Many doctors plan to quit or cut back: survey

WASHINGTON (Reuters) - Primary care doctors in the United States feel overworked and nearly half plan to either cut back on how many patients they see or quit medicine entirely, according to a survey released on Tuesday.

And 60 percent of 12,000 general practice physicians found they would not recommend medicine as a career.

“The whole thing has spun out of control. I plan to retire early even though I still love seeing patients. The process has just become too burdensome,” the Physicians’ Foundation, which conducted the survey, quoted one of the doctors as saying.

The survey adds to building evidence that not enough internal medicine or family practice doctors are trained or practicing in the United States, although there are plenty of specialist physicians.

Health care reform is near the top of the list of priorities for both Congress and president-elect Barack Obama, and doctor’s groups are lobbying for action to reduce their workload and hold the line on payments for treating Medicare, Medicaid and other patients with federal or state health insurance.

The Physicians’ Foundation, founded in 2003 as part of a settlement in an anti-racketeering lawsuit among physicians, medical societies, and insurer Aetna, Inc., mailed surveys to 270,000 primary care doctors and 50,000 practicing specialists.

The 12,000 answers are considered representative of doctors as a whole, the group said, with a margin of error of about 1 percent. It found that 78 percent of those who answered believe there is a shortage of primary care doctors.

More than 90 percent said the time they devote to non-clinical paperwork has increased in the last three years and 63 percent said this has caused them to spend less time with each patient.

Eleven percent said they plan to retire and 13 percent said they plan to seek a job that removes them from active patient care. Twenty percent said they will cut back on patients seen and 10 percent plan to move to part-time work.

Seventy six percent of physicians said they are working at “full capacity” or “overextended and overworked”.

Many of the health plans proposed by members of Congress, insurers and employers’s groups, as well as Obama’s, suggest that electronic medical records would go a long way to saving time and reducing costs.

(Reporting by Maggie Fox; editing by Chris Wilson)

What do you think?

I read not too long ago that less than 5% of current medical students plan to go into Family/Primary Care medicine. Sad situation indeed.

You make more money in the specialties.


It will be worse if Obama get hist National Health Care. At that point doctors will have no choice on what to practice and more will leave. Will Obama “persuade” them to stay and what level of care will be provided then?

Exactly. Procedures is where the money is, not office visits.

What happens when demand exceeds supply

There would be less quality doctors

Nurse Practitioners are foaming at the mouth for the GP to disappear so they can take over.

There aren’t nearly enough of those either.

This is anecdotal, so it can be ignored.

Some time ago I had a conversation with a friend of mine; a specialist who is the head of his department at a large hospital/medical group. We were talking about doctor shortages, and I heard myself remark “yes, it’s too bad the primary qualification for medicine is math. You miss out on a lot of good doctors because of it, and get a disproportionate number with Asperger’s”.

His jaw dropped and he asked me to repeat it, which I did. He asked me to explain and I said, “well, to get into a pre-med program, you have to be good at math, which you have to be good at to be good at chemistry.” You have to do well in pre-med, particularly chemistry, to get into med school." I had read somewhere or other that something like 30% of all physicians have some symptoms of Asperger’s. I told him I meant him no offense, but that there was too much science to the preparation for medicine, so those who might be best at the art of medicine are almost automatically excluded except for a small handful. Furthermore, of course, doctors in practice almost never use math or chemistry in any way at all. They rely on literature, usually provided by drug companies and never, ever work out the chemistry of meds themselves.

He didn’t say anything.

A few days later, he called me back and told me he had thought about it and decided I was right in what I said. He, himself, is one of those rare doctors who are equally at home with the science and the art, and agreed that those who would excel at the art of medicine are almost automatically excluded.

It’s a shame. With our aging population, and with the government pouring ever more money into medicine, we don’t have near the practitioners we ought to have, and constraints on the number and type of medical school admissions are one of the major reasons.

I find your statement and assertions here very interesting and compelling.

Certainly much to ponder on as I desperately search for a primary care physician who accepts Medicare for my elderly mom.

I remember halfsigma suggesting that there are too many law school students who don’t get good jobs at big law. He stated that the physician shortage can be solved by encouraging people to enter into the field of medicine instead of law. He suggests that having too many lawyers is a waste of intellectual talent.

We all need leisure time, including doctors. We need more doctors, lower medical school costs, and higher salaries for primary care physicians.

Some conservatives allege that the AMA drives up doctors’ wages by restricting the number of people who can get into medical school. Maybe they are right.

There might not be enough, but there are a lot of NP’s out there and my statement was NOT anecdotal.

But the art of medicine IS science. It’s entire basis is on science. You want a doctor writing your pescription who has no clue about how the drug or that drug family works? A big reason they need chemistry is b/c of all the biochemistry in med school. Look at the curriculum for med school; the first 2 years is all science. With regards to math, when I was researching med schools the highest math you needed was college calculus or college algebra, and a lot of that depended on the school where you took your chemistry courses (whether chemistry required calc or alg.).

Saying there is too much science preperation for medicine is like saying there is too much math preperation for accounting.

What’s wrong with having 30% with Asperger’s? It’s thought that a lot of your detailed surgeons are in that 30% category.

Less lawyers in the world is a good thing, no matter what field they choose instead. :smiley:

Regarding your first point, I am inclined to agree with you in principle. However, there are too few places available in medical schools. I have seen too many lawyers make monkeys out of doctors in court to believe the former do not have the talent for it. But most lawyers I know are not good at math, and I doubt most could get admitted to medical school as a consequence. Most lawyers are intuitive thinkers, and a lot of doctors are afflicted with a sort of tunnel thinking. One lawyer I know joked about what he called the “Rolling Head Syndrome”. His joke was that if most opthalmologists, for example, saw a disembodied head roll into their offices and examined its eyes and saw no obvious pathology there, they would swear there was nothing at all wrong with its owner.

One of the things that troubles me about medicine nowadays is the lack of independence so many doctors have. There are very few solo practitioners or small group practitioners in most places. All are employees of very large organizations. Among the problems small practitioners have is dealing with the paperwork and the complexity of billing this insurance company or that, or Medicare or Medicaid. They routinely see their bills cut by some clerk with nothing but a pencil and a computer program, and have no idea at all why. So, they have to buy the computers and some pretty expensive programs (which have to be updated all the time) simply to get paid for what they do. That’s pretty daunting.

I have often wondered what medical costs for basic care would be if family practitioners just got paid in cash the way lawyers do. But, as one doctor said to me once, since “nobody expects to actually pay for medical care” they can’t do it with anybody except the uninsured. But if they belong to big groups, they can’t just accept what the patient can afford. Their programs force them to charge “reasonable and necessary”, and it all goes off to the billing and collection departments.

Family practitioners also have “production” goals, which determine their incomes. Those goals don’t just include the number of patients they see, but also the number of referrals they make to the “princes” of the system; the specialists, and utilization of labs and equipment. Those family med people are carrying a very large bureaucratic burden on their shoulders.

I will say one thing in defense of the legal system. When it comes to individuals, they have to charge what the client thinks is reasonable to pay or they don’t get hired. When you see lawyers making a good living at, say, $150/hour for work actually performed, you have to wonder why your insurer gets charged $100 for maybe five minutes of doctor time. If he/she is a primary care physician, he/she sure doesn’t get that $100.

However, as we all know, medicine needs people (physicians) who CAN and DO think outside of the box and who have people skills. For example, my dd was 3 mo. old when she was taken to the doctor for what appeared to be a HORRIBLE cold, not a common, simple cold, but a HORRIBLE, I’ve never seen a cold this bad, cold. The doctor just pushed us and her off as being overparanoid and that it was just a “bad” cold. A few hours later my dd was being admitted to the hospital for RSV (a VERY contagious respiratory virus), Bronchiolitis and Pnemonia. The doctor couldn’t look past his own “I know better” attitude to actually think that maybe, just maybe this child has more than the common cold (I could hear her weezing chest and see her struggling to breath with each cough, but he obviously “knew” better). The emergency room doctor was SHOCKED that her doctor sent her home earlier that day from her appointment. Needless to say, we never went to that doctor again, and everytime we were in the waiting room (he was part of a group, the rest of the doctors were outstanding) I would inform everyone how terrible that doctor was and his treatment that day toward our dd and us.

My step-dad is dealing with some serious medical issues and the NP is giving my mom serious attitude about it, like she’s being put out because she has to send a fax for tests to the local clinic. I’m sorry, but some may “know” the science and medicine, but their people skills are so TERRIBLE that they really should look into the research and lab part of medicine.

The opposite is also sometimes true. I remember a case in which a man believed he hurt his hand at work. It hurt when he struck something and sometime later it became extremely painful. He went to a local primary care physician who looked at it, talked to him for a bit, and diagnosed “Buerger’s disease” (don’t look it up yet, it will give it away) and told him to quit smoking.

But, the “upline” being what it is, the doctor was obliged to send the man to the vascular specialist because he obviously had compromised vascularity. The specialist did various things, prescribed this and that, and, when it only got worse, hospitalized him. Among the specialists he saw were a neurologist (who felt he had reflex sympathetic dystrophy and prescribed various things without result) an infectious disease specialist who did some tests, found nothing and just scratched his head, an orthopaedic surgeon who considered the possibility that he might have to remove some fingers, in whole or in part, due to what seemed an imminent danger of gangrene. Preventive antibiotics were administered.

The man was given all kinds of meds, and narcotic drugs due to his off-and-on extreme pain. It was odd because sometimes his hand seemed okay, but sometimes it seemed horrible, with no circulation. It turned all kinds of colors. Looking at the nurses’ notes, sometimes they read, e.g., “patient resting comfortably. No pain. Vascularity good. Capillary refill brisk. Turgor good.” Later notes reflected "Patient in extreme pain. Fingers purple. Refer to Dr. X. Dilaudid (or whatever) Rx.

This went on and on, until finally a nurse noticed that twice, the following sequence occurred. First, the patient was okay. Later,
“Patient went out to smoke.” Later notes would reflect horrible pain, no circulation, fingers turning black, etc. Ultimately, and after several days’ hospitalization, the nurse got the attention of a vascular surgeon who diagnosed "Buerger’s Disease’, advised the patient not to smoke and dismissed him.

Now you can google “Buerger’s disease”

The same skills sets are not required for law and medicine. While many people have the basic aptitude needed to master the science that is necessary for medical school, many more simply cannot do what is required. I happen to be an attorney who started my undergraduate studies in a scientific major. Law school does not require any particular major for the undergraduate degree in preparation. Medicine does.

Both groups of students may have higher than average IQs, but their talents and aptitudes don’t all cover the same ground. Additionally, many highly intelligent people simply become bored with a career. They want to use different talents later in life. I had a surgeon and a few nurses in my law school class along with some ex-cops and numerous CPAs. I also know of people who started out practicing law and then became writers.

I do not believe that setting some standards for their profession is a ploy by the AMA to drive up costs. Someone who has poor math skills and who cannot understand chemistry has no business going into medicine. I do not want a doctor who cannot perform math calculations trying to figure out appropriate dosing for my medications. I do not want a surgeon who does not understand how spatial relationships and calculations work for solid objects. I don’t want a doctor who gets queasy at the sight of blood, but with my lawyer, who cares.

I have a number of friends who are still practicing physicians. The most common complaint that I’ve heard them voice is the frustration with billing (for patients and insurance) and with insurance companies in general for things like pre-approval for precedures and tests and even refills on certain medications. They tend to voice frustration with some of the same things that annoy attorneys and take them out of direct client contact jobs.

I would agree that, in general, the same skill sets are not required for law and medicine. But while not many lawyers become doctors and not many doctors become lawyers, some manifestly do.

I agree that undergraduate education is also different. People who want to go into law are usually advised to take philosophy, history and literature, if anyone advises them at all. Usually lawyers are “word people”, and it’s sound advice. People who want to be doctors must follow what the medical schools require for admission.

Doctors do not do the math for prescriptions. Doseages are charted by manufacturers. If the doctor gets it wrong, (can’t or doesn’t read the manufacturer’s chart) the pharmacist calls the doctor and straightens it out. I have no doubt that once up a time when doctors mixed their own prescriptions they utilized math and chemistry. But they haven’t done that for eons. I am persuaded that pharmacists really do know the chemistry of medications. But I am persuaded that most doctors don’t, except in a very general way. I have seen them make too many mistakes to believe otherwise.

And to imagine that surgeons sit down and figure out physics equations for surgeries is well beyond it. They do know the properties of the materials of the body and of the devices utilized in the same sort of way an exotic materials welder knows metals. Surgeons are a long way from knowing those things in the same way an engineer knows materials. In any event, physics is not required either as an undergraduate subject for medicine or part of the medical school curriculum.

I will definitely agree that doctors hate the billing process. That’s largely because virtually all medical services are paid by third parties, and it’s a hassle. People actually pay for legal services themselves, and legal billing is vastly more simple.

Don’t get me wrong, I believe physicians should look past what is considered “standard” when the situation calls for it. I had a discussion with a Urologist not too long ago about procedures that were considered standard care practice when he began practing in the mid 1970’s that are no longer done today b/c other physicians questioned the necessity of it. Example: nasogastric tubes being done after ALL prostatectomies; the relevance became questioned and it was phased out. I believe you need the strong science background first, which is given in med school (not the residency) before you go monkeying around.

With regards to your last paragraph, NP’s do not have scientific backgrounds. The most chemistry the need is an all-in-one general chemistry and organic chemistry they took when they first did their undergrad RN and the most biology they do is bio 101 and their basic anatomy and physiology. This is far behind what MD’s need just to get into med school.

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