Is a career in medicine really worth it?

my_0.02 · August 9, 2006, 4:15am

From the August 8 New York Times.

by ROBERT PEAR
Published: August 9, 2006

WASHINGTON, Aug. 8 The Bush administration on Tuesday proposed a cut of 5.1 percent across the board in Medicare payments for services provided by doctors to elderly and disabled patients in 2007. 

It said the cut was required because spending on doctors services was increasing faster than expected, and faster than the annual goals set by a statutory formula.

The increase directly affects beneficiaries because their premiums are set each year to cover about 25 percent of projected spending under Part B of Medicare, which pays for doctors services and other outpatient care.

Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, said Tuesday that the premium would probably rise to $98.40 next year, up $9.90 or 11 percent over this years premium. The figures do not include separate premiums paid by many beneficiaries for prescription drug coverage.

Our current system of paying for physician services is simply not sustainable, from the point of view of taxpayers or Medicare beneficiaries, Dr. McClellan said.

The White House, Congress and doctors have been talking for more than a year about ways to link Medicare payments to the quality of care doctors provide. To date, they have not offered any specific proposals and are still seeking ways to measure the quality of care, particularly for medical specialists.

More than 42 million people are insured by Medicare. Officials estimate that the program will pay $61.5 billion to 875,000 doctors and other health care professionals next year.

Such spending has increased sharply in recent years, Dr. McClellan said, because of increases in the number and complexity of services furnished to Medicare beneficiaries, including more frequent and intensive office visits, and rapid growth in the use of imaging techniques, laboratory services and physician-administered drugs.

Budget estimates are based on the assumption that doctors fees under Medicare will be cut in 2007 and later years, as required under the statutory formula. Congress often steps in to block or moderate such cuts, but it normally looks for some way to offset the cost of its action, often by trimming payments to other health care providers.

Dr. McClellan said it would cost the government $13 billion over five years if it blocked the cut scheduled for 2007, without giving doctors any allowance for inflation. The costs would ripple through later years because future updates would be computed from a higher starting point.

Carthaginian · August 20, 2006, 4:09am

There’s a lot of comparison about doctors and CEO’s here…

I’d like to point out that, in general, a doctor, once finally out of school, generally can get a position and be assured of making a decent, or indecent, income from his investment right away.

An MBA on the other hand general is not awarded a CEO position right out of school unless they start their own business which usually is not immediately, if ever, successful enough to pay anywhere near physician salaries. You can’t look at the top 1% of MBA’s and compare them to the 99% of physicians.

In any event, quit farting around with how much you think you’re going to make in a field (whatever it is, you’re likely wrong) and go for whatever it is that you think you will enjoy doing. Even if you make a pile of cash, if you don’t like what you are doing it’s like taking aspirin for cancer…though I could be wrong, there are probably a fair amount of prostitutes that just love their jobs because it pays so well…

Carth

ubi_sum · September 13, 2006, 8:17pm

Well put.
If you want to make money, DON’T GO INTO MEDICINE. There are easier ways to make money than this. Want to make money? go into banking and investments. I was talking to a 2nd year med student @ brown plme prog and she said you’re one dumbass if you think med is the easy way to get rich. you better love med, 'cause you’ll ‘die trying.’

hye345 · December 17, 2006, 7:06pm

Bookmarking

my_0.02 · January 17, 2007, 8:02pm

From the January 15 AMA News
<a href=“http://www.ama-assn.org/amednews/2007/01/15/prl20115.htm[/url]”>http://www.ama-assn.org/amednews/2007/01/15/prl20115.htm</a>

See the survey results at: <a href=“http://www.acpe.org/education/surveys/morale/morale.htm[/url]”>http://www.acpe.org/education/surveys/morale/morale.htm</a>

Doctor morale shaky as practice stressors surge
Support from spouses and other family members is important to prevent burnout among physicians.

By Damon Adams, AMNews staff. Jan. 15, 2007.

Doctors are singing the blues. They’re down about low reimbursement rates, loss of respect and too many patients.

Many suffer from sagging morale, burnout and depression, according to a new nationwide survey of physicians. Six in 10 doctors have considered leaving medicine because they are discouraged by the health care system.

Some struggle to put a bright smile on what they see as a grim reality.

“It’s getting worse. It’s almost like a snowball rolling downhill,” said Gregg Broffman, MD, medical director of Lifetime Health Medical Group in Buffalo, N.Y., who is familiar with the survey and has practiced for more than 25 years. "No one ever taught us this in medical school. No one ever said, ‘Folks, the world is going to change professionally for you, not only technologically, but also in the way that business is done.’ "

The American College of Physician Executives queried 1,200 physician executives – most of whom see patients – about their morale and published the results, with related articles on stress and burnout, in the November/December 2006 The Physician Executive.

Low reimbursement rates and loss of autonomy were the top two reasons for poor morale.

Bureaucratic red tape, patient overload, loss of respect and the medical liability environment were among the other reasons physicians cited.

Those work problems caused fatigue in 77% of physicians, emotional burnout in 67% and marital/family discord or depression in about one in three physician respondents.

One emergency physician who answered the anonymous survey contemplated suicide and reported to be close to filing bankruptcy. “I am working every day, sometimes double shifts multiple days of the month, just to keep up with the bills. HELP!”

To combat their troubles and stress, more than half of the discouraged doctors talked to colleagues about their morale problems. About one-third searched for a job outside health care. Others received counseling or sought relief by lobbying local, state and federal authorities for changes in the health care system.

“The things we see affecting [morale] are the frequent frustrations with trying to provide the kind of health care you want in the current health care system,” said Lynne Kirk, MD, of Dallas, president of the American College of Physicians. “It makes us concerned about how many internists are throwing in the towel.”

Making changes can help

In a related article, physician executive coach Manya Arond-Thomas, MD, of Ann Arbor, Mich., writes that stress is an occupational hazard for doctors, and they shrug it off without realizing its impact on their well-being. Physicians should recognize that a successful life is based on more than accomplishments and productivity, she said. She suggests doctors give themselves multiple vacations, both short and long, as a way to rejuvenate.

“Part of it is to help them reconnect to what is it that gives them a sense of passion and purpose about their work life,” Dr. Arond-Thomas said. “Managing stress has to be a conscious part of your routine, and you sort of build it into your life.”

The University of Virginia School of Medicine offers a stress reduction class to help faculty and community physicians avoid burnout. The course teaches meditation techniques and shows doctors how to relieve stress and deal with their emotions.

John B. Schorling, MD, MPH, who teaches the course, said doctors need to make time for themselves, whether it’s meditating, exercising or spending time with family. He said exercise and meditation are part of his routine to alleviate stress.

“I don’t go home and ruminate about it anymore. When I’m with my family, I’m really with my family,” said Dr. Schorling, director of the physician wellness program and head of the section of general medicine at the university.

Sometimes, doctors don’t accept help when it’s offered. Physicians and administrators at Lehigh Valley Hospital in Allentown, Pa., created a support group, but few physicians showed, said John E. Castaldo, MD, the hospital’s chief of neurology. Many doctors said they didn’t have time to attend.

“We’re a profession, but we’re not a community as we should be. As a physician, there’s no one who seems to care for you. Your colleagues never ask you how you are,” Dr. Castaldo said. “We have to start looking out for each other.”

Medical leaders say support from spouses and other family members is important to prevent low morale and stress among physicians. They said doctors should not neglect their health. And they recommend that physicians reduce work hours to 55 to 60 hours a week to lessen the risk of burnout.

“It’s very important to set aside time for things that make you feel happy,” said Steven Gabbe, MD, who has studied physician burnout and is dean of the Vanderbilt University School of Medicine in Nashville, Tenn.

Doctors should be open to talking to colleagues and others about dealing with the stress of their profession, physician leaders said.

“There may be something in the psyche of physicians that people rely on us, and we might not be as good at relying on others,” said Rick Kellerman, MD, a family physician in Wichita, Kan., and president of the American Academy of Family Physicians. “Somehow we’ve got to make sure physicians are taken care of.”

GodzillaBorland · February 3, 2007, 2:22pm

Your survey has a bias supporting low moral. You might want to be less judgmental and ask about moral in general, including the option of being highly satisfied with being a physician and why. For instance, why did you not have a question such as: Please choose the SINGLE biggest factor that you believe raises the morale of physicians working in U.S. health care? a. Respected position in community b. Respected by individual patients c. Able to be in an independent business d. Top 10% of income in the country e. Able to live anywhere I choose. f. Mentally stimulating/challenging work g. Ability to have an impact on someones life I believe that we have an obligation to our profession to continue to look at what makes the profession great and why. Too often we look at the negative. I hear docs say that they wouldn’t want their children to be physicians. Rubbish. I have four children and they can do whatever they want, but if they become physicians, they will have more flexibility and lifestyle choices than just about any other profession that they could choose.

bluedevilmike · February 3, 2007, 2:40pm

It is insufficient to claim bias because you don’t like the conclusion. My experience shows that physician morale varies significantly but is well in line with this discussion.

Medicine as a career has many positive aspects to it. I wouldn’t be in medical school if I didn’t believe so. It’s just important that aspiring physicians understand this world as it actually is – with open eyes and heavy consideration.

sar · February 3, 2007, 5:43pm

The govt should be focusing more on cutting drug costs (if it can dodge the pharmaceutical companies’ political clout). The way the pharmaceutical industry makes money is just nutty.

On a side note, someone mentioned that doing something you hate for money is like taking aspirin for cancer… the analogy isn’t perfect, but research shows that aspirin might actually help reduce the risk of certain cancers. lol

Bigredmed · February 3, 2007, 7:44pm

The one thing I’ve always found interesting/unaccounted for with regards to morale is how “new” or younger physicians (less than 8-12 years since med school graduation) feel, specifically. The whole “medicine is changing” argument has been around for at least 20 years (I’ve seen opinion pieces written in 1988 that sound like they could have been written today). Personally, I know that older physicians are upset at the changes, but wonder if it’s really going to matter to me if it’s what I’ve always known.

bluedevilmike · February 3, 2007, 9:02pm

The pharmaceutical industry uses some of the profits for R&D, and isn’t a huge part of medical expenses anyway. By far the largest block of health care expenditure is related to hospital services.

And yes – it would make sense that aspirin, being a COX-1 and COX-2 inhibitor, would have the same anti-cancer effects that were suspected of COX-2 inhibitors like Vioxx. In fact, it was during a cancer trial – not a normal painkiller trial – that Vioxx’s negative cardiovascular effects first became widely known.

my_0.02 · February 6, 2007, 12:23am

Sadly, most of these factors are illusory in this day and age: Respect, income and the ability to relocate have suffered real erosion. Unfavorable liability climate, the withdrawal of numerous liability carriers from whole states and the exorbitant price of tail coverage limits geographic flexibility.

Medical practice can be mentally stimulating and have an impact on the world, as can teaching, farming, or engineering.

sar · February 6, 2007, 3:35pm

I want to practice and teach. But that usually requires doing research too, doesn’t it?
aw poo.

Bigredmed · February 7, 2007, 1:48am

Yes it typically does. There are other options though. Volunteer faculty serve an important part in the development of pre-clinical medical students. I won’t go into everything at the moment because it’s late and I’m drunk on a Tuesday. But there are plenty of other options that could allow you to teach in a less formal setting.

sar · February 12, 2007, 3:05pm

I’m glad to hear there are other options. :)

OldPerson · March 29, 2007, 5:04pm

It used to be worth it but not any more. At the onset of modern medicine the doctor had respect, but an income slightly above average. Then the doctor get a better income and also had great respect. At first, the HMOs took away the doctor’s respect (eg. clerks make treatment decisions). Then the HMOs took away the money. So what is left beside long hours.

gangubhai · April 5, 2007, 5:00pm

<a href=“http://www.business-services.upenn.edu/publicationservices/pdf/WHARTON%20ALUMNI%202006-2007.pdf[/url]”>http://www.business-services.upenn.edu/publicationservices/pdf/WHARTON%20ALUMNI%202006-2007.pdf</a>

At age 45, Wharton graduates had “Median Personal Income” $100,000 - $124, 999.
This is out of the horses mouth- the Wharton Alumni magazine.

CEO’s make 10 or 1000 times more, but average physician makes more than average Wharton graduate.

BTW, among b-schools, Wharton is again #1.

bluedevilmike · April 5, 2007, 5:43pm

That can’t possibly be correct data, since the avg. Wharton grad makes more than that upon graduation.

EDIT: Yeah, that’s the statistics for the people who receive the alumni magazine. You can see from the line above that a large portion of the pool is Wharton alums of some kind, including undergrads and non-MBA candidates. Many of them are int’l, etc.

gangubhai · April 5, 2007, 6:35pm

I have no idea what Wharton grads make, on an average. I mean not even in the ballpark figure. That’s what makes it so difficult to compare with physicians, the incomes of whom are published in a million places. What were you thinking Wharton grads make on average?

Before posting I had also understoof that these incomes are of their readers but on looking at the website more closely I think it kind of says readers have to be grads (although not just MBA’s but also PhDs etc). International I think they still could be Wharton grads as they are the ones who might be the CEOs and lower level buisnessmen all over the world!!

bluedevilmike · April 5, 2007, 6:50pm

Wharton grads, according to USN, have a “starting salary” of $105K, immediatley after B-school. (I think that might even be immediately before b-school, but I’m not sure.)

So for their lifetime average to be $110 would be silly. Plus I’m sure much of their compensation (another half entirely) would be in bonuses.

fjm_001 · April 6, 2007, 10:50pm

My twin brother will be going to Wharton next year, and their undergrads hit that range after graduation, before b-school.

Is a career in medicine really worth it?

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