hospitals. Woudnt it be interesting if every physician managed to do it.?

          • ninguem

            The hospitals all too often get “certificate of need” protection for their monopoly.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes!

          • Thomas D Guastavino

            Wow, its sounds like you would like to see that happen.

          • buzzkillerjsmith

            200k? What a nightmare.

    • JR DNR

      This applies to patients too. And it’s what I want the most out of my health care: control.

      • Thomas D Guastavino

        Agreed

  • Patient Kit

    People who take on difficult roles in life and want to commit to them long term need to find a way to pace themselves. Talking about doctor burnout, surely there are things that can be done to improve your working conditions and work/life balance short of quitting.

    How much vacation does the average doctor in the US take? What about doctors in other countries? What are their vacation rates? It just seems like a good vacation should be considered before quitting.

    I sincerely hope most docs aren’t at the point where they are praying to be diagnosed with cancer so they can get some sleep. :-(((

    • http://www.idealmedicalcare.org PamelaWibleMD

      Is there a way to improve the work/life balance in a slaughterhouse or a concentration camp?

      Please watch this video and let me know what you recommend for this fin physician. Maybe she needs to take a class on mindful meditation or deep breathing or maybe, just maybe, she needs to quit. What do you think Patient Kit?

      https://www.youtube.com/watch?v=l2IngrAq7yA

      • Patient Kit

        I can’t watch the video now because I’m at work. But I’ll try to remember to watch it later. I have to say though that, although I do understand that there are major issues with Corp Med employers, I think characterizing hospital employment as working for “slaughterhouses” and “concentration camps” is way over the top.

        • http://www.idealmedicalcare.org PamelaWibleMD

          watch video and you may change your mind.

      • SteveCaley

        Hope is in the power of ideas. Look at the Berlin Wall. In the 60′s and 70′s it was a death zone. They shot a man and left him to die as an example to others who wanted to escape. It took days for him to die. They did not allow him to be rescued. That is true.
        In the 1990′s, simple human beings realized that the Berlin Wall was a horrible idea, and inhumane. Not one or two human beings. It took all of them to realize the wall was intolerable.
        So they took it down.
        Look at pictures of the Berlin Wall, and realize that it is nothing compared to the humanity and dignity of human beings.
        When we want to change, it will happen. But do not put the blame on THEM. The problem is US.
        Until we humanize medicine, do not ask – who runs the slaughterhouse? Who runs the concentration camp? Do not ask Who? Look in the mirror and ask Why?
        And there is no moral excuse.
        I think characterizing hospital employment as working for “slaughterhouses” and “concentration camps” is way over the top. That’s the same complaint some people made about reporting Robin Williams’ death – the grisly details!

        But a man died. Is it hyperbole to say that his life was a concentration camp, a slaughterhouse, at its bitter end? Any human suffering can be minimized – any cruelty can be explained away.

        I have read Arendt’s account of Adolf Eichmann. He was no monster. I have met many Eichmanns in my day. To surrender one’s conscience, to minimize human suffering, to validate the reasons for cruelty – that is simply worshipping the spirit of Eichmann. That spirit did not die in Jerusalem in 1960. That inhumanity is in our society, here, at home, today. We swim in that water; we drink from it.

        There are single-mom physicians living on the poverty line; you don’t have to believe that, you don’t have to acknowledge that. There are physicians who kill themselves – you don’t have to believe that, you don’t have to acknowledge that. To ignore is to endorse. To deny is to be complicit. Go to Sobibor; go to Treblinka, to Manzanek. Out of sight, out of mind. Bergen-Belsen was a regrettable consequence of human nature that was way over the top. Let’s forget it now, and we relive it in a few generations.
        The greatest struggle of a culture is the struggle to preserve goodness and humanity in the face of dehumanization and evil. We should try it sometime. We are not a society that respects human beings by any stretch of the imagination; white nor black, gay nor straight, men nor women.
        Hope and justice must be chosen. We do not care to choose.

        • http://www.idealmedicalcare.org PamelaWibleMD

          I love you SteveCaley!

          • SteveCaley

            Same here, Dr. P. Take a look at Charlie Chaplin’s massive speech at the end of the movie “The Great Dictator.” It was done around 1940 – and got him in so much trouble at home, he never made another picture.

            “We all want to help one another. Human beings are like that. We want to live by each other’s happiness – not by each other’s misery. We don’t want to hate and despise one another. In this world there is room for everyone. And the good earth is rich and can provide for everyone. The way of life can be free and beautiful, but we have lost the way.

            Greed has poisoned men’s souls, has barricaded the world with hate, has goose-stepped us into misery and bloodshed. We have developed speed, but we have shut ourselves in. Machinery that gives abundance has left us in want. Our knowledge has made us cynical…More than machinery we need humanity. More than cleverness we need
            kindness and gentleness. Without these qualities, life will be violent and all will be lost…
            By the promise of these things, brutes have risen to power. But they lie! They do not fulfil that promise. They never will!
            In the 17th Chapter of St Luke it is written: “the Kingdom of God is within man” – not one man nor a group of men, but in all men! In you!
            You, the people have the power – the power to create machines. The power to create happiness! You, the people, have the power to make this life free and beautiful, to make this life a wonderful adventure.
            Then – in the name of democracy – let us use that power – let us all unite. Let us fight for a new world – a decent world that will give men a chance to work – that will give youth a future and old age a security.”

            I’d watch the video – it’s ten times more powerful. Would that we were led by someone as wise as Chaplin in the manner of human healthcare.

      • buzzkillerjsmith

        Wait a minute. This doc sounds male, not female. What gives?

        • http://www.idealmedicalcare.org PamelaWibleMD

          Concealing voice to protect doctor.

        • buzzkillerjsmith

          ok

  • QQQ

    I’m sorry that you feel this way Pamela. But hey, at least your able to put smiles on peoples faces for helping others!

    • http://www.idealmedicalcare.org PamelaWibleMD

      Hey, I feel great!! These are things I felt back in the 1990s when I was what they called “an employed physician.”

  • Patient Kit

    I understand that vacations are not the answer to all problems. But even in good work situations, people get burned out if they don’t take some vacation time to relax and refuel and regroup. I spent the last 20 years working in the nonprofit world where I’d routinely work with people who bragged that they hadn’t taken a “real” vacation in years. It was a badge of honor to them. And it was highly counterproductive to the big picture of the work we did together. It is true that there is usually a backlog of problems waiting for us when we return from vacation though. Still, I think it’s more productive for both employees and employers for people to take “real” vacations.

    • http://www.idealmedicalcare.org PamelaWibleMD

      A doctor who loves his or her work will feel like he or she is on vacation. I often feel like I am retired though I am still working. Why? I own my own practice. I call the shots. I control my life and my destiny.

      • Patient Kit

        I think anyone who says they feel like they are on vacation while working — no matter how much they love their work — are in unhealthy workaholic territory. Everyone needs a break, even if they love their work. I think there is likely a connection between workaholism and suicide too, certainly when the workaholic loses their job or stops loving their job (another kind of loss).

        • http://www.idealmedicalcare.org PamelaWibleMD

          I took a break and actually missed my work. I favor the zen poet quote on work:

          A zen poet once said, “People who are masters in the art of living make little distinction between their work and their play, their labor and their leisure, their mind and their body, their education and their recreation, their love and their religion. They hardly
          know which is which and simply pursue their vision of excellence and grace, whatever they do, leaving others to decide whether they are working or playing. To them they are always doing both.”

          • http://www.idealmedicalcare.org PamelaWibleMD

            Life when lived correctly is supposed to feel like a perpetual vacation.

          • NPPCP

            Best Response award of this blog!!! I’ with you!

  • http://www.idealmedicalcare.org PamelaWibleMD

    A vacation from a toxic work environment is like placing a Bandaid on an arterial bleed.

  • http://www.chrisjohnsonmd.com/ Chris Johnson

    I’m 62 and have always been very happy practicing as an employee in a large, multi-specialty group.The organizations are nonprofits, if that matters, and I think it does.

    I’m also a pediatrician, though, and we consistently have the highest overall job satisfaction ratings — over 80% satisfied or very satisfied in most surveys.

    • Patient Kit

      That’s good to hear. Good for patients and good for you. :-D

    • buzzkillerjsmith

      Peds is a different ballgame entirely. When I worked at Kaiser the peds were happy and the family docs and internists were sad. It’s the specialty that is key.

      • http://www.idealmedicalcare.org PamelaWibleMD

        But that can vary by region, employer, and from year to year. Though hanging out with happy kids can’t hurt—unless you are doing peds oncology.

        • buzzkillerjsmith

          On average, Pam. I am not speaking in mysteries here.

      • SarahJ89

        I’ve worked with many age groups and with families, individuals and organizations. In my experience the two groups that give something back are kids and old people. It helps mitigate the drain on one’s batteries to work with either of these groups. (I happen to prefer old people, always have.)

        • http://www.idealmedicalcare.org PamelaWibleMD

          Why do you suppose? Kids are not socialized and indoctrinated yet as worker bees and old folks have nothing to lose so they speak the truth. . .

          Thoughts?

          • SarahJ89

            Ha, ha, ha. I’m 66. I don’t give a carp!

  • http://www.idealmedicalcare.org PamelaWibleMD

    Leaving an abusive job is like leaving an abusive marriage. E-mail I just got from a doc trying to extricate herself from the abuse:

    “Had a 1.5 hour meeting with administration today where I was told that I was making a ‘terrible mistake’ and would never survive in private practice–’you will be so unhappy.’ I told them that I was unhappy now, and if I’m unhappy in private practice, at least I would be able to do what I want. He told me I would have to increase my volume substantially and it would never be financially worth it. ‘You are going to want nice things. All doctors do.’ Well, frankly, Mr. F*ckhead Suit, the only nice thing I want is my soul back. Everything else is irrelevant to me right now.”

    • ninguem

      Funny thing with that. These big box practices all say you can’t survive in private practice………yet they still impose noncompetes.

      If private practice were impossible, then it would be like those POW camp movies out in the middle of the desert. Or the Klingon dilithium mine at Rura Penthe. There are no walls, no fences, if you leave, you will die. Say it with a German accent or Klingon as you see fit.

      In fact, I’m surprised the 1.5 hour meeting doc didn’t have a noncompete in her contract.

      • http://www.idealmedicalcare.org PamelaWibleMD

        The primary people generating revenue in health care are the docs. We are our employers only competitors.

        • http://www.idealmedicalcare.org PamelaWibleMD

          In paper chains.

          • ninguem

            “…..He [corporate suit] told me I would have to increase my volume substantially and it would never be financially worth it…..”

            Funny thing with that, too.

            Physician practices, sees “X” number of patients and generates “Y” income.

            The Medical Group Management Association says a primary care doc needs 4.5 employees per physician.

            How many employees does Dr. Wible have? Is it anywhere near 4.5? I don’t dispute MGMA’s statistics for Big Box places. The problem is they don’t survey small practices. They assume that if Big Box has 100 primary care docs and 450 employees, Little Box has 50 docs and 225 employees, then they extrapolate to say Dr. Wible has four and a half.

            Overhead is actually HIGHER in a Big Box setting, than a solo or small group setting.

            Yet at the same time, I am not surprised to hear that the doc in question may have to increase volume to maintain cash flow. It might, maybe be true.

            But IF it is true, it reveals……what we already know……that Big Box clinics actually charge HIGHER fees, because of their ability to tack on facility fees.

            The doc quoted here, may find her per-patient collections half of what she got as an employee of Big Box (not that she got that money, or even saw the numbers).

          • querywoman

            She says she doesn’t have any. She’s direct pay, little overhead. It’s mostly between the patient and her.

          • SarahJ89

            I would happily go the direct pay route but there is no one in my area whose practice has not been eaten up by the Big Box “nonprofit” hospital (that pays its CEO $750K plus bennies).

          • http://www.idealmedicalcare.org PamelaWibleMD

            Uck! Do you know any docs or nurse practitioners personally? Send any discontent docs to me. I train them in 2-3 months to open their own clinics. It’s easy!

          • JR DNR

            Did you see the article over on Medpage? ”
            Small Practices Score Big Gain in Reduced Admissions (CME/CE)”
            http://www.medpagetoday.com/PracticeManagement/PracticeManagement/47324

            I can totally see how a small practice where the people know who you are can improve outcomes.. at least in someone like me who is chronically ill.

          • NPPCP

            Absolutely. It is true.

          • NPPCP

            Absolutely right….middlemen require extra money – and they know it.

          • http://www.idealmedicalcare.org PamelaWibleMD

            The reason why docs feel hypovolemic after a day at the office is that they are supporting so many parasites.

          • NPPCP

            I have mentioned on here before – it is like the big shark or whale you see on a documentary swimming by; they have all those little sucker fish and parasitic fish attached to them and they can’t turn around and reach them and remove them and eat them……

          • http://www.idealmedicalcare.org PamelaWibleMD

            yep.

      • NPPCP

        Hi ninguem,
        Private practice impossibility is a lie, a lie, a lie. The suits don’t want you to know how wonderful it is.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Brilliant NPPCP.

          EXACTLY.

          Manipulation, intimidation, and control at its best.

        • Suzi Q 38

          Well, there were so may private practices in Los Angeles and elsewhere in the 70′s, 80′s, and 90′s……it looked wonderful. The doctors made us pay up front, and the insurance reimbursed us almost all of the bill.

          I remember befriending a few office-based nurses. We used to go out to lunch from time to time. Sometimes, the doctors would like a free lunch, so they would try to get invited to our lunches. The nurses didn’t mind, because at times, if the doctor tagged along, I could put it on my business Big Pharma expense account, and we could all go for a decent lunch at a nicer restaurant.
          The lunches would stretch for over an hour!

          Doctor’s schedules were busy, but some would make time to go golfing once a week, on Wednesdays. Hence, on Wednesday afternoons, many offices were closed. Ditto for Friday afternoons. Many went home a little early, say about 3:00 or 4:00PM.

          Doctors having private practices are very possible.
          At least they have their sanity, and they sound happier. I am sure money is a problem, as the money will be less at first…..I think that having more control of your day to day lives would me more pleasant than working for a corporation who constantly tells you that you are not working fast enough.

          It reminds me of working on an assembly line at a factory….the conveyor belt is moving faster and faster with us patients, and the doctor can not keep up……

        • ninguem

          ^^ what NPPCP said ^^

    • SarahJ89

      ‘You are going to want nice things. All doctors do.’
      How insulting.

      It’s been my experience that when people cannot get what they want they settle for what they can get. Often it’s “nice things.” The administrator should take a good look in the mirror. He won’t, of course. The system is working for him.

      Interesting how invested he is in your correspondent’s failure.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Materialism replacing meaning. It’s classic consumerism.

  • QQQ

    “3. You’re a top-rated doctor,”

    I never wanted to be the “very best” or the “top guy”! I try hard (of course) to succeed in life and give it 100%. However when your “the best” or the “top guy”, you start accumulating too many problems and enemies along the way (which I’ve seen first hand countless time from others)

    Plus, you know what happens when your “the top guy”? The only place to go from that point is down!

    Plenty go down pretty hard!

    • http://www.idealmedicalcare.org PamelaWibleMD

      Oooooh. I guess you’re right.

      • QQQ

        Meow! (^_^)v

    • ninguem

      Funny thing about the “top-rated doctor” award. When I did work for a Big Box, I would get emailed from Big Box administrators, to make sure I voted for Big Box docs in Big City Magazine’s “Best Doctors” polling.

      Some of the absolute crappiest docs, for whom I worked as a trainee, people I knew just plain sucked as physicians, I would not send a dog to them, ended up profiled in Big City Magazine’s “Best Doctor” issue.

      It’s all rigged.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Yes, I was just wondering that. Who the heck decides which docs get into the Eugene Magazine’s TOP DOCTORS. Seems like everyone is town was listed—including me.

        Go figure.

      • Suzi Q 38

        I agree. Paid advertising.

      • querywoman

        I’ve seen some truly horrid docs in my local magazine version of that, including one who had to pay a bunch of money back to the feds. In that guy’s case, his record shows clean on the medical board, but he narrowly escaped criminal prosecution.

      • Eric Strong

        Lists of “top doctors” are as useless as lists of “top hospitals”.

    • jpsoule@hotmail.com

      An internet savvy specialist once told me I had a 5 star rating on a popular doctor rating site. I just shook my head and said ‘Obviously there is no accounting for taste’, and rattled off some of the other doctors I knew were far better than me.

  • http://www.idealmedicalcare.org PamelaWibleMD

    E-mail from a doc: (who approves that I share this anonymously)

    I took a hospital employed job 3 years ago when my attempt to escape the world of assembly line medicine exploded in front of me. I had left a position as a program director with a very well known integrated health system to take a boutique job in the NE. It seemed almost too good to be true… And it was. 10 days after I arrived… And after the practice was dumped by one insurer and my first check bounced the practice manager confessed that I had joined what I later learned was essentially a criminal conspiracy. Within a week I had resigned without notice and spent 4 hours being interviewed by a special investigator for Medicaid fraud in the state AG’s office.

    And then the reality of unemployment hit. As I learned of my former employers violent tendencies I became more and more panicked. I experienced full blown anxiety attacks nearly daily. My wife felt so exposed. We blacked out our windows. I bought a pump 12 gauge shotgun that I kept loaded with 00 buckshot, round in chamber, on safety, next to the bed. We only felt safe in the darkness of movies and we saw a lot over the 3 months it took to find the hospital employed job. It was pure hell.

    And then the new job started. And it got more interesting

    ….ok Pam I’m getting anxious just going this far

    • SteveCaley

      Sad to read this. Doc, keep breathing! Most people will blow it off, as it doesn’t fit their mental image of reality. It’s not a cartoon world out there. I’ve filed for unemployment claims as a doctor. That’s the truth.

    • QQQ

      Yes, its truly heart dropping! I’m sorry for what that poor doctor went through!

    • Suzi Q 38

      I feel sad for this doctor.
      I hope he and his wife get better and the job situation improves.

    • querywoman

      I sued an insurance company, a major one, through a state employee’s version of state court once.

      I managed to obtain a hospital contract that they did not want me to have.
      I was starting to feel creepy and a little paranoid about having it.
      The health care industry is a modern Teapot Dome.

    • buzzkillerjsmith

      Violent tendencies? Beyond the limits of good taste.

  • lurking for answers

    It is both heartbreaking and fearful to watch an engaged, curious doctor lose their will to treat. I’ve watched two of my doctors go from energetic doers, willing to investigate and take charge of the illnesses I battle, to become surly, hopeless drones fighting against the system in which they were trapped. Both quit, leaving me to try to find other physicians. Unfortunately I found drones, trapped in treatment algorithms and unwilling to think.
    Doctors can quit being doctors…I can’t quit being sick.

    • http://www.idealmedicalcare.org PamelaWibleMD

      When do you think these idealistic humanitarians become hopeless drones? Med school? First real job?

      • lurking for answers

        Most of the “drones” I’ve encountered were fairly young docs. I think that their independent thinking skills were beaten out of them in school. They were “taught to the test,” therefore their treatment follows suit: follow the algorithm.
        They are so consumed by pushing patients through the office every 15 minutes that they never had time to read a chart or research a condition they had not learned of in medical school. When confronted with a condition they did not know of, their first instinct was to discount it or blame it on me (It’s in your head.) Then when the algorithm treatment did not work as expected, there was no option left and I was told that my needs no longer matched their skill set.

        • http://www.idealmedicalcare.org PamelaWibleMD

          The humanity was beaten out of them in med school? So no reliance on intuition, heart, soul, and no ability to connect to their patients or the mystery and meaning of life.

          Why do you think we beat the soul out of the young idealistic humanitarians who enter med school with the noble desire to help people?

          Why?

          And who has decided this is the right way to train our blossoming young doctors?

          Thoughts?

          • lurking for answers

            I think this started much earlier than med school. The deliberate separation of spirit from body occurs in grade school. Spirit is not allowed because that would constitute religion, so systems are taught and the spirit is ignored or denied.
            This is further emphasized in med school, when the body is deliberately divided into organs, and systems and diseases. Germs are to be killed, diseases treated and systems and negative emotions are to be manipulated by chemicals. Once you remove the spirit from the body, all you are left with is meat.

          • http://www.idealmedicalcare.org PamelaWibleMD

            The failure of reductionist medicine.

          • JR DNR

            Just googled reductionist medicine… and I can say that yes this is a huge problem with American medicine.

          • lurking for answers

            It is also a failure of modern education. We are reaping the fruit of this separation and will continue to do so for generations.

          • SarahJ89

            Lurking,
            Just to put things in context, try having kids observe a moment of silence in school. The religious people will be on you like a duck on a June bug.

          • SarahJ89

            There is a huge aversion in our culture for silence, solitude or contemplation of any kind.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Stay busy. Don’t think. Repeat.

          • SarahJ89

            Follow the money. It’s not in helming a crew of independent thinkers.

        • Suzi Q 38

          I have an uncle who is about 78.
          His advice to me recently was this:

          “Nowadays, if you go to the doctor, you had better be smart and clearly think about what you are experiencing and diagnose yourself before you get in to see the doctor. If you don’t, there is little hope for you, as they will just hand you a prescription for what they think you need and move on to the next patient…”

          He said that many are not into being the curious “detectives” of years past.
          That this generation or group of doctors were bought off by “big Pharma,” so there is a drug for everything that ails us patients.

          • lurking for answers

            I don’t accept the “bought off by ‘big Pharma’” theory. Most of the docs I’ve ever seen don’t really know what they are prescribing and how it will interact with what the patient is already taking. There are too many drugs with too many actions for them to understand all of that too. There are some docs that have been “bought” and tout the benefits of the latest fad drug, passing out samples like candy on Halloween, but many don’t.

            I just don’t think that many doctors are taught to think.
            The information and number of diseases and conditions is so far beyond one human mind’s ability to contain that they aren’t even taught to try. Even logic and progression are shunned when there is an “evidence based” algorithm to follow.

            This really leaves those with rarer disorders without help of any kind, other than Dr. Google. Docs have been so conditioned to only “see horses,” that when confronted by “a zebra,” they absolutely won’t believe it. Even those who want to help are so slammed by time/budget constraints that they can’t research the disease enough to provide any meaningful care to the patient.

            This is where I’ve seen the most physician pain: the ones that actually care but aren’t allowed to do so by the constraints of their practice.

          • Suzi Q 38

            Thanks for posting,
            Yes, one man’s opinion does not make it true.
            Interesting thought, though.
            You are right on with your last paragraph.

            My uncle was right on with the fact that we have to do much of the research ourselves, as the doctor may or may not have the time to do so.

          • lurking for answers

            The frightening thing about self-research is that we ARE NOT doctors, we DO NOT have the training and our assumptions based on research can be very wrong. Even “trusted” sites like PubMed don’t show us whether the docs doing the study are respected by their peers or just blowing smoke to get their names in print. You have to dig deep into the articles and authors to find disclosure of conflict of interest (who funded the study.)

            Oftentimes, the rarer conditions are at the edge of medical science, so there is no “evidence” to go from and the next study can contradict or disprove the current one.

            Medical sloppiness and stubbornness is where I get upset. I’ve had several docs read only one article in one journal and assume it was absolutely correct and that was all they needed to know for treatment, only to get upset when I cite four others that contradict their one. Questions from patients are usually not well received, because they have to engage the lesser used portions of their brains and go into unfamiliar territory of science. If it scary for them, it just gets scarier for us! Patients are supposed to trust doctors with their lives and health, and scared doctors take it out on those very patients.

          • Suzi Q 38

            “…….Questions from patients are usually not well received, because they have to engage the lesser used portions of their brains and go into unfamiliar territory of science. If it scary for them, it just gets scarier for us! Patients are supposed to trust doctors with their lives and health, and scared doctors take it out on those very patients….”

            Yes, and I was one of those patients. My having a little knowledge was helpful, though. I know we are not medically trained, and it is not our job, but sometimes you have to take a chance and do what you need to do, or nothing gets done. The result is that you get worse.
            I would use a well used website: “Up To Date.”

            The information garnered on this site is used by so many doctors and nurses. It costs money to subscribe to, but can be accessed for free at the hospital that you go to. I used to go to the nurse’s library at the hospital and use their computer and printer.

          • SarahJ89

            ” It costs money to subscribe to, but can be accessed for free at the
            hospital that you go to. I used to go to the nurse’s library at the
            hospital and use their computer and printer.”

            Thank you for this information!

          • Suzi Q 38

            You’re welcome.
            When you get access to the site, just type in the medical condition you want information on.
            Once in, there are so many links to related conditions that you can read and learn about.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes, many hospitals have a library still and a librarian who will actually do research for you. :)

          • SarahJ89

            My standards have sunk so low I’m happy just to find someone who doesn’t treat me like garbage if I ask questions.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Tragic. This is heath care in 2014.

          • http://www.idealmedicalcare.org PamelaWibleMD

            The more organized you are for your appointments the better, of course.

          • SarahJ89

            I do not think most docs have been bought off. They are being controlled by those who have been, however.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Once one’s soul has died, you are easy to control.

          • SarahJ89

            Oh yeah. Been there, recovered from that. Hooray!

          • http://www.idealmedicalcare.org PamelaWibleMD

            When docs function in survival mode there is little time for eating, urinating, or curiosity. Do you think this doc gets bathroom breaks?

            https://www.youtube.com/watch?v=l2IngrAq7yA

          • Suzi Q 38

            Not getting bathroom breaks is ridiculous and abusive. Not getting a lunch break is against the law.
            A doctor’s curiosity or detective skill is lost because I have realized from you and other physicians on these boards that there is simply little time for such, unfortunately.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes. Other health care workers (and folks in most jobs) get mandatory breaks at intervals to take care of basic human needs (food, water, bladder, bowel) but somehow docs don’t get the same.

          • SarahJ89

            I remember working in another country for 12-hour shifts in a nursing home. No time to pee. We had ten minutes for supper break. We’d take any leftover tea, bread, butter and marmalade off the patient’s tray after they were done and put them in the small kitchen. Tea time for staff comprised ten minutes of silence wolfing down bread, butter and marmalade with lashings of tea. No time for conviviality, thank you.

          • http://www.idealmedicalcare.org PamelaWibleMD

            In the Netherlands, 10-SECOND Pap smears are the norm!!! And you only get one every FIVE years no matter what your circumstances. That’s what the Dutch cookbook calls for in one-size-fits-all health care. Here’s my interview with a patent who flew in to the USA for a physical with me rather than get hers in Europe:

            https://www.youtube.com/watch?v=SXJmNk_159U

          • SarahJ89

            The German experience she had sounds quite like my current US experience. My experience in Ireland was quite different from hers in the Netherlands. The doctor was very informal. I only had to go once in two years (I’ve never been one for going to doctors unless I’m actively ill with something I can’t deal with myself.)

            In Northern Ireland I was treated at a large, internationally known hospital in Belfast. I ended up getting a job in the Biochemistry department there. I was seen by two specialists, had x-rays and an appliance made for what ended up being a dental problem. No charge whatsoever.

            My cousins tell me the Irish system is broken. They let insurance companies in during the economic boom. The middle class took care of themselves and abandoned a formerly fine system. We’ll find out when we move there this year.

            My husband’s cardiology/pacemaker told us today that Ireland is excellent for cardiology. Most of the testing used in the US is done in that country. One of my cousins runs a little medical empire outside of Dublin, employing the many nurses in our family in her large nursing home. She will be a valuable resource for referrals.

        • SarahJ89

          I’m watching my excellent, experienced PT bang his head against the wall of metrics. The cookbook is everything and is so mindless.

          Not just in medicine, either. I’ve seen it in younger licensed electricians unable to work on any house that’s not brand new, doctors (and vets) unable to respond once they see a certain number and whose thought processes leads not to diagnosis but to expensive imaging and (of all things) a bicycle repair shop unable to install a basket on an older bike until I showed them how (the little holes on newer bikes weren’t on my bike and they were helpless without them).

          I often wonder… will these young people develop thinking and problem-solving skills with experience? Will they be allowed to do so? (Maybe in a bike shop.) Does every older generation see this kind of split in training? (This is the first time I’ve been old so I don’t know.)

  • luv2read

    I am very disturbed by this comment: “you develop a perverse pleasure in your patients’ pain”. Perhaps some of these blogs should not be open to the public. This does nothing but create more concern for those who are losing their trust in medical professionals.

    • http://www.idealmedicalcare.org PamelaWibleMD

      These comments are posted so that we can tell the truth about what is really going on as this is the first step to healing. Here is the origin of this quote luv2read. Please for a moment place yourself in his shoes:

      “I am a third-year medical student. I have done very well in both my coursework and national boards. I have publications, research. On paper, I am successful. Yet I find myself thinking about killing myself frequently. Walking into traffic, jumping through the window, just dying in the course of a normal day. Miserable thoughts. I went to the school psychologist to be fixed; I was referred to the school psychiatrist, who looked just as broken as I felt. He offered me antidepressants, if I ‘wanted to take them.’ It doesn’t make sense. I never felt this way before medical school. I loved, I thought, I reflected. I enjoyed being creative, yet now I’m chained by procedure, bureaucracy, and paperwork. There are no creative solutions to problems, there is no effective effort to improve the system except from big top-down initiatives of whatever hierarchy you’re subject to. It’s maddening. I used to watch the stars and smile. I volunteered. I ate well and exercised. I enjoyed playing with children. Now I’m finding a sort of perverse pleasure in patients’ pain; I recognize this as sadistic. I’m shocked. I’m revolted at how far my soul has degraded. It’s insane. I’m chronically sleep deprived. I can’t think or learn when I don’t sleep. I can’t smile without ulterior motive. I’ve confided in my family, who don’t understand the demands or the situation and have told me that ‘it’s my decision to feel sad.’ The [professors] don’t teach; half of them treat us as annoyances. Learning and healing both got lost somewhere. The good teachers leave or are ground down. I’m full of hate and sadness. I’m not sure why I’m still here, but I am. I feel like an echo of myself.” ~ John

    • Suzi Q 38

      I disagree.
      We, the public need to know, for our own well-being.
      Not every doctor wants to do this job, and moreover, not every doctor is good at it.

    • JR DNR

      I want to make medicine a safe place. I want patients to be able to get medical care without fear. I want patients to not refuse to go to the ER from bad experiences in the past. I want to change medicine so that a patient’s mental and emotional health are held to the same priority as the physical status.

      I do agree, reading such things can be very stressful and triggering for patients. But the first step in fixing the problem is admitting it’s a problem. Pamela’s articles allow medical professionals to admit: yes, there is a problem. It’s important they have that outlet.

      Because only then can they change and make things better for us.

      • lurking for answers

        The patients are seeing it. They may not know what is going on or why, but they can sense the frustration and despair. I watched the spark almost go out of one doc my age. I knew he had both young kids at home and a passion for his patients. During one of the wrap-ups after an appointment, I quietly told him: “if you want to leave this practice, I will follow. I will find you if you want me to.” He looked up, a little startled and responded that he would not go far, he had too many roots in the city. When it came time to make my next appointment, several months later, I was informed that Dr. X was “no longer with the practice and that Dr. Z would be taking all his patients.”
        In less than 10 minutes I was making an appointment with my old doc in a new, much smaller practice. When I saw him, he seemed revived, but almost haunted, as if waiting for everything to get yanked out from under him. I see him again in a few months, so I’ll see.

        • http://www.idealmedicalcare.org PamelaWibleMD

          You may have saved your doctors life.

          A sweet and appreciative comment from a patient can be a lifeline for a struggling doc.

    • SarahJ89

      Honestly, luv? I doubt you have much to lose in terms of trust. The Great Divide has been fomented and maintained by people at a higher pay grade than you and me. Hearing how doctors really feel only helps to build bridges as we listen to one another. And yes, being powerless long enough can cause a person to take whatever sense of power s/he can get, hence the “perverse pleasure.” This isn’t unique to medicine and should be more widely understood.

      • http://www.idealmedicalcare.org PamelaWibleMD

        The more bridges of empathy we can build with one another the less the divide-and-conquer routine will work.

  • lurking for answers

    I have started running to take the leap…
    I hope that i have found a new GP. I have my first patient appointment (he granted an interview to see if we “mesh”) at the end of September.
    The downside is that he is 52 miles away, across town in heavy traffic.
    Let’s pray for good health, no complications and mid-day appointments!

    • http://www.idealmedicalcare.org PamelaWibleMD

      Praying! Good luck. :) Hope these posts help you have a better relationship with docs in general.

  • http://www.idealmedicalcare.org PamelaWibleMD

    DrBadFish ~ DPC makes a lot of sense for primary care. Please let me know if I can help with your transition in any way. Congrats!!!!

  • http://www.idealmedicalcare.org PamelaWibleMD

    Here’s what happens when your health insurance pays for breakfast –> http://www.idealmedicalcare.org/blog/when-your-health-insurer-pays-for-breakfast-heres-what-happens/

  • SarahJ89

    I was in Switzerland for a week in my teens. I was astounded by the Alps. For some reason the White Mountains are known as “the Switzerland of America.” They are not. I was embarrassed every time some courteous Swiss would exclaim “Ah, the Switzerland of America” when they found out where I was from. Clearly, they had never seen NH.

    The Whites are beautiful and I love them, as I do Vermont’s Greens (I love Vermont). But they aren’t the Rockies or the Cascades. Each range has its own pleasures. The Berkshires seem like teddy bears to me. Even the trees are round down there.

    Mountains get under your skin. It’s hard to leave the mountains once you’ve lived in them.

  • JR DNR

    How about 11. You find yourself online calling patients nasty names.

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