“When I look at my career at midlife, I realize that in many ways I have become the kind of doctor I never thought I’d be…” wrote Dr. Sandeep Jauhar, director of the Heart Failure Program at the Long Island Jewish Medical Center.”…impatient, occasionally indifferent, at times dismissive or paternalistic. Many of my colleagues are similarly struggling with the loss of their professional ideals.”
As part of an adapted essay, from his book , recently published in the Wall Street Journal, Dr. Jauhar couldn’t be clearer about his “disillusionment” as a physician in America today. “It could be just a midlife crisis, but it occurs to me that my profession is in a sort of midlife crisis of its own. In the past four decades, American doctors have lost the status they used to enjoy,” writes Jauhar.
And he is not alone. In the past year, a series of articles, and letters to the editor have been written by physicians on the very subject of their increasing discontentment with their profession. As to the factors which contribute to their unhappiness managed care, decreasing salaries and not enough time for patients are largely at the core.
According to Jauhar, “U.S. doctors spend almost an hour on average each day, and $83,000 a year—four times their Canadian counterparts—dealing with the paperwork of insurance companies. Their office staffs spend more than seven hours a day,”– certainly not what they aspired for in medical school I’m sure.
A Washington Post article titled, A growing number of primary-care doctors are burning out. How does this affect patients?, tells the story of Dr. Janis Finer, a primary-care physician in Tulsa, Okla., who gave up her practice to care full time for hospitalized patients. Attracted by regular shifts, more time off and a pay increase, the transition didn’t solve her main gripe, spending more time doing paperwork than she was spending with patients.
Trying to avoid the heavy administrative role of managing payer contracts and dealing with practice finances, Finer sold her practice to a hospital but soon found that working for the hospital system offered her no more flexibility in managing patient care. “…hospital administrators dictated the pace, telling her she needed to see 22 to 28 patients a day. ‘At one point, we were scheduled to see patients every 11 minutes,’” writes The Post.
Not to mention, while physicians are being forced to spend their time handling bureaucracy and rush through patient appointments, they have a looming fear of lawsuits and outrageous malpractice-liability premiums. Basically, the system forces their attention away from patients – then holds them intensely accountable for poor patient care.
As if the added stress and burden imposed by managed care wasn’t enough, physicians are being paid less on top of it, especially in the case of primary care physicians. According to Jauhar, “In 1970, the average inflation-adjusted income of general practitioners was $185,000. In 2010, it was $161,000, despite a near doubling of the number of patients that doctors see a day. “
This phenomenon can be again attributed to the monstrous third party payer system, where much of the actual dollars spent on healthcare are being allocated. Jauhar cites a 2002 article in the Journal of Academic Medicine, which explains the return on educational investment for primary-care physicians comes in just under $6 per hour, as compared with $11 for lawyers. Which is why many see primary care physicians switching to Direct-Pay and Concierge models – attempting to cut payers out of the picture as much as possible.
Jauhar writes, “We need systems that don’t simply reward high-volume care but also help restore the humanism in doctor-patient relationships that have been weakened by business considerations, corporate directives and third-party intrusions.”
No Time For Patients
A NY Times article cites a study, going as far back as the late 1980s, where researchers trailed 15 doctors-in-training over five nights in an effort to understand the evolution of managed care and how it effects physician/patient interaction. They found, ”…that residents spent only about 20 percent of their time with patients, with the bulk of their nights at the hospital devoted to paperwork, tasks that did not have to be done by a doctor like drawing blood and inserting intravenous catheters, and frequently interrupted attempts at sleep.”
This environment, having been perpetuated now for over 30 years is finally making an impact on physician morale.
“I believe most doctors continue to want to be like the physician knights of the golden age of medicine. Most of us went into medicine to help people,” notes Jauhar. “We want to practice medicine the right way, but too many forces today are propelling us away from the bench or the bedside.”
Another, more recent study, cited by The Times, suggests that interns now spend approximately half their days in front of a computer screen. This is actually more time than they are spending with patients themselves.
Perhaps this is the final straw for dedicated physicians, not being given enough time to do what fulfilled their dreams of practicing medicine in the first place, helping people.
“For most doctors, this compass begins and ends with their patients. In surveys, most physicians—even the dissatisfied ones—say the best part of their jobs is taking care of people. I believe this is the key to coping with the stresses of contemporary medicine: identifying what is important to you, what you believe in and what you will fight for, “ writes Jauhar.
Who is Really Suffering?
And ultimately, it’s the patients who suffer. A new generation of patients is being born. Ones who have a less personal, intimate relationship with the physicians that care for them. Lost are generations of family members able to maintain the same primary care physician, maybe because of changes in insurance or perhaps because the physician has moved on from practicing traditional medicine due the unfavorable conditions.
Point is, everyone — physicians, politicians and even health insurance executives are patients at some point in their lives. Is the kind of environment we have created for physicians to work with, really the one we want to be cared for in?