Sunday, October 16, 2011

Physicians Concerned About Their Career Choices

I read the blog titled "Young Doctors Worry About Career Choices" By Bruce Japsen on the New York Times - Health - Prescriptions.  I like it.  The blog article comments on the reults of a Merritt Hawkins' survey

It starts: "Even though young doctors still receive a lot of job offers in one of the worst markets in decades, nearly one-third would select another profession if they had to decide on a career all over again, according to a new study out Thursday."

This is significant, very significant.  Why?  Because it is the opinion of those who are just starting their medical career.  According to the article "... a growing number of these hot employment prospects still regret their choice of profession, citing large medical education debts, the changing economics of health care, and the health care law and how it might affect their future practices and profession."

Is this opinion related to their limited experience, and the reality is not that bad?  Or is it an indication that those are smart enough to understand that there are problems, even before getting into the career?  I favor the latter explanation, and I am impressed.  I am impressed that such a remarkable proportion of young physicians are doubting their decision to be in the career of their choice because of the factors cited in the article (debts, economics, and the impact of the health care laws on their practices and profession).  They were able to recognize the importance of those issues.  But, those are not even the worst worries that are out there.  There are actually other more profound reasons that they probably were not made aware of, and that can make the most resilient to eventually regret being a physician.  Here are things that come to my mind.

1.  Physicians lost a lot of autonomy because of the tremendous regulation that is happening now.  Doctors working in hospitals (whether as independent contractors or as employed physicians) are monitored in a way that no other profession to my knowledge is.  Even though that is in part due to the high standard required of being a practicing physician, the monitoring is actually not used to improve performance in a collaborative way, but rather to judge who need to be axed.  Essentially, there is an atmosphere of deep skepticism against physicians.  The excuses to start an investigation and end up with a disciplinary action have such low standards of fairness and impartiality that, essentially, almost any physician can be a victim.  Only with the grace of being connected, politically correct, and fitting in, that anyone can be reasonably confident that they will not be subjected to elimination.  If you do not fit in from so many aspects, there is a very good chance that sooner or later you will be ruthlessly eliminated.

2.  Physicians lost respect as leaders.  They actually are low down in the hierarchy of effectiveness in a hospital setting, unless they also hold political power, or are liked by those who hold such powers.  Some of the physicians who climbed the power ladder became more of bureaucrats and sometimes anti-physician executives than being part of the general community of doctors.

3.  Physicians are the only career that I know of where, once you become a victim of a disciplinary action of severe magnitude, no matter how unfair the process was to you (and there is nothing that guarantees, even remotely, that the process will not be heavily tilted against you as a physician), your reputation will be ruined by a mandatory reporting to the famous National Practitioner Data Bank, effectively destroying your career.  You'll be ostracised, marginalized, and you'll lose the ability to find an employment or obtain privileges or be credentialed.  I think most surgeons have felt threatened or actually became victims unless they are among the selected, or too young in their career that they have not yet been touched by malpractice claims, peer reviews, anonymous complaints, etc etc.

4.  If you dream of opening your own private practice, be aware that the current structure is evolving into an environment that is both economically and politically unsupportive (dare I say hostile?) to the independent physician.  Eventually the solo will seek a hospital employment.  If that has been your dream and aspiration when you went to medical school, congratulations!

Entering into a career of practicing medicine in the US is a gamble.  It is a profession that can break the heart of the best physicians.  It is merciless for some, and too forgiving for others.

URL of the article under discussion:

1 comment:

  1. There used to be a time when a Physician was looked upon with prestige, when the Patient-Physician relationship was intact and not infected with multiple "Third-Parties" that has eroded it, and the overall Healthcare System in the United States (for the most part) worked. Well, that time no longer exists and is getting exponentially worse. For those who somehow believe this is a Political thing, or that it is relatively new, they do not understand the core problems that have occurred over the last 25 years or so that has devolved the Healthcare Delivery System here to a chaotic mess. Yes, the attempted Political fixes being done now are really not making things better; if not worse. But this is a problem that has been ongoing for some time now. Our Society and its Leaders have basically ignored the fundamental viruses or "Entities" that slowly crept in and flawed the System. No longer are Physicians in control of anything. Patients are so unaware that the care they get now is really determined by other non-Medical related Professions behind the scenes that have corrupted the "culture" of Medicine. The problems we have today (and why Physicians like myself are seriously thinking of leaving) are a direct result of the recognition and unregulated abuse of a Profession (Medicine), that naturally has negative outcomes, by the Law Profession. This was the initial "virus". Everything else that has occurred since has been a "reactionary" attempt to control the forced ubiquitous culture of "Defensive Medicine" that exists today. Unless you are in the "trenches", this "culture" cannot be quantified or recognized to the enormous degree to which it exists. The CBO has no clue what they are trying to "quantify" from the outside looking in. At this point, the Profession has fragmented so much, that any and all "fixes", whether Political, Administrative, Regulatory, Bureaucratic, or otherwise, are so short sighted, selfish, and meaningless. It's like adding new bandages (to make it look good that day) to the infected wound without treating the infection. Patients and some Physicians (who walk around and don't even consciously realize it themselves) better begin to understand that they are just "pawns" on the Chess Board. Unless the "Queen" (core problem) and her workers (the other ignorant selfish "Third Parties") are dealt with properly, the Healthcare Delivery System in the United States will continue to deteriorate and the costs will continue to exponentially sky rocket. This is unsustainable. It breeds discontent and disgust for those of us that entered the profession with noble reasons; and will be the ultimate reason we all leave.