Keeping doctors in practice

This is my column in yesterday’s Greenville News.  While my Sunday column often covers issues of faith, family or culture, I do write about medicine from time to time.  This is an issue I find relevant.  Although I risk the anger and attacks of those who disdain any creative criticism from physicians, medicine is a necessary feature of modern life.  We need to find ways to make it more ‘sustainable,’ to use a popular term, for physicians in practice.  To ignore the various problems with modern medical practice is to risk diminishing access to healthcare for generations to come.

https://www.greenvilleonline.com/article/20140202/OPINION05/302020009/Ed-Leap-Column-Keep-doctors-practice?odyssey=mod%7Cnewswell%7Ctext%7COpinion%7Cs&nclick_check=1

The Greenville News recently ran an in-depth story on the current and pending shortage of physicians in South Carolina.  I quite enjoyed it.  It gave detailed statistics and discussed the ways that the Palmetto State is hoping to address the looming absence of qualified DO and MD practitioners.

However, the problem is more complex than adding warm bodies in lab coats.  Over the years I am finding more and more physicians, relatively fresh from training, who express their frustration with practice.  They express a sense of burnout as early as residency training.

Why is this?  Surely it isn’t poor screening in college or medical school.  I’ve had the inestimable privilege of lecturing pre-med and medical students in South Carolina, and of recently touring the USC School of Medicine, Greenville. The students are incredible and frankly, I’m glad I’m not competing with them for my medical school spot!

The problem isn’t likely to be the rigors of post-medical school training residency training (depending on one’s specialty of course), which has been made ‘kinder and gentler’ with rules to limit work hours.  So we’re left with practice itself.  What makes older physicians leave early (a well-documented phenomenon) and younger physicians want to leave sooner than ever?

Is it the actual work?  Seldom.  Most men and women who enter medicine love what they do.  They enjoy caring for the sick and injured, providing preventative care, meeting and knowing patients and making a difference.  What they don’t love is the endless top-down control so typical of modern medicine.

They find themselves increasingly crushed under the weight of immense government regulations.  This, even as small armies of hospital administrators stand over their shoulders with pens and clipboards at the ready.  They are endlessly reminded of customer satisfaction surveys (which use notoriously poor techniques to determine good or bad care), or of the next meeting, initiative, program, consultancy report or business plan.  Ask your physician friends if I speak the truth, but healthcare suffers from the same administrative imbalance as higher education.  Too many chiefs, over-stressed Indians.

Physicians are driven away by the cost of practice as well.  It’s the reason so many young doctors opt to be employees rather than open practices, or to open offices which only accept cash.  But whatever model a young physician uses, many have as much as $250,000 in student loan debt upon graduation, plus interest thank you very much.  That new physician will also be paying at least $20,000 per year in malpractice insurance (on the low end).  If that physician takes call in a hospital and sees a significant number of uninsured (or underinsured) patients, then financial stresses are unavoidable, especially since those who are not hospital employees will be paying for health insurance, disability and other costs for both themselves and their employees.

Of course, there are other issues. The much-touted wonder of electronic medical records (EMR) has made physicians into data-entry clerks who, according to recent research, spend more time at the screen than at the bedside.  Pay attention next time you’re in the office, ER or hospital.  The mouse is more integral to modern medicine than the stethoscope ever was, and the result is a complex chart designed for billing and data-capture, but almost indecipherable as a means of communicating useful information.

Space limitations preclude me from discussing other troubling issues, like epidemic narcotic addiction and ‘Maintenance of Certification,’ a cash-cow that costs physicians huge amounts in order to be ‘certified’ by various bodies calling themselves non-profits but collecting very large sums each year.

In short, students enter medicine to use science and compassion to help the sick, heal the injured and save or comfort the dying; and of course, to make a good living.  But now they face a monstrosity; a conglomeration of huge debt, control by external forces and regulations that treat them more like criminals on parole than caring providers of healthcare who sacrificed their twenties (and much of their thirties) to do their jobs.

After reading this, some may consider me just another whining doctor in need of a new career.  But what I’m actually trying to do is help us prepare for the future.  I’ll need doctors too, you know; as will my children and grand-children.  This matters to me.

You see, I’m confident we can keep adding physicians, in SC and around the country.  The real question is for how long, and in what manner, they will practice.  To borrow from our legal friends, ‘the jury is still out.’