How Being a Doctor Became the Most Miserable Profession

http://www.thedailybeast.com/articles/2014/04/14/how-being-a-doctor-became-the-most-miserable-profession.html

by vwinsyee • 12 years ago

119 114 12 years ago

rayiner• 12 years ago

Suicide rates are about 17.7 per 100,000 for men and 4.5 per 100,000 for women, and 11.3 overall. There are about 535,000 male physicians in the U.S., and 234,000 female physicians, and 66,000 of unreported gender. So the expected number of suicides would be 113 rather than 300.

josephschmoe2• 12 years ago

I like you. Isn't suicide also extremely rare among adults with more than a bachelor's?

curtis• 12 years ago

I don't have a citation handy, but it's my understanding that doctors attempt suicide at a rate less than the general population but when they do make a suicide attempt they are more likely to succeed.

josephschmoe2• 12 years ago

You'll find this is happening in many industries. Despite that it lowers productivity and increases costs.

The problem is that management is filled with perverse incentives. It looks good on the books to have fewer employees - until you realize you have highly trained specialists spending hours per week working on paperwork or rushing their actual job and increasing long-term costs.

tdees40• 12 years ago

The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone.

Making it easier to become a doctor would improve things immediately (especially given the recent research that makes it clear that nurse practitioners do just fine).

pessimizer• 12 years ago

Phil Ochs - A.M.A. Song

https://www.youtube.com/watch?v=6lkvswrSRAE

wehadfun• 12 years ago

could you expand

zavi• 12 years ago

It would be interesting to see some data and in depth analysis on this subject to tell apart unfounded conspiracy claims from an actual problem that needs to be addressed.

FD3SA• 12 years ago

The worst part about this set up is that increasing the number of doctors won't actually reduce healthcare costs, but paradoxically, increase them. This is because doctors in the USA make money through ordering tests and exams, rather than just spending face time with patients, as the article points out. There was an excellent Time [1] article on this phenomenon.

To make matters worse, Canada is suffering the effects of the American system. Doctors licensed in Canada are encouraged to go to the USA (particularly specialists), by the allure of much higher salaries. In order to prevent a vicious brain drain, the Canadian Medical Association must pay doctors as much as they can to stay and practice in the country. As such, Canadian healthcare costs have been skyrocketing due to specialist salaries soaring ever higher to compete with American rates.

Comparing physician salaries in the US and Canada with other commonwealth countries like Australia and the UK provides a clearer picture as to what is going on. The American healthcare system is completely and utterly FUBAR. It needs to be torn down and rebuilt based on a functioning healthcare system from another country.

1. http://time.com/198/bitter-pill-why-medical-bills-are-killin... (Unfortunately, it is now paywalled)

msandford2• 12 years ago

There's a million fixes for that. Ultimately it needs to be the patients that are in charge of the payment.

As it stands there are no published prices (or they're bogus, if your published prices are 3x what insurance companies pay it's not a real price) for anything so nobody can shop around. That means there is no competitive pressure on the non-critical, non-life-threatening things that are expensive-ish but possible to pay out of pocket. And that means that nobody can circumvent insurance. And that means that doctors have to keep spending $58 to process a form that will net them a $20 to $30 copay and maybe another $50 worth of reimbursement? So the doc nets between $30 and $40. Call it $35 and multiply by 5 (12 min per patient) and the doc is billing out at $175 per hour provided he teleports from one exam room to the next.

There are a great many people who could afford to pay $100 cash (or equivalent) for a doctors visit, for say 30 minutes with a doctor. So that's $200 per hour.

Major medical plans (for big stuff) coupled with health savings accounts will empower patients to ask "do I really need this" with a price sheet in hand and a real conversation about the benefits vs the costs. Right now that happens approximately zero.

araftery• 12 years ago

I disagree. The problem is frankly that we've come to expect too much from modern medicine. Doing a triple bypass surgery on a 90-year-old is expensive, plain and simple. Yes, we can save his life, but we have to be willing to pay the cost—and we aren't.

Medicare is a monopsony. They represent such a large share of patients for many practices that they set their own prices. And when people expect medicare both to pay for their triple bypass and not to go broke at the same time, what we get bankrupt hospitals and over-worked doctors.

Being more responsible about the way we apportion healthcare is the only reasonable option.

karmajunkie2• 12 years ago

I don't know any cardiologists who would perform that kind of surgery on a 90yo.

rdmcfee5• 12 years ago

Coming from the healthcare marketing field, I can tell you there are many doctors who are looking for more patients. Especially specialists.

mudil3• 12 years ago

I am a doctor, an anesthesiologist. I don't like AMA. But to blame AMA is a complete nonsense. (AMA really is just an insurance and loan agency, just like AARP.)

The real problem is government regulation of our profession, of the whole clinical process, and of devices and medications.

Those of you who go up in arms when government sticks its nose in your internet business, should imagine how it is to deal with the government that is there all the time for us. For example, how about trying to bill Medicare for a surgery, when one phrase--one phrase-- is missing from the documentation, and I don't get a penny for a 4 hour surgery?

sizzle2• 12 years ago

http://www.scpr.org/programs/airtalk/2014/04/15/6508/ can you comment on this radio segment please?

mudil3• 12 years ago

The Association of American Medical Colleges (www.aamc.org) sets number of medical students, and not AMA.

thecage411• 12 years ago

I don't think your example is very strong. It's not exactly clear what you mean by government "sticks its nose in your internet business" but for most that probably means regulation. But in your example Medicare is just a really big insurance company; if a private sector insurance company denied your claim for some stupid reason would you complain about the private sector? I'm sure there are examples of onerous regulations that would make a better example?

GFK_of_xmaspast2• 12 years ago

Bet you're pretty happy to have the government there with barriers to entry for your profession tho, keeping supply down.

Shinkei• 12 years ago

I don't believe you.

I am a physician too and you are repeating a lot of the falsehoods that are perpetuated among those that don't understand the billing process or aren't actually physicians.

AMA is an insurance and loan agency? I... I... don't know what to say to this. How about start by reading this (poorly written, but summary nonetheless):

http://en.wikipedia.org/wiki/American_Medical_Association

and one of their most influential functions:

http://en.wikipedia.org/wiki/Specialty_Society_Relative_Valu...

It's true that insurers set up arbitrary requirements (for sentinel effect, mostly) to try and refuse reimbursement, but often a simple change and resubmission will result in payment. These are issues that are dealt with in your contract with the insurer--have you read this contract? If not, then you can't complain! Even the CMS has a contract with its physicians.. and contrary to popular belief, they pay pretty well for most anything. It's Medicaid that is atrocious... especially since it covers children/poor and will often limit their access to healthcare.

LiweiZ• 12 years ago

From a demand/supply perspective involving only patients and doctors, it seems correct. I actually have the similar thought. But can anyone provide more dimensions of this "market"?

riahi7• 12 years ago

I hate to make this a common refrain, but I make this same comment every time I see a comment like yours:

The supply of doctors is not restricted by the AMA. The supply of doctors is determined by the number of residency spots available to new graduates; that number is entirely determined by the Centers for Medicare and Medicaid (CMS). Thanks to the Balanced Budget Act of 1997, Graduate Medical Education (GME) was dramatically slowed due to decreases in Medicare funding of residency positions. [1]

As long as we require physicians to be US trained and to have completed a US residency, the bottleneck will be GME funding. To fix that, the AMA or any other concerned citizen can lobby Congress for an increase.

[1] http://jama.jamanetwork.com/article.aspx?articleid=182532

Retric3• 12 years ago

Why exactly must the government pay for it? It seems obvious if it's a net cost it really should be paid for by the students.

Also, if you could go to med school without an undergraduate degree you can increase the number of years a doctor could work thus lowering costs and increasing supply at the same time.

GFK_of_xmaspast2• 12 years ago

Friendly warning, the article quotes Malcolm Gladwell uncritically.

aaronem• 12 years ago

True, but amazingly enough this is one of the two times per day when Gladwell's stopped clock happens to coincide with the actual time.

rdmcfee5• 12 years ago

There's no evidence that the profession causes doctors to commit suicide. It's not a stretch to hypothesize that people accepted to medical schools are self selecting for perfectionism and bipolar disorders.

jseliger• 12 years ago

Also relevant: I wrote "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" (http://jseliger.wordpress.com/2012/10/20/why-you-should-beco...) based on watching the experience of my fiancée and her friends and peers.

EDIT: In the essay I describe why it can become so hard to leave medicine after one has invested more than a year or two in med school because of student loans; that may help explain the suicide issue: people who feel trapped may in turn feel like death is the only way out.

A surprisingly large number of doctors hit residency and realize they don't want to become doctors. In most professions that's not a tremendous problem, but in medicine the only way to pay back $100 – $250K in graduate student loans is by becoming a doctor.

erikcw• 12 years ago

A similar phenomenon is at work with law students. Granted law school is shorter than an MD program at only 3 years -- but can still result in $150k of student loan debt.

karmajunkie2• 12 years ago

This is true of almost all terminal degrees today. Higher education is such a corrupt industry, feeding those at the top of the pyramid by making promises to prospective students they are fully aware are unrealistic.

DanBC• 12 years ago

Another explanation of the suicide rate: doctors have access to means and methods of completing suicide. They are also aware of techniques that make completed suicide more or less likely.

cylinder• 12 years ago

With Pay As You Earn a debtor won't pay more than 10% of AGI to federal student loans. Note that's AGI, not gross income, meaning you can contribute to retirement and not have it counted. Loans aren't as big of a constraint on career options as people make them out to be. Debtors are also willfully ignorant of these sorts of options and choose to instead destroy their lives paying debts that don't need to be paid.

To be clear, it's a huge problem, and we shouldn't have this sort of debt loads on those who want to educate themselves. It also weakens the broader economy and drives up professional services costs. But to say people are killing themselves because of student loans is a mistake.

riahi7• 12 years ago

While it is true that PAYE is capped at 10% of AGI, if you have an average medical school debt and are making a resident's salary, your payment will be less than your interest accrued each month. PAYE does nothing to cap your interest.

Further, implying that Doctors are willfully ignorant of loan financing options is...interesting. All Federal borrowers are required to complete exit loan counseling upon graduation from medical school. That counseling includes discussion of the various repayment options (Standard, Extended, ICR, IBR, PAYE, and forbearance).

collyw2• 12 years ago

Medicine is a very wide profession in itself, with lots of options for specialization in something that interests you somewhat. On top of that I am sure it is not too difficult to go into research that is only slightly related to medicine (I personally know a couple of people doing this).

al2o3cr• 12 years ago

For fun, reread this article with "doctor" universally replaced by "teacher", and note the similarities. Then note that the doctor is probably taking home 4-5x the cash.

There's also this: http://seattlepostglobe.org/2011/03/07/warnings-of-doctor-sh...

Dan_Nguyen• 12 years ago

After 1.5x-2x the schooling, 3x-5x the apprenticeship period, and around 6x the debt.

eldavido7• 12 years ago

This is completely a story of industry structure and bad incentives, and how people react to them.

Currently, in the United States, we believe all of the following things: (1) Human physicians, are the only qualified parties to diagnose, treat, and/or recommend courses of action related to health (not nurses, physician's assistants, computer programs, etc.), (2) everyone has a fundamental right to healthcare, (3) health professionals must undergo expensive, lengthy, difficult courses of study and training, and (4) we reimburse for procedures, not pay for outcomes.

Given these incentives, it's not hard to see why doctors are some of the most overworked, stressed-out, and generally miserable professionals out there. They're at the nexus of a crushing conflict between keeping people healthy, a management system that demands more revenue (and remember that revenue=procedures, because we reimburse for procedures, so the only way to increase "productivity" is to do more, faster, with fewer breaks and longer shifts), and a legal regime which mandates DOCTORS perform procedures, and only after a lengthy course of study.

I believe the way forward is to shift the discussion away from procedures and more toward outcomes, and give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles. I believe this outcome is inevitable, but will take a decade or more to surface, because it requires major shifts in how doctors and insurance companies think about billing, greater human trust in computers and recommendation systems, and a collective realization that the current state of healthcare is untenable.

clarkmoody• 12 years ago

give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles

I agree completely, but you forgot to add under what we believe: (5) "government has the solution for everything." At least that's what it feels like lately.

The cynic in me says that the healthcare industry will continue to get worse for some time before it gets better, if ever. We may see complete nationalization because the government must swoop in and "save us" from the monster it has helped to create through misguided regulation.

cwal373• 12 years ago

In countries with socialized healthcare systems, costs are much lower, as is the overall amount spent on healthcare.

Americans actually display stunning recalcitrance towards this fact, and as a result we have an incredibly polarized debate which has led to a bastardized and amalgamated system comprised of several other, and often conflicting, constructs.

seanstickle• 12 years ago

Point of clarification: physician assistants are qualified to diagnose, treat, and recommend courses of action related to health care.

Per the American Academy of Physician Assistants: "PAs perform physical examinations, diagnose and treat illnesses, order and interpret lab tests, perform procedures, assist in surgery, provide patient education and counseling and make rounds in hospitals and nursing homes. All 50 states and the District of Columbia allow PAs to practice medicine and prescribe medications."

http://www.aapa.org/the_pa_profession/what_is_a_pa.aspx

Disclaimer: I work for the Physician Assistant Education Association.

eldavido7• 12 years ago

Interesting. This seems like a step in the right direction. What can't PAs do, that MDs can?

vacri3• 12 years ago

give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles.

They are not tried and true. A friend of mine worked as a QA engineer at my city's most prominent children's hospital (a minor power on the world stage). His thankless task was to find ways to improve communications between departments and curb the errors. It was simply not possible - every doctor had their preferred provider, sometimes from merit, sometimes because they liked the shiny goodies that the sales reps brought.

All the individual systems interoperated very poorly, and none of the physicians would budge, and the hospital administration could not force their hand. Any time admin tried to regularise something, the affected physician would just state "If we make this change, children will die". It didn't matter that everyone at the table new that this was a total lie, because the official authority for that department (or speciality) was that specialist. They got their 'free market', being able to use their preferred products for each individual specialist, for personal preference at the cost of better overall treatment. The whole was very much less the sum of its parts.

Another friend became a sales rep for a pharma company. The rep she took over from was a fairly standard rep, but she was quite ethical, and would only allow her 'freebie' budget to be used on things that developed the practise. Some doctors already do this. Others were more like "ah, well, the ride is over with this rep". Some were absolutely outraged that she should dictate to them what this 'extra income' was spent on - how dare she suggest medical charts instead of football tickets?

I myself have personally seen a specialist in a field report on some clinical studies so badly that we technicians had to go to other specialists and get them redone. That specialist didn't get any more of that kind of work at our practise, but his utter incompetence was never followed up beyond "don't hire him again".

I guess the moral of the stories are that freedom to run practises as you see fit does not mean ethical (or even ethically neutral) behaviour, and that an environment where every physician uses their preferred products does not mean better care is delivered.

momerath• 12 years ago

I worked in a hospital, and saw similar things, but I think the moral of the story is that huge organizations operate internally more like a feudal oligarchy. They crystallize, regardless of the external market.

humanrebar• 12 years ago

Healthcare has been such a regulated industry in every aspect that anecdotes like these do little to discredit free markets.

idiot9003• 12 years ago

greater human trust in computers and recommendation systems

I am an MD and have a degree in CS. Expert systems are not remotely there yet for this purpose. On no planet would I trust care of my patients to a computer. Far too many subtleties involved in accurate diagnosis and treatment that are not encoded in a machine-readable format.

legal regime which mandates DOCTORS perform procedures, and only after a lengthy course of study

Good reasons for this - it actually takes that lengthy course of study to safely perform many procedures, and, more importantly, to fix things when they go wrong.

NPs and PAs are helpful but based on the quality of care that I personally observe they should not function without physician oversight.

There is no escaping that medicine is an extremely complex field, and it is only getting more so. Not long ago, many of the people who today are restored to their usual state of health would simply have died. The sicker a patient is, the more complex and difficult to manage they are. By definition a doctor is the one who is able to do so.

I am still waiting to meet a patient who comes to the hospital and prefers to have their care rendered by non-physician providers over physicians, or would even settle if there were an option.

eldavido7• 12 years ago

I am still waiting to meet a patient who comes to the hospital and prefers to have their care rendered by non-physician providers over physicians, or would even settle if there were an option.

Attach a price tag to each and find out. Maybe someone who couldn't afford a $500 consultation with an MD could settle for a $250 or $100 consultation with a PA, or an expert system. You really don't know until you experiment, and find out.

HIbachikabuki• 12 years ago

It's not that simple. A society cannot afford the triple-A gold standard of everything for everybody. Not everybody can live in a McMansion and not everybody can afford to have an MD/CS for their every single health need, no matter how minor or how routine. Tradeoffs have to be made.

US medicine has been very successful at creating a guild system that's prevented lower-cost provision of care for decades, all under the concern of "it'll lower the standards of patient care." End result has been millions of people who can't afford medical care at all.

One anecdote: for a time I was splitting living in the UK and the US and had health care experiences in both places. It was fascinating to see the differences in treating my (very ordinary) health issues. One time I came down with a mild rash that rebounded a few times before it finally went away. In the UK, the GP looked at the rash, punctured the pustules with little pokey thing so they'd drain, and they cleared up in a few days. In the US, the dermatologist wheeled in a big machine filled with liquid nitrogen and froze the pustules; they went away in a few days after that too. End result the same; cost to administer - orders of magnitude different. In the US, it seems like there's no medical treatment that we can't make more expensive by requiring more specialists with more years of training, using ever more expensive machines and medications.

I love modern medicine. My dad's a retired doctor and I almost became an MD myself. But the system we've created has costs out of control while simultaneously creating worse societal health outcomes than other countries.

hershel• 12 years ago

There's some research that at least some expert systems("decision support system") implemented in the right culture do improve medical services[1].

But still due to huge resistance by doctors, who like the autonomy of the job, such systems are rarely used.

I could only imagine how rapidly such systems would improve if the backbone of medicine would be dependent on them, and enough revenue would be shifted towards them.

[1]http://www.ncbi.nlm.nih.gov/pubmed/24573664

LordHumungous2• 12 years ago

I believe the way forward is to shift the discussion away from procedures and more toward outcomes, and give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles

Holy meaningless platitudes Batman. How do you have a system that is simultaneously profit driven and that allows everyone a fundamental right to healthcare? Short answer: you can't! You can either have a system that avoids treating the most expensive (free market), or you have a system that ensures a certain level of care for all (socialism), or you have some bastardized hybrid that costs ungodly amounts of money and does not serve the sick and poor well. (the system we have).

eldavido7• 12 years ago

I don't think it's either-or. Conditional and unconditional cash transfers [1] have many of the benefits of free-market competition (focus on efficiency and cost reduction) with many of the social benefits of an expanded welfare state. I could easily see a system where people get "medical vouchers" to spend on their most pressing care problems, and providers compete to supply care at the lowest possible price to either vouchered payers, or those paying in cash.

[1] http://en.wikipedia.org/wiki/Conditional_cash_transfer

rdmcfee5• 12 years ago

In Canada our GPs are paid approximately $31 for a regular visit. They pay their overhead out of this $31 and still typically keep 65-70% of their billings.

It's amazing that the billing costs in the US are a factor of magnitude higher.

adventured• 12 years ago

I wonder how salaries for nurses and doctors compare in the US vs Canada. Do you happen to have any data on that (or know of a good government source for it in Canada)?

I know that compared to much of first world Europe, our nurses and doctors often make two to four times as much as their counter parts there. Wonder if that's true compared to Canada as well.

rdmcfee5• 12 years ago

In my province of BC, all payments from the Medical Service Plan (MSP is our public insurance system which costs Canadians a maximum of $65/mo or as little as $0 for low income individuals) publishes all annual payments to physicians:

http://www.health.gov.bc.ca/msp/legislation/pdf/bluebook2012...

The average for Family Doctors is around $240,000 CAD and for specialists is about $430,000.

Average registered nurse salary in BC is about $61,000 CAD.

PeterisP• 12 years ago

If you take away the need to pay back six-figure student loans and tens of thousands each year for malpractice insurance - then much more of that money stays in the doctors pocket.

Doctors in Europe live quite well, and don't have as ridiculous workhours as the numerous USA examples listed, or the suicide problem.

jstalin• 12 years ago

I paid cash for a time for my medical care, and GP visits for regular illness or annual physical generally were $70 to $80.

ams61102• 12 years ago

What is the malpractice liability exposure for a Canadian doctor? In the US, malpractice insurance is a huge expense for most doctors, and for some specialties (e.g. obstetrics) it's very close to prohibitive.

dataminer• 12 years ago

Canadian doctors are protected taxpayer subsidized insurance called CMPA. Typical cost is 1/10th of what it costs in US.

http://en.wikipedia.org/wiki/Canadian_Medical_Protective_Ass...

SapphireSun5• 12 years ago

I don't get why overworked personnel aren't regarded as a dire safety issue. There's a reason the FAA restricted the number of hours commercial pilots are allowed to fly per week without rest.

http://www.usatoday.com/story/todayinthesky/2014/01/03/pilot...

I met a resident the other day, and they routinely get four hours of sleep or less and worked for shifts that are insanely long that are basically dictated by patient demand. Why not just hire more doctors, maybe lower salaries by increasing supply, and give them a healthier lifestyle? Maybe medical school prices would go down with additional scale.

hga3• 12 years ago

One solid reason is the same reason sleep deprivation is used in basic training. Most doctors, will, at some point in their life, have to make life and death decisions when they're operating far from 100% ... or at least that was true back in the days when they'd take calls at any hour of the day (as late as the '70s). Less dire, they have office hours they must keep unless they're really sick, and they certainly won't be at 100% every day.

So this is useful training, albeit at a cost. Although if they make a mistake that kills a patient during residency and learn they can't deal with the consequences of that, I suppose the earlier the better. They can of course move to less life and death specialties.

SapphireSun5• 12 years ago

I get that deprivation training can be helpful, but to be deprived nearly 100% of the time in a safety critical, fast paced environment? That's crazy. These guys aren't special forces (who I assume have in-field careers similar to pro-sports players), they're normal people trying to work at this for many decades.

If your goal is to reduce medical errors, create systems that don't depend on a single person's fluctuating energy level (e.g. have two doctors responsible for each patient, keep patient loads low enough that they can deal, automate as much as possible with computer systems (e.g. billing), and delegate to e.g. PAs for mundane diagnoses). Exhausted people make mistakes, can't work or think as quickly, are less creative, and are generally less happy. All the technology in the world won't help you if the key decision makers screw up at the wrong time.

After all, coffee does exist for those times when your natural energy level won't do it for you. ;)

joe_the_user• 12 years ago

It is a logical argument but it's far from "solid" given today's realities. Humans simply don't adapt to sleep deprivation and organized, constant sleep deprivation clearly is going to make decisions worse over time.

There's no justifiable reason to give a large, urban hospital an organization system fit to the battle field.

adharmad• 12 years ago

Not sure why you were downvoted, but this is the exact reason that a couple of my relatives in medical profession gave when asked why their training involved 24-36 hour shifts routinely with very few sleep breaks.

LordHumungous2• 12 years ago

So... possibly put real patients at risk on a regular basis in order to train doctors for hypothetical situations that they may face at some point in their career? That doesn't sound like a solid justification to me.

mentalhealth• 12 years ago

It's extremely difficult to study the effects of sleep deprivation on the rate of medical error, but several studies have shown that the highest numbers of medical errors occur during handoffs between shifts. Reducing the frequency of those handoffs by increasing shift length reduces the total number of detectable medical errors.

Additionally, the work hour restrictions placed on residents over the last few years appear to have done nothing to reduce the overall number of medical errors.

(I am in favor of reducing medical work hours myself, but these are some of the data-driven reasons that it will be very difficult, not to mention the structural reasons inherent to the current system of medical training.)

nine_k• 12 years ago

Longer shifts does not mean that doctors can't have longer sleep that 4 hours. Let doctors have 16 or even 18-hour long shifts interleaved with days without shifts at all, for sleeping and some [light] paperwork.

judk2• 12 years ago

By having more doctors working less intensely for overlapping shifts, they can take more time to complete handoff documentation and conversations properly, and have fewer handoffs (by taking on fewer patients after the first half of their shift)

nilkn• 12 years ago

Maybe medical school prices would go down with additional scale.

It seems like a bit of a chicken and egg problem. Medical school is already so expensive that the salaries are necessary in order for newly minted doctors to have the same disposable income after loan payments that, say, a programmer or chemical engineer who's 7 years younger has (4 years medical school + 3 years residency minimum). Who would make the sacrifices necessary to become a doctor, taking out massive loans, only for an income that won't sustain them comfortably?

judk2• 12 years ago

So, Apple suppressing engineer wages indirectly made the medical profession more attractive for doctors!

analog31• 12 years ago

I'll bet that the half of doctors who want out of the profession, are the ones who are exploited by the other half. Naturally the profession wants us to see doctors as selfless workers saving our lives, not as rentiers who are ruining us.

thefreeman• 12 years ago

And now that Medicare payments will be tied to patient satisfaction—this problem will get worse.

That just sounds crazy. Can you imagine if your car insurance had to pay less if you complained about your mechanic? Not to mention that medicare is for the elderly who tend to have a lot to complain about anyway.

Can I pay my taxes based on my satisfaction with the government?

tokenadult• 12 years ago

A comment here mentioned the absolute number of physicians in the United States, so I did some Googling and found a convenient website showing the number of physicians per 10,000 population in different countries. (The primary source for these data is studies by the World Health Organization, but the WHO website is not quite as user-friendly.) Note that in some countries the level of training and clinical experience to become a physician is much higher than in other countries.

http://kff.org/global-indicator/physicians/

joshlegs2• 12 years ago

In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.

OP missed a perfect headline opportunity: "9 out of 10 doctors recommend not becoming a doctor."

But seriously, we wonder what's wrong with healthcare. I seriously believe it's because of the lawsuit-happy nature of patients nowadays. Yeah, something could go wrong during your surgery, or your diagnosis for that matter. But that's an inherent risk in having something wrong with you that you need checked out.

alayne• 12 years ago

I've read that malpractice insurance is a few thousand dollars a year and the premiums have been going down.

eldavido7• 12 years ago

Anecdotally, nonpayment is a much bigger problem than lawsuits. I remember listening to the CEO of Carle, a large Central Illinois healthcare chain, talking about this, and saying that "we expect to collect 60 cents of every dollar we bill".

It's a revenue optimization problem -- the goal is to collect the most revenue overall. Set prices too high and people/insurance goes elsewhere, too low and you leave money on the table the org could use to cross-subsidize non-payers.

ryanburk• 12 years ago

"We expect to collect 60 cents of every dollar we bill"

you have to be careful with that statement since it can be a clever way of talking about what insurance agrees to pay with the chain versus the "retail" rate the doctors charge.

my father is a general practitioner and I was always amazed when he started saying about 25 years ago that he wouldn't let me become a GP if I had gone into medicine. and this article covers all of his concerns well.

malpractice is a big part of the issue and it varies state to state. for example, in pennsylvania malpractice insurance is amazingly expensive. and people sue all the time, which is sad unless it is gross incompetence, since every doctor I've met is trying their best.

joshlegs2• 12 years ago

so what you're saying is no matter how the healthcare system is designed, the healthy (or maybe just wealthy?) always end up paying for the rest?

cassowary37• 12 years ago

A consideration of the economics would suggest that any doc who trained in the last two decades isn't in it for the money - the ROI on an MD is far less than most other advanced degrees. If we wanted to be wealthy, with the grades and letters required to get into med school in the US, most of us could readily have chosen other professions. (Heck, some even walk away from startups, believe it or not). My impression as someone in practice for more than a decade, who cares for a large number of docs, and has run a large clinic: It's really not the reimbursement. It's the combination of dealing with payers determined to deny treatment, massive requirements in terms of documentation and ongoing accreditation, and - in particular - constant pressure to spend less time with more patients. Then, we read posts like these which buy into conspiracy theories about how we're out to poison patients with expensive medications to line our pockets. The time problem in particular afflicts primary care docs the most, but even the surgeons complain about it. As far as ACA and its impact, there's no question it's a hack (and not a good one) - most economists not on the far right agree single payer would be optimal - but under the political circumstances, it was probably the best we could get. Regardless, we'll move to a system where the majority of care isn't delivered by docs. Then we'll complain about it. But, it will be more cost-effective.

DatBear• 12 years ago

Funny that the article links to http://www.dailymail.co.uk/news/article-2600319/Medicare-dat... which references the top paid doctors by medicare... I read an article last week saying that this data would be misinterpreted, as a lot of the "top paid" doctors actually are just like whole departments using the lead physician's billing code, and they don't actually get any of that money - and here we are.

sizzle2• 12 years ago

did this article "borrow" from the air talk segment this afternoon on the radio: http://www.scpr.org/programs/airtalk/2014/04/15/6508/

rflrob• 12 years ago

"Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care."

I'm curious how the arithmetic on that works out. The median pay for medical assistants is $14.12/hour [1], which means that assuming the assistant is handling the insurance form, that works out to just over 4 hours per patient encounter. There might be some fixed costs (filing space, for instance, is not free), and some costs associated with communicating with the insurance company, but it's really not obvious to me how any of those can add up to $58/visit.

[1] http://www.bls.gov/ooh/healthcare/medical-assistants.htm

dunmalg• 12 years ago

Cost of employing someone is more than just their hourly rate * hours worked. For example, at one job where I was paid $26/hr, my time was billed at $48/hr--- and this was for a government agency internally billing itself, so there was no profit margin involved, just the cumulative cost of wages, benefits, and associated overhead.

How Being a Doctor Became the Most Miserable Profession

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