February 26, 2008 The Pump Handle 4Comment

Today’s front page story in USA Today is about a shortage of surgeons at U.S. hospitals, with a focus on rural areas; the shortage threatens the health of 54 million rural Americans, reports Robert Davis. Part of the problem is that medical schools held enrollment steady for too long, rather than increasing it to account for the fact that so many doctors will be retiring at the same time that aging Boomers are needing more care. But changes in U.S. healthcare have also played a role.

Med school loans spur a lot of medical students to choose a high-paying field and then go where the money is:

“[F]ewer and fewer are going into family medicine and primary care,” says James King, president of the American Academy of Family Physicians. And “many are not willing to go” to rural areas.

After an industry-wide review of allegations that surgeons were charging too much, Medicare lowered the amounts that the U.S. government pays doctors during the 1990s. For some common procedures, general surgeons now get about half the money they received 20 years ago, Fischer says.

“Are the best and the brightest going into medicine like they once did? The answer is no,” [Beth Israel Deaconess Medical Center Chairman of Surgery Josef] Fischer says. “They are becoming investment bankers, attorneys and captains of industry because the American way — how prestigious things are — depends on money.” …

King says some of his physician friends are telling their children to avoid medical school.

“They tell their kids not to go because of all of the hassles,” says the family physician from Selmer, Tenn. “They say it’s not worth the headaches anymore.”

By “headaches,” Dr. King might be referring primarily to long hours and time on call, but I doubt it. Having a lot of family members in medicine, I hear a lot about the headaches of healthcare practice, and they mostly involve insurance and reimbursement issues. Time and mental energy that medical professionals want (and ought) to use for interacting with patients or keeping up on medical literature goes instead to slogging through an ever-changing landscape of the covered procedures, documentation, and reimbursement practices of payers. Doctors in private practice have to hire staff solely to deal with the paperwork, and then they have to see more patients in order to meet their expenses; for primary care doctors whose reimbursement rates are low, this means scheduling several patients each hour and spending just a few minutes with each one. Does this sound like an appealing job?

Driving away good potential physicians: one more hard-to-measure cost of our current healthcare mess.

4 thoughts on “Med School “Not Worth the Headaches Anymore”

  1. I am lucky in that I am old enough to retire, but still work four days a week because I enjoy my patients so much. At 80% Doc and 20% other I could not make a living anymore, but I am able to nuture my other professions as a bluegrass mandolinist and writer. (They don’t pay well either.)

    The problem now is there are too many people involved who know nothing about sick people. As a friend of mine who got into hospital PR work said, “I thought we were going to talk about germs; all we talk about is money.”

    Here is a true story that says it all. Years ago, I was at a hospital picnic, and my band was playing. An administrator rushed up to the stage, and said there was an emergency- someone had been stung by a bee.

    I immediately went to the scene and expected full blown anaphylaxis. Instead there was a young fellow with a small whelp on his hand.

    I checked him out, and asked all the right questions. The sting had been twenty minutes prior, and he had no difficulty breathing, so I recommeded ice, and to go to the ER if any respiratory distress developed.

    The administrator asked me if I knew who the boy was. (I knew he was the grandson of a trustee.) I said, “Sure, he’s the kid with the bee sting.”

    Well, that was not good enough, and of course the whole damn entourage had to parade over to the emergency room to prove “something was going to be done,” and more important that they were the ones who deserved the credit. There he got an ice pack, but I’m sure the bill for 400.00 bucks was waived. The ER Doc told me this is exactly what happened, and he laughed as hard as I did over the stupidity.

    Once we turned it all over to bureaucrats, administrators and insurance folks, folks have exactly what they have begged for, and I really don’t feel sorry for the public for it. As for me, I wrote my Congress people till I was blue in the face, and it never did any good. I didn’t figure it would.

    After all, I am only a Doc with a quarter century experience, no lawsuits, and one who still studies for Boards and exceeds the 90th percentile. What would I know about it? After all the years of trying to get people to understand, I retired from any hope of changing anything. I continue to be a Doc and try to fight for my people the best I can, though it is clearly with one hand tied behind my back. That is all I can do.

    Dr. Tom Bibey


  2. The scuttlebutt from Britain is that the medical profession is dwindling there too, but funny – their education is totally paid for by the National Health Service – so it’s not about school loans. It’s also not about the idiosyncracies of insurance companies, as there is only one. It IS about lower reimbursement rates, having to do multiple shifts, and on call policies.

    The United Kingdom has started solving the problem of workplace bullying, and the USA has not. Doctors and their staff can be mercilessly bullied in America, and it’s still perfectly legal. For some reason the medical profession has a lot of bullies and bullying policies.

  3. I am an undergraduate science major in college and I cant express how thankful I am for articles like this one. Right now, I am actually deciding to redirect my goals towards other careers in pharmacy or biotechnology because I dont think its worth it to be a doc anymore. Im not saying that Im part of the “best and the brightest,” but I am only one of MANY who is beginning to lose interest.

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