Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a non-profit society for medico-legal cover. If I want to I can do additional private sector work to earn more (but I don't). I live in a country where a high standard of medical care and longer life expectancy is provided for less than half the per capita health spend of USA, and the public health system is so good that the private health sector really does struggle to offer much additional benefit.<p>There are many great examples of socialised health systems in the world, I'm not sure why the US ignores them? Some of the WSJ comments list all the problems inherent in the US system and then blame socialism for them when the problem is completely the opposite?
I'm a physician. I love the value I bring to patients, and I enjoy what I do (most of the time). But the industry is disgusting. The people who are creating the real value for patients (nurses, technicians and doctors) have been saddled with increasing regulations and there are incredibly levels of administrators and belt-phone business guys riding them to extract every profit out of the environment.<p>There is no chance I would do it again.
I think it's funny that the first picture in the article is of a doctor taking a patient's blood pressure. It's a little ironic because I've never actually had a doctor take my blood pressure (in the US). I'm not even sure if I've had a nurse do it, but more likely a physician's assistant or phlebotomist. Just like other industries medicine has been turned into an assembly line where patients are herded through the system with professionals at each level of the training pyramid doing their part. We do this to be efficient and cost effective, but speaking from personal experience, the side effect is that information gets lost from transfer to transfer and a patient has less time to bond with a doctor. I'd like to believe that many doctors would be happier working with a patient from start to finish like in the old days.
This resonates with what I've observed, and in 2012 I wrote an essay that fits this genre: "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" (<a href="http://jseliger.wordpress.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/" rel="nofollow">http://jseliger.wordpress.com/2012/10/20/why-you-should-beco...</a>), which explains everything my girlfriend wishes she'd known before she started.
Demographics is huge headwind for doctors. In the past 30 years, median age of the population in North America went from about 27 to almost 40 and is still rising.<p>Doctors are usually on a fixed fee for service arrangement but every year as people get older, the length of time it takes to perform the average "service" goes up. The amount of time and ressources needed to treat older patients is almost exponential with age. Older patients' state of health is often very complex with all kinds of interactions between illnesses and medication side effects to manage. Sick people get more "services" but also each service takes significantly more time to perform. Yet doctors are expected to be able to perform as many of them each year.<p>There is an oversized population of people in their fifties right now. This is the age where people start to get sick but are still young enough that they are often the main income earner for their family having one or more dependents.<p>Doctors have to work more hours for less money trying to help families cope with increasingly common and tragic medical conditions. When a family is collapsing because of an illness and people pile up in the doctor's office (justifiably) in tears, there is no ethical way to "process" these patients in the time that is supposed to be allocated to them.
I think we're the new independent professionals. Nobody has required a license to "practice technology" (yet, but I suspect California will find a way eventually...) and so we can do our job anywhere, for any hours, for any pay. Until bureaucracy swallows us up(as it does all professions ultimately) we'll have our golden age too.
All this sounds quite a bit like Marx's theory of alienation:<p><i>"The theoretic basis of alienation within the capitalist mode of production is that the worker invariably loses the ability to determine his or her life and destiny, when deprived of the right to think (conceive) of himself as the director of his actions; to determine the character of said actions; to define their relationship with other people; and to own the things and use the value of the goods and services, produced with their labour."</i><p><a href="http://en.wikipedia.org/wiki/Marx's_theory_of_alienation" rel="nofollow">http://en.wikipedia.org/wiki/Marx's_theory_of_alienation</a>
Many friends of mine are doctors and they've expressed the same feelings. There are days when they absolutely love what they do, but as an outsider, I see them experiencing more low days than high days.<p>Just as an anecdote, part of it is the expectations of the patient population in the Bay Area - and I'm only referring to the high income neighborhoods here; the situation differs significantly in low income neighborhoods.<p>Patients from high income backgrounds tend to be much more demanding than patients from low income backgrounds. At Stanford, the doctors in the emergency department are (informally) expected to stop what they're doing and sing Happy Birthday to certain high income individuals.<p>A lot of doctors translate this to a lack of respect, which echoes the quoted statement in the article.<p>Here's another anecdote. While sites like WebMD are fantastic for educating the general public about health issues, it also makes some people falsely believe they know more than the doctors treating them. And I don't mean they simply question their doctors - that is a good practice and everyone should be as educated as they can about their own health. But apparently many people argue and flat out ignore their doctors, even when their own knowledge is tragically incorrect. As one doctor put it, "Why did they come and see me at all, if they are already convinced of what they have? Just to waste their own time and money, not to mention my time?"<p>Again, there are times when one should definitely question their doctor and be as educated as they can. Second, third, and additional opinions can be very useful. But I'm sure many doctors would appreciate less arrogance and animosity in their attitudes.<p>One more note. Apparently a very high number (between 75-99%) of all doctors will have faced a malpractice claim at least once in their career. Most of these claims are frivolous, but going through something like this is extremely demoralizing. A couple of doctors I know came close to leaving the profession because of it, even after they were cleared of all wrongdoing.<p>I once described the job of a project manager to a doctor friend as a "thankless profession," and he immediately said, "that sounds like my job too!"
I love my primary care doctor who is also my cardiologist. He is amazing. Explains everything, and is never rushed. The only negative is sometimes he is off schedule. I just had open heart surgery and that was also wonderful. The techs, nurses, PAs, and doctors were great. In simple terms, I am thrilled with the care I got and except for one nurse from hell, I have no complaints about care and I have the utmost respect for those who helped me.<p>Now the dark side. I cannot imagine how many people are preparing bills, sending them to Medicare and then to my supplemental insurance. And how many questions I have about billing and how many phone calls I have to make. I am sure that the cost of administering payments is much higher than the cost of care. And yet none of that administrative work prevents disease or cures me. We need a single payer system and need to reduce the non-care-related paperwork. And let the healers heal.
The business model for doctors works out to is surviving a grueling educational process to gain a license against which they charge rents.<p>The business model for professional athletes devolves to surviving a grueling selection process in the service of building their brand as a performer against which they can charge rents.<p>The business model for performing musicians devolves to surviving a grueling selection process in the service of building their brand as a performer against which they can charge rents.<p>This has a personal cost.
I think another frustration doctors are feeling today is due to a lack of patient-doctor relationships.<p>Society views doctors as tools that society has a legal right to.
Surprised the average income for a GP is $161,000 in the US, thought they would be paid more than Canadian MDs who's average is $300k <a href="http://www.theglobeandmail.com/life/health-and-fitness/health/how-much-are-canadian-doctors-paid/article7750697/" rel="nofollow">http://www.theglobeandmail.com/life/health-and-fitness/healt...</a><p>Canada also heavily relies on US medical labs in Houston. I had to have a blood analysis done as part of a health check for a work contract years ago and my provincial health authority shipped my samples there for testing. It's cheaper for Canada to outsource all this work to Americans wonder what they are paying lab technicians.
We've all read about how much health care costs in the US, but I'd like to know: Into whose pockets is that money actually flowing? My guess is that those people will be doctors, even if directly caring for patients isn't how they make their money. From what I've gathered by reading about this over the years:<p>* More than half of doctors are self employed, meaning that their salaries don't tell the whole story about their incomes.<p>* Doctors are heavily invested as stockholders in provider businesses (insurance, HMO's, etc.), and the malpractice insurance industry. Until recently, my employer-provided health care was delivered by a large organization that was entirely doctor-owned.<p>Sorry, no links or evidence for either of these, and I think the gathering of that evidence may be difficult due to the complex financial relationships involved. But it makes me skeptical when I read about doctors struggling against "the system." Who owns the system? It may very well be that medical care costs less overseas simply due to a simpler system where costs can actually be tracked. Medicine might become a better profession in the US if med school were free, doctors worked for a salary, and everything else was owned by the government.<p>To be fair, it may be doctors exploiting doctors, and your career prospects upon finishing medical school may have a lot to do with how much investment money (e.g., inheritance) you have at your disposal to buy into the portion of the business that ultimately profits.
1. I understand their frustration!
2. Yes--you are fighting with insurance companies; So are
your patients.
3. No--you are not the "pillars of society" anymore. (That's change has been slowly taking place. Patients
educated themselfs, I don't know, but patients wised up;
they realize when when they are dragged in for unnecessary
office visits--just to invoke another billing.)
4. O.K.--You are not making the money your father did--neither are most of your patients; the world changed.
Hopefully, things will get better. You guys deserve Tort
Reform--I think, but then again I sometimes feel the only
reason you guys pick up the phone, or refill a prescription is because you you don't want a lawsuit. (It pathetic I'm
even thinking like this?)
5. In the end, we are all in this mess together, and one
day You will be a Patient.
6. I swore I would never comment on HN again. (The political Correctness is stifflling, but I needed to respond to this article.)
7. Goodbye again. That said, if you have realatively good
genes, and you eat somewhat healthy; I would steer clear
of most Doctors. I never thought I would say that about
allopathic physicians.
I am a physician in Australia.
Being a doctor sucks here too.<p>I encouraged my son to avoid medicine.
He followed my advice and is enjoying himself in private equity.<p>Anyone bright enough to do medicine would do far better in another profession.
Is Obamacare going to be the first step towards making the U.S. a socialist country ? Is the true goal to reditribute wealth ? It is meant here, <a href="http://www.mymustardseeds.com/ultimate-goals-of-obamacare.html" rel="nofollow">http://www.mymustardseeds.com/ultimate-goals-of-obamacare.ht...</a>.<p>Or is it just verbiage to shine for the next election ?<p>Will people suffer from Obamacare ? Are consequences to the whole system really under control (increase of the premiums, ...) ?
Most important takeaway (other than a series of anecdotes, a general history lesson, and a few random undefended policy suggestions):<p>"In 1940, in inflation-adjusted 2010 dollars, the mean income for U.S. physicians was about $50,000. By 1970, it was close to $250,000—nearly six times the median household income."
Do you know what's incredible?<p>Plenty of SDE 2s make more than 200k a year, and plenty of doctors don't.<p>I'm not sure if we are overpaid or they are underpaid.
More work for less pay huh? Being squeezed by profit taking business people at the top... surely no one other than doctors can relate to such changes in the economy.<p>*Edit I am of course being a bit sarcastic. It's interesting to see how shifts in the general economy are changing the medical profession.
You can definitely feel this as a patient. If I could give my vitals to an app and have it diagnose and prescribe remedies, I would do it in a heart beat and never visit a doctor again (of course you would need robot surgeons too :).<p>I've never seen a doctor research anything either (although I'm sure they do behind the scenes). They seem to be pulling from whatever information cache they have in their head which I often suspect is horribly outdated.<p>I'd take a crowd sourced db of health info over a doctor's personal knowledge any day of the week.
In my opinion(and general opinion), this is the most important job. Maybe we can find someone depressed(like in the article), but come on they save lives.