Physicians love their work but are frustrated

I recently finished reading In Their Own Words: 12,000 Physicians Reveal their Thoughts on Medical Practice in America. It is a summary of a 2008 survey from the Physicians Foundation. I vaguely remember filling out this survey. I was interested to see what my colleagues had to say.

Many physicians describe themselves as at the breaking point.

“I am so mired in this mess that I can’t see clearly enough to give any good advice.”

“I make close to the average American salary of $37,000 though I haven’t had a vacation in six years and I’m on call 24/7.”

“We are drowning in a sea of regulations and paperwork.”

“I plan to quit as soon as I possibly can.”

Some simply wrote “help.”

It was not surprising to learn that nearly sixty percent of respondents would not recommend a career in medicine to their children or other young people. Nearly half of the physicians were planning to reduce their patient volume, retire or seek work in a non-medical field within the next three years. Some of the dissatisfaction stems from the increased volume of paperwork physicians are doing. Sixty three percent of respondents report it caused them to spend less time with their patients.

The authors provide background into some of the unique aspects of medical care in the US. Unlike most professions, physicians typically do not set their own fees; a third party whether Medicare, Medicaid or private insurer determines the payments. Actually getting paid is another ball of wax; physicians must fill out myriad forms or pay staff to do their billing for them. It is among the reasons that many physicians have turned to cash only practices, opting out of all insurances.

Physicians in the area of primary care are especially struggling to keep up with their business expenses as expressed by this comment, “I cannot provide care for $37-50 per patient when my overhead — malpractice, labor, light bill, rent and supplies — is $60-75 per patient.”

After eleven or more years of schooling and facing school debts of $100,000-200,000 these physicians are finding the work is unsustainable. Another comment sums it up, “hairdressers charge more than what we receive for office visits.”

Although physicians generally agree the current system is in trouble, they were divided as to how to fix it. Among the approaches physicians suggested were a single payer system, malpractice reform, reduced cost for medical school, enhanced use of the medical savings accounts and other market driven approaches. The most radical and intriguing suggestion I found was “bring a class action lawsuit against the managed care industry.”

Clearly physicians are frustrated with the current state of affairs. Many however expressed their love of the work and the calling that first brought them into medicine. One respondent summed it up, “I just want to be able to treat my patients to the best of my ability.”