Thursday, September 25, 2008

Physician demoralization - Who Cares: Dimensions of Disappearing Doctor Dilemma

Almost one in three Connecticut physicians are thinking about changing jobs or moving out of the state because they are sick and tired of practicing medicine here

Hillary Waldman, “Docs Grow Sick of Their Jobs,” Hartford Courant, September 24, 2008

The practice environment in Connecticut appears to be having a demonstrable impact on the supply of physicians in certain medical specialty areas and on the patients’ access to care.

Robert Aseltine, Jr, and Matthew Katz, MS, “Connecticut Physician Workforce Survey: Initial Perceptions and Potent Impact on Access to Medical Care, Connecticut Medicine, October, 2008

Doctors in Connecticut, perhaps the most affluent state in the country, have a serious morale problem. If it’s bad here, how bad is it elsewhere? That will be the subject of another blog.

A survey by 1077 practicing doctors by the Connecticut State Medical Society indicates 1 of 3 physicians are considering quitting or leaving the state.

Here are the numbers.

1) Doctors who say they’re contemplating a career change.

Yes, 19.3%, No, 65.1%, Not Sure, 15.6%

2) Doctors who say they’re planning to move.

Yes, 10.8%, No, 71.0%, Not Sure, 18.2%

Doctor critics are likely to say.

So what? The clinical Cassandras are at it again. Doctors are just whining. When push comes to shove, they will never quite practice or move.

Concerned students of the unhappy doctor problem may say. Look. This data discourages medical students from becoming primary care doctors, the most unhappy segment of the physician population, and contributes to the escalating primary care shortage.

In the Connecticut survey, 40% of family medicine and internal medicine reported decreases in their numbers while those in more affluent specialties reported increases: cardiovascular diseases (59%), gastroenterology 54%, orthopedic surgery 45%, and oncology 44%. This is symptomatic of a looming primary care shortage.
Only 2% of medical students plan a career in family medicine.

Why don’t we take steps to improve the situation, like making medical school more affordable for potential primary care doctors, partially forgiving their medical school debts, and paying primary care doctors more, and creating medical homes with increased pay?

Yet another school of more cynical thought exists. Who cares?

• Who cares if primary care doctors feel they’re underpaid and overworked? “Everyone knows” they have the biggest house on the block.

• Who cares if primary care doctors aren’t the first responders? After all, there are growing numbers of foreign medical school graduates, physician assistants, nurse practitioners, “doctor” nurses now being trained at 75 nursing schools nation wide, alternative practitioners, naturopaths, chiropractors, and self-care, and if all else fails, health food stores. .

Doctors care. Doctors know they’re the only ones that have gone through rigorous training needed to diagnose and treat disease, to handle nuances and complications of chronic disorders, to make difficult diagnoses, to administer life saving drugs, to perform procedures to restore life styles and life itself.

And we know this: most people most of the time want to see “the doctor,” not some less well-trained and less-qualified substitute. They want to see “the doctor” they know personally promptly and conveniently who can offer them coordinated and comprehensive care without long waiting lines and without running through a gauntlet of anonymous specialists.

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