The Alienation Of America’s Best Doctors

Doctors are hurting and they don’t have the time to reach out.

Physician Careers are Rapidly Losing Their Appeal

I grew up in the ‘80s in awe of my dad who was a talented general surgeon. As a kid, I used to make rounds with him at the local hospitals in Los Angeles and had the opportunity to witness the overwhelming appreciation his patients had for his work. Our home was inundated with dozens of homemade baked goods, knitted scarves, gift baskets, and colorful “thank you” cards carefully prepared by his patients. He never complained about his job. Even if he had to leave a family event or wake up in the middle of the night to do a trauma case • he was never resentful. He felt invigorated by saving thousands of lives. He was grateful to be well compensated for his sacrifices. He worked extremely hard (sometimes putting in over one hundred twenty hours a week), but he was able to do his work the way he felt was best since he ran his own private practice. He was beloved, respected, and couldn’t imagine pursuing any other profession that offered greater rewards.

Unfortunately times have radically changed. The best and the brightest simply don’t want to become doctors anymore. Physicians are burning out. They are leaving the profession. They are going bankrupt. They are selling their private practices to big hospitals. They are retiring early. We are facing a growing doctor shortage. Doctors no longer want to be a part of a health care system that doesn’t value them after decades of sacrifice, debt, and brutal training. Physicians now have the highest suicide rate of all professions.

Doctors no longer want to be a part of a health care system that doesn’t value them after decades of sacrifice, debt, and brutal training.

As an undergraduate at Harvard University, I was fortunate to be surrounded by some of the country’s most talented students. Back then (in the ‘90s), many of the students were on the fence as to whether to apply to medical school or join the dozens of consulting and financial companies that aggressively recruited us. After speaking to the new generation of Harvard seniors at networking events — I realize that they are no longer on the fence. Our country’s brightest graduates are simply not choosing to become physicians anymore.

Of course, we cannot deny that we need to focus on curtailing health care costs. But we absolutely cannot cut health care at the expense of alienating physicians. Our talent pool is rapidly shrinking. Nearly every month now, another one of my most brilliant physician colleagues (from Stanford, Yale, Johns Hopkins, UCLA, and Harvard) leaves his medical practice. This is real. This is palpable. These talented physicians are quitting to join startup ventures, “concierge” practices for the ultra-wealthy, pharmaceutical companies, or the ranks of corporate America where they feel they are better compensated and respected for their brain power and sacrifice.

Let’s look at some of the facts to help explain why becoming a physician in America is rapidly losing its appeal.

1. Private practice medicine is increasingly unsustainable due to rising overhead costs and declining reimbursements

2. Doctors spend more than two-thirds of their time on paperwork rather than taking care of patients

3. Medicare reporting incentives do not reward over 99 percent of doctors

4. The average debt doctors face after medical school is $183,000

5. Many new doctors earn barely more than minimum wage when accounting for hours worked per week

6. State governments are passing laws to limit the compensation of “out of network” physicians

Doctors are hurting, and they don’t have the time to reach out. They don’t have the time to lobby Congress. They are far too busy trying to help their patients and keep their practices afloat.

Our country needs to figure out solutions to help preserve and encourage physician autonomy• not continually restrict it. With rapidly increasing government reporting regulations, new plans to move away from fee-for-service payments, growing patient complaints about high deductibles, Medicare audits, more complex documentation mandates, increasingly complicated coding requirements, payment denials, time-consuming prior authorizations, expensive Electronic Health Records mandates….why would our country’s top talent go through years of debt and brutal training to face over-regulation and exhaustion?

We also need to continue to compensate physicians at a fair level that matches their skills, high level of education, and sacrifice • not figure out ways to “bundle away” what they make. Should health care dollars be shifted away from those who are waking up in the middle of the night to save lives, who are spending countless hours researching cases after work, who are neglecting their families to study for re-credentialing boards, who are saddled with inexorable debt, or who are spending thousands of dollars to attend meetings all over the world to find out the best way to care for patients? Contrary to popular belief, physician reimbursements comprise only a small proportion of our country’s total health care expenditures.

by Melinda Hakim MD

Contact MPS today if you are interested in learning about non-clinical career opportunities for physicians.

Better to Live and Die in the U.S.A.

The United States healthcare system is often berated for how it treats patients near the end of life. They are purportedly attached to tubes and machines and subjected to unnecessary invasive procedures that cause inordinate pain with no potential benefit, there is underutilization of more compassionate hospice services. This “travesty” is expensive, as the care of dying seniors consumes over 25% of Medicare expenditures. We hear this story so often; it is almost taken as gospel-- but is it actually true? Is it more expensive and invasive to die in America than in other developed countries?

Gun Ownership and Doctors?

According to the Pew Research Center, there are approximately 32,000 gun-related deaths annually in the United States; 19,000 are suicide, 11,000 are homicide, and the rest are accidents, police shootings or of unknown causation. Moreover, there are more than 78,000 nonfatal gun wounds each year. Given the disproportionate number of victims that are less than 40 years of age, the morbidity and mortality of gun violence is significant. Physicians are involved with many types of public health issues, but few are as controversial or divisive as gun safety. Is it really an issue that falls within the medical domain?

O Tempora, O Mores: Affordable Care Act - Big Dream or Big Let Down?

I confess I was a strong proponent of the Affordable Care Act. My reasoning was subtler than the hallowed pantheons of its staunch supporters and the apocalyptic predictions of its detractors. Forty years after graduating medical school I concluded, after many stutter steps, the American healthcare delivery system was economically unsustainable and the citizenry was neither living longer, nor better, despite medical expenditures that dwarf any other developed nation. My career also allowed me to personally interact with cardiac surgeons from all continents and see that their clinical results and research efforts were laudatory by any standards.

High Depression Rates in Resident Physicians — Fact or Fiction?

The December 8, 2015 issue of JAMA had a startling key clinical point; the prevalence of depression or depressive symptoms among resident physicians in training was 28.8%. The data was generated by meta-analysis of 31 cross-sectional and 23 longitudinal studies published in peer-reviewed journals involving 17,560 trainees. Two-thirds of the trainees were in North America, but the others were from Asia, Europe, South America, and one from Africa. Sensitivity-analysis confirmed that no individual study affected overall prevalence by more than 1% and that the incidence of depression was not influenced by study design, continent of origin, surgical vs nonsurgical program nor level of residency year.

Can a Robot Outperform Your Surgeon?

In the current competitive environment, healthcare providers often attempt to separate themselves from their competition by marketing themselves as using the newest technologies for their procedures. This is an age defined by finding the next best thing and the American public responds to this strategy. My personal experience has been in cardiac surgery, but the principles are equally applicable to other specialties, particularly tertiary referral practices.

Hospital Administration Attempts to Cut Costs and Increase Quality at Expense of Physicians

A nonprofit hospital care system in Oregon with 450 beds has been in an acrimonious negotiation with its staff hospitalists for the past 2 years. The mounting economic pressures on this small, community oriented institution have had the expected consequences of hiring new administrators to implement the latest trends to rein in the budget and effect efficiencies of healthcare delivery-- as if that has been so successful in the rest of the country. The battle has really centered over the physicians losing control of their work time allocation, individual decision-making for diagnostic and treatment plans, as well as bristling at bonuses based on the administration’s definition of quality.

Michigan Physicians Society Supports Inner-City Education

Yesterday afternoon I had the privilege of helping to honor the graduating class of 2016 at Experiencia Preparatory Academy. They have 3 graduates this year that have overcome a special set of challenges, including moving from Mexico to the United States and having English as a second language.

Affordable Care Act: Affordable for whom?

Entering its third annual open enrollment period, Obamacare is the subject of cacophonous political acrimony, again, championed by its supporters and vilified by its opponents. Each side presents its own “metrics” of success or failure

Big Pharma Using Mail-Order Pharmacies to Maintain High Prices

The United States has the dubious honor of paying the highest prescription drug costs in the world. Many healthcare economists attribute this to relatively lax cost regulation compared to other wealthy countries; however, a decade of insurers paying only for generic drugs when available and limiting drug choice in specific formularies has had little modulating effect.

Mental Health Spending: A Story of Failed Supply and Demand

Several weeks ago I was in Palo Alto, California walking along Camino Real abutting the Stanford University campus. I noticed a newly-constructed high-link fence isolating the commuter train tracks from the pedestrian walkways. Another “shovel-ready” infrastructure project to nurture the economy?

Photos - MPS Auto Show Event - Lingenfelter Collection!

Our auto show event at the Lingenfelter Collection was a huge success! Approximately 100 attendees enjoyed an evening of learning, networking, and fun at the Lingenfelter Collection, one of the most notable car collections in the world! A special thanks to M1 Concourse and the Lingenfelter Collection for sponsoring this event.

Michigan Physicians Society Auto Show Event - Lingenfelter Collection!

We are excited to announce our next MPS event! MPS members will enjoy an exciting evening of learning, networking, and fun at the Lingenfelter Collection, one of the most notable car collections in the world! Learn about car collecting as an alternative investment strategy while enjoying a private tour of the Lingenfelter Collection.

Physicians Role in Drug Pricing

Two new drugs, Repatha and Praluent, were approved by the Food and Drug Administration several months ago amid much ballyhoo. Both are antibodies that specifically target PCSK9, a protein which reduces the number of receptors on the liver that remove LDL cholesterol from the blood. By blocking PCSK9’s ability to work, more receptors are available to clear LDL. This novel mechanism was proven safe and effective in clinical trials, lowering LDL cholesterol levels by 40% or more in patients already taking statin drugs. However, powerful treatment comes with a powerful cost-- over $14,000 per year for each patient.

Physician or Salesperson? - The Ethics Behind Patient Donors

Maybe it’s because we have entered the silly season with a full cast of presidential aspirants, but I have recently mulling over the perception of behavioral impropriety. To translate from spin doctor to medical doctor, I mean professional behavior that may not be overtly unethical, but exudes self-interest over patient well-being. In the academic world, full disclosure includes financial interest with potential conflict, disclaimer of previous publications, responsibility for informed consent and approval by the appropriate research committee. In our practices, particularly in the clinic or hospital setting, much focus is on constructing a firewall between the pharmaceutical and the medical-device sales force and medical providers.
Page: 1234 - All