How Being a Physician Evolved Into the Most Unpleasant Occupation
by D. Drake, 4/14/14;

By the end of this year, it’s estimated that 300 doctors will commit suicide. While depression among medical professionals is not new—a few years back, it was named the second- most suicidal occupation—the level of sheer unhappiness amongst doctors is on the rise.

Simply put, being a doctor has become a dismal and humiliating venture. Without a doubt, many doctors really feel that The United States has declared war on physicians—and both physicians and patients are the losers.

Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retire as quickly as possible. Physician MBA programs—that promise doctors a way into operations—are flourishing. The website known as the Drop-Out-Club—which hooks physicians up with positions at hedge funds and investment capital corporations—has a strong following. In fact, physicians are so bummed out that nine out of ten doctors would dissuade everyone from going into the occupation.

It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system. Maybe that’s why author Malcolm Gladwell not long ago implied that to deal with the health care turmoil, the public needs to realize what it’s like to be a doctor. Imagine, for things to get better for clients, they need to empathize with physicians—that’s a tall order in our poisonous and extremely un-empathetic times.

After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they ought to sense anything but scorn for these kinds of physicians— particularly when US citizens haven’t gotten a raise in decades. But being a primary care doctor is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care physicians do the job that no one else is prepared to do, being a primary care physician is more like becoming a janitor—but without having the social reputation or union rights.

Unfortunately, things are simply becoming worse for the majority of doctors, especially those who still accept health insurance. Just processing the insurance forms costs $58 for each and every patient experience, as outlined by Dr. Stephen Schimpff, an internist and ex -CEO of University of Maryland Medical Center who is producing a book about the turmoil in primary health care. To pay the bills, physicians have had to raise the amount of patients they see. The end result is that the typical face-to-face clinic visit lasts about 12 minutes.

Neither patients nor physicians are happy about that. What concerns many doctors, however, is that the Affordable Care Act has codified this damaged system into law. While forcing everybody to purchase health insurance policies, ACA might have mandated a uniform or structured claims procedure that would have gone a long way to improving access to health care. As Malcolm Gladwell noted, “You don’t educate a person for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”

In fact, difficulty dealing with insurance organisations has caused many doctors to close their practices and become staff members. But for patients, seeing an employed doctor doesn’t provide them additional time with the physician—since employed physicians additionally have excessive patient loads. “A panel size of 2, 000 to 2, 500 patients is too many, ” says Dr. Schimpff. That’s the number of patients primary care doctors ordinarily are compelled to take—and that means seeing twenty four or more patients a day, and frequently these individuals have 10 or more healthcare challenges. As any seasoned physician knows, this is do-able, but it’s certainly not ideal.

Most patients have experienced the rushed clinic visit—and that’s where the malfunction in good medical treatment begins. “Physicians who are in a hurry, don’t have the time to listen,” states Dr. Schimpff. “Generally, clients get referred to specialists when the difficulty can be solved in the office visit.” It’s correct that specialist referrals are on the rise, but the time crunch additionally will cause doctors to rely on guidelines rather than personally tailoring medical care. Unfortunately, mindlessly adhering to regulations can result in negative consequences.

Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their positions. Business leaders are fixated on patient approval, in spite of the reality that high ratings are correlated with worse outcomes and greater expenses. Indeed, attempting to please whichever patient arrives ruins the integrity of our work. It’s a simple fact that physicians acquiesce to patient requirements—for narcotics, X-rays, doctor’s notes—despite what market research advocates claim. And now that Medicare payments will be tied to patient satisfaction—this problem will get even worse. Doctors need to have the ability to say no. If not, when individuals go to see the physician, they won’t really have a doctor—they’ll have a hostage.

Yet the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” checklist continues to increase. A dazzling and unrestrainable amount of forms— frequently illegible—show up each day on a physician’s desk needing to be signed. Reams of lab results, refill requests, email messages, and callbacks pop up persistently on the pc monitor. Calls to beg with insurance providers are peppered all through the day. Every single decision carries with it an intended risk of malpractice litigation. Failing to attend to these items brings prompt disciplining or patient complaint. And mercilessly, all of these responsibilities have to be accomplished on the fatigued doctor’s personal time.

Almost comically, the response of health care leadership—their solution— is to require more physician testing. In reality, the American Board of Internal Medicine (ABIM)—in its own act of hostage-taking—has decided that besides being examined every ten years, physicians must conform with new, expensive, "two year milestones. " For countless physicians, if they don't conform be the conclusion of this month, the ABIM will advertise the physician's "deficiency of complying" on their web page. In an era when nurse practitioners and doctor assistants have shown that they can offer superb primary health care, it’s nonsensical to raise the obstacles for doctors to participate.

In an era when you can call up regulations on your smartphone, demanding more physician assessment is a ludicrous and self-serving reaction.

It is tone deaf. It is punitive. It is wrong. And practicing doctors can’t do a damn thing about it. No wonder physicians are suicidal. No wonder younger doctors want nothing to do with primary care.

But what is a bit of a wonder is how things became this awful.

Certainly, the relentlessly negative press coverage of doctors sets the tone. “There’s a mass media narrative that blames doctors for things the doctor has no control over,” states Kevin Pho, MD, an internist with a well-known website where physicians often vent their frustrations. In fact, in the popular media recently physicians have been held responsible for everything from the wheelchair-unfriendly home furniture to laboratory expenses for pap smears.

The meme is that doctors are getting away with something and need constant training, watching and controlling. With this in mind, it’s almost a reflex for policy makers to pile on the restrictions. Controlling the doctor is an easy sell because it is a pipe dream—a Freudian fever dream—the wish to minimize, discipline and manipulate a disappointing father or mother, give him a report card, and tell him to wash his hands.

To be certain, many people with good intentions are working toward solving the healthcare crisis. But the solutions they’ve come up with are driving up prices and driving out physicians. Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to the majority of people.

But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to somebody.




“Under the care of Leo J. Borrell, M.D. since December 2001, I have seen a remarkable improvement in my mother’s condition. She is responding dramatically to the new regiment Dr. Borrell has prescribed”

- Beth Rose


Feb 3, 2008

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by Dr. Leo J. Borrell, featured in Assisted Living Consult for November/December 2006. A HealthCom Media Publication