Thursday, August 2, 2012

Where Have All the Doctors Gone?

     America is projected to be short 160,000 doctors by 2025.
     And in 2009 a poll showed that 45% of doctors said they'd leave medicine if Obamacare policies were enacted.  If these doctors are serious, America will be short 510,000 doctors in 2025.
     Why are doctors leaving medicine?
     Their main reasons are too much bureaucracy and the increased malpractice risks.  They bemoan the loss of physician autonomy under the new health plan.
     Forty years ago it was unheard of for physicians to stop practicing their art.  They went to work every day until they died. They got more even-tempered and astute with age.  Physicians never filed for disability; none took "early retirement."  They seemed not to get disabling diseases.  They didn't suffer the frustration and anger of today's solo docs, or the ennui of employee-dom that physicians who work for corporate and bureaucratic institutions exhibit.
     In my twenty years of medical practice I have not been able to persuade a single bright young student to consider a career as a physician.  It's not that I haven't tried.  People can see that I am exhilarated by my profession.  We solo doctors are an independent, quirky lot.  We have lots of enthusiasm, creativity, ideas for problem-solving that come from intense observation.  We are eager to share what we know.  Over the years I have hosted many high school and college students who shadow, volunteer, or take jobs in my clinic.  I want them to know how wonderful it is to be a doctor.  They say they love it--but don't end up applying to medical school.  They must be getting contrapositive messages about medicine from the rest of the world.
     The physician exodus started twenty years ago.  Back then huge malpractice lawsuits were being settled, and doctors were made to feel like criminals whenever a patient had a bad outcome, despite the odds.  Tort reform in many states is now turning the attention of lawyers away from malpractice cases, to one of the fastest growing areas of legal work:  the defense of doctors accused of fraud.
     Why are doctors such big targets?  Are we really such a disappointment to our patients and government? I used to hear the epithet "God-complex" about doctors--it referred to a doctor who acted as though he thought he was God.  But most of the doctors I've known have been humble people.  True, it takes brazenness to wield a scalpel, but that's not the same as presuming godliness.  Right before I lower the scalpel to perform surgery, I ask for help from above.  I don't think I'm much different from all the other doctors out there.  It's daunting to mess with nature.
     Maybe society has expected doctors to be God, and we've failed.  We keep changing our minds about how people should eat, and act, and live.  We fail to make patients alter habits that are killing them--we haven't found the pill to do that yet.  And we haven't been able to keep everyone, finally, from dying.
     Does America hate its doctors?  Does the government hate us?  Do insurance companies hate us? Because it sure feels that way.  Individual patients say they love us--when we try to help them, or when we can get them better.  But as a culture the attitude toward doctors is crummy.
     My friends often forget my profession and start ranting about their doctors:  how bad they are, how they don't spend enough time with them (too busy documenting), how much it costs (less than a dinner out), and how long they have to wait (Walmart has trained people to think everything should be quick and cheap).  I find myself siding with the doctors.  People have no idea what is being asked of medical professionals these days.
     If more bureaucracy is really coming down the pike, I can't imagine where it's going to fit in my clinic.  There are already more volumes of requirements than we can fit on our shelves.
     But if I join the 40% of doctors who are leaving, I wonder what I should do?
     I'm thinking about opening a candy store--such a simple business!  People walk in, choose candy, pay, and leave.  I wouldn't have to keep up with vast amounts of medical information.  The documentation is minimal, it smells like chocolate, everyone leaves happy...and who ever heard of FBI agents in SWAT gear raiding a candy store?

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