Today I was reading yet another article on physician burnout keep wondering why they do this to themselves? They have been slowly making in roads in stopping the insane hours of residency They are barely starting to figure out that NO one thinks clearly or learns well when sleep deprived. All those hours does not make for a better physician. They KNOW that. But seem determined to continue with this sort of extended hazing process.
The physicians themselves limit the number of medical school spots available and then strangely complain about the shortage or primary care providers that they are purposefully creating. ( BTW, thank you for making it easier for me). Now, they are working themselves into the ground, burning out and creating a depersonalized health care system that we all agree is not working. But who is creating scheduling themselves for 30-40 patients a day? They are.
I sometimes wonder what came first the burn out and resulting depersonalization of healthcare or the 10 minute visit that led to the burnout? They have the power to change this. They do. I wonder if they are depressed? You know how depressed folks just get "stuck"? They know it is crazy. They know it is scary as hell to go home hoping to whatever God you pray to that you didn't miss something important. But they do it.
They really do have the power to change it over night if they wanted to. They could all just linkedin, fb, tweat, or g+ each other to say NO. No, I won't see more than x patients today or any other day. It is dangerous. It is wrong. It doesn't work. They could do this. They write their own rules. There are laws against the corporate practice of medicine. No one can force them., except themselves.
I am honestly wondering about the secondary gain. They say that they want to be with their families. Do they? They could be. They each have the power to hang out a shingle just Marcus Welby and make their own hours. They could stop taking insurance and start practicing medicine and healing again. I promise you that they are NOT forced into this situation. This is the life that they are choosing for themselves.
I'm not sure how others feel, but when your debt is way more than your income, it is a difficult, sad and humbling position to be in. At my first job out of residency, I was expected to see a patient every 10 minutes. If it was my walk in day, in 8 hours I'd often see 40 kids, and my 12 hour day (our 12 hour day was always walk in day), I'd see 60 kids. No one asked me if I wanted to do this, and no one cared that I didn't want to do it. No one cared that I thought it was better to triage patients instead of letting families of 6 children get seen when only 1 child was truly ill. When I and my colleagues made suggestions on how to make it better, we were either ignored (or maybe it was just me who was ignored) or our lives made to be even more miserable. Community clinics in underserved (medically, economically) neighborhoods are swamped with patients. ALWAYS.
ReplyDeleteThe numbers of patients we saw - ridiculous, but imagine the fact that many of my patients there had many social needs, special needs and other issues. 10 minutes were not enough. I had a new patient, with no records, with a disorder that TRULY required a 30 minute visit. So what?! I got just 10! Thankfully the registration desk ladies, CNAs, Nurses and check-out lady were all incredible. At my next 2 jobs, I had to do a lot of the work that was previously done by others. I had 15 minutes in which to see patients, call the hospital, look up labs, do referrals, counsel, referee, give shots, and if I got lunch before leaving for the day, BONUS!
I found out over the past 8 or so months (while trying to purchase a practice) that having ones own practice is no where near as easy as people may think. I know little about articles of incorporation and thus must pay an attorney LOTS of money to do that so as to be sure it is right. Malpractice insurance isn't at all cheap. Supplies, paying a staff, renting space, billing, EMR, sharps removal service, etc - also not cheap. I already pay my own health, dental, disability and life insurance which many employee physicians don't have to worry about. More expense for me!
Many of us who remain employee doctors do so because even though it is sometimes a deal with the devil, it is an easier deal with the devil. We are the money makers, we make our bosses rich, and we DON'T have a say. While we're hustling like street workers, our bosses are taking nice vacations on the bonuses we've earned them.
I could say more, but I won't. Just my two cents. I wouldn't trade it for the world, but it certainly isn't at all what I thought it would be.
Signed,
Thankful but disillusioned Pediatrician
Thank you so much for your response. I agree that the 10 minute visit is much too common and very dangerous. I work those community clinics too and many days go through my day in near panic mode- trying to sort through very complicated problems with patients who have limited understanding. I KNOW that you can be effective and so can I. We CAN make a difference, but it takes time. And it takes us being fed and hydrated and well rested. We don't do our best thinking in panic mode, we don't.
ReplyDeleteWhat I am wondering is what it would take for all of you, collectively to say NO! There are laws against corporate practice of medicine. They are actually not allowed to tell you how many patients to see without being guilty of that ( practicing medicine without a license).
It is difficult to strike out on your own and damnit those attorneys are pretty ruthless with the prices! But, there is a growing group of providers who are saying no to all this craziness. They are not taking insurance. They are doing what docs have done from the beginning of time- charge a fair price for their services. Many are not even having a receptionist. They are doing it all. I think it CAN be done.
This push to see so many patients is scarey as hell but it only happens if all of you let it! When I was growing up the unions did offer insurance, but doctors didn't have a staff full of folks to track it all. They signed a form you brought with you to the office. The patient paid the bill at the time of service and the patient was reimbursed by the insurance company. Now, the overhead from taking insurance is insane!
I can't count the ways in which they add to the cost of medicine. How many letters I get reminding me that I patient I gave erythromycin to 4 weeks ago is also on a statin. I KNOW that. But they want an explanation. Time suck. They want to tell me that my patient's A1C is high. Yeah, I know that. And I wish I had more time to talk to the patient instead of jumping through insurance hoops. I could help. That is what I am educated to do.
I really want to know what would happen if you all just said NO. Like an occupy movement. Educate patients on what is REALLY happening. Did you know the CEO of the NON PROFIT Blue Shield in California made 4.6 million last year. Cigna CEO made 19.1 million! And what is it that they do exactly? Certainly not care for the sick or promote wellness.
You SHOULD be disillusioned. You are doing all of the work and they are taking the money needed to improve our healthcare. How many wellness programs could be run with their salaries?