June 4th, 2014
My Fellow Doctors, Are You Miserable?
A few weeks ago, I read a Daily Beast article, titled “How Being a Doctor Became the Most Miserable Profession,” by Daniela Drake. The teaser at the top declares, “Nine of 10 doctors discourage others from joining the profession…” That is an unsettling fact. Are the leaders in our profession burned out, and are most of us too tired to care anymore?
As far as I can tell, we have taken many steps to enhance the quality of our profession, but almost every idea has been either hijacked or twisted. We develop guidelines to improve our practice, but now lawyers and insurance companies use them to justify suing us and denying payments to our patients. We decided to develop electronic health records in good faith, and now they want us to spend a lot of time filling in useless information and limiting our time to interact with patients. Also, many hospitals use practice guidelines for the unintended purpose of measuring physicians’ productivity. Many doctors now accept less compensation for their work, but the insurance companies, hospitals, and even the government don’t pass these savings on to patients.
The worst thing is that, for many different reasons, we doctors no longer have good standing in society. I always wonder why everybody is so worried about fraud, overspending, overtesting, and excessive referrals. Any profession can have a few bad apples, but to my eye ours isn’t particularly plagued by this wasteful behavior. Meanwhile, the system asks for perfection from members of our profession: no mistakes, long working hours, continuous availability, permanent training, and often inadequate compensation. These expectations, in the aggregate, are a fantasy. I don’t know of any other profession that has to accept such unrealistic terms.
Many people think that the new horizon for us will be “corporatization” and business consolidation, recognizing all the while that these features are fundamental to the problem. Shouldn’t we be concerned about the possibility of actually limiting free and true competition? We know what happens after that: Quality declines and prices rise. Remember, once you eliminate competition, it’s gone for good — so I think it is crucial to preserve competition at any cost.
A new analysis from Stanford University found that prices were most likely to increase when hospitals bought physician practices, rather than forming looser contractual relationships with physicians. Hospitals have increasingly bought physician practices during the past decade, arguing that it helps them to coordinate care and control costs. However, insurers and many economists say that the hospitals’ primary motivation is to negotiate higher prices with insurers and build referrals to increase admissions.
Excellent arguments abound on all sides, but the reality is that the system is not working overall. Sometimes people do the right thing for the wrong reasons and sometimes the wrong thing for the right reasons. What are we doing in this case? Is choosing the least of many evils our only option? If being a doctor has become a bad idea, what kind of talent is the profession is going to recruit? I see a very cloudy future ahead.
Do you think being a doctor is now the most miserable profession? What can we do to change the path we’re on?