by Suneel Dhand, MD
Becoming a physician is one of the most demanding and costly professions to go into. After 4 years of college, another 4 years of medical school, and then anything up to 7 years of residency training -- this path is not for the fainthearted. Average debt upon finishing school is around $200,000, so it's no surprise that doctors want a good salary when they are done with residency. Most of them first went into medical school with very altruistic intentions. Studies show that more than three-quarters chose medicine with the simple desire to "help people." Most new graduates after residency still have those very altruistic intentions and high ideals, yet after a couple of years in practice -- something seems to change.
A quick glance at medical print and online publications and the news will tell you it's no secret: we face an epidemic of physician job dissatisfaction and burnout. Some research shockingly suggests that this tops 50% for all doctors. So what happened? Over the last 20 years we have faced a perfect storm of factors coming together.
The corporatization of healthcare
Medicine is no longer about independent practice doctors who have (a certain degree of) autonomy and control. The current regulatory and reimbursement environment makes it very difficult for physicians in independent practice. The employee model may bring some benefits in terms of perceived "job security" -- but that comes at a great price as well. Physicians, by their nature, are very independent-minded and free-thinking souls, and this doesn't always sit well in a controlled employer-employee type relationship.
Increasing regulations and bureaucracy
Following on from the above, less and less time is being spent by physicians doing what they were actually trained to do, as they face a mountain of administrative tasks to deal with. For instance, some studies suggest that new interns are spending as little as 10% of their day in direct patient care (yes, just 10%). It goes without saying that if you change the essence of any trained professional's day so much from what they are supposed to be doing, they will not react well to this. Add to this mix the burden of electronic medical records (a whole different topic) and the massive data-entry requirements placed on physicians, which have seen them become more like data-entry clerks instead of highly trained doctors.
The financial squeeze is on
Let's be realistic: our healthcare system is unsustainable. As a nation, we spend almost $3.5 trillion on healthcare. To put that into perspective, that is more than the total GDP of every country in the world apart from China and Japan! Germany, next on the list, has an entire GDP of $3.4 trillion. If the brakes are not somehow applied, spending could reach over a third of entire GDP within 30 years: a figure that would quite simply destroy the American economy. Currently, at 18% of the economy, we spend almost double the OECD GDP average percentage of other western nations. Yet our outcomes are nowhere near what they should be. The population is aging, and our treatments are getting more expensive -- all against a backdrop of rising expectations. The pressure to reduce costs is filtering through to all levels of our healthcare system.
It is vital for any society to have good and motivated physicians to serve the public. If we are now in a situation where we just accept that all doctors are destined to dislike their work after only a couple of years in practice, this has huge consequences for the country. Every human being deserves the right to be happy and fulfilled in their vocation. Many physicians are now being forced into cutting back their hours, looking for alternative ways to work, additional income streams -- and yes, many are leaving clinical medicine altogether. This ship needs to be somehow turned around. And it needs to happen fast.
Suneel Dhand, MD, is an internal medicine physician, author, and speaker. He is co-founder of DocsDox, a service that helps physicians find local moonlighting and per diem opportunities, bypassing the middleman. Hear him talking about these issues in this presentation.