With respect, Dr. Manny: you’re not primary care. We don’t make no money, and we don’t get no respect. I have advised both my doctor sons NOT to go in to primary care.

Although it causes me gastric distress to suggest this…the only way medicine will solve these problems is for physicians to a greater degree and hospitals to a lesser degree must surrender self regulation to government regulation. Possibly this would have to include a body of criminal laws aimed at medical practitioners and special medical courts to manage offenses. Doctors should not, in these days and times, be the ones to determine when other doctors are licensed or de-licensed. It would be a socialist nightmare but the whole system may collapse without it.

There is nothing in Obama’s health care plan which addresses this physicians’ 4-point wish-list. In fact, tort reform is not a part of the Obama health agenda. However, more bureacracy will be a major part of the new plan. Also, I believe that the Obama plan will create more unrealistic, not realistic, expectations on what the health care system can provide.

What are the chances a lawyer is going to be an advocate for malpractice reform? Hmmmm.

I work in IT at a large hosptial that supports these types of folks. If you want over worked and underpaid people who are sick of their job and the bureaucarcy you don’t have to look to far around my office area. Most of the time it’s due to supporting the over compensated and over blow egos of the docs.

My mother advised to to avoid the medical field. I wish I had listened to her. Medicine is glamorized on TV, but in real life, it is a nasty, back-stabbing, highly regulated a litiginous field. I think anyone considering becoming a physician is ignorant of exactly what they are getting into. If I could find something else to do that would allow me to pay off my mortgage-sized school debt, I’d leave the field in a heart beat. The regulations and decrease in compensation is only going to get worse.

Had physicians not sold out their profession to insurance companies but instead policed their own profession there would not be the amout of malpractice cases that there have been. As an RN of 23 years I will call out a nurse or physician if I know they have not washed their hands. The profession has itself partially to blame for not policing itself, not lobbying about insurance companies who only care about profits (alas the actuarial tables) and take back control of your profession.

Obama’s reforms with definitely aim to reduce compensation to “overpaid” physicians. More and more with quit, exacerbating the shortage. Their higher incomes are supported by ridiculous hours. For some, 16 hour days are the norm. Call wakes them all times of the night. We better keep the work rewarding for physicians if you expect prompt care in the future.

Good luck. Obama and the Dems are going to crush doctors and our health care system along with the economy. It’s going to get very ugly. Get ready for socialism then communism.

I am not surprised. With the law schools spewing out piles of hungry, socially worthless new lawyers every year, all of them with physicians in their cross-hairs, why would anyone go into medicine? Or teaching school? Or auto manufacturing?

I think the money is in opening another law school.

As a small town country doctor for 10 years, I must say I would have a hard time convincing others to go into medicine today. It’s not just the long hours and fatigue. I regularly deliver babies, round at the local hospital and manage a busy clinic schedule and go days at a time without a real break. Our town only has me and one other family doc to provide OB care to six surrounding counties in southern TN. It’s a shame the bureaucracy and insurance issues have created a nightmare scenario for traditional , private practice primary care physicians. Billing and TennCare headaches, joint commission chart reviews, random chart audits by insurance providers all take valuable time and energy from patient care. The harder we worked and the more patients we saw, the further in debt we sink. My business is failing, I’m looking for a new job and the patients will be without care. I hope some new, young doctors are recruited in, but I doubt it will happen. Many specialize and avoid primary care and around these parts, only nurse practitioners will be left. So long Marcus Welby MD!

Do you want socialized medicine? If so, why don’t you just move to Canada?

Being a doctor is not much fun anymore. America is going to have a huge physician problem in 10-20 years from now. There won’t be many of us left! There aren’t enough of us now to take care of all the patients. My wife practiced OB/GYN for 3 years, then quit. She doesn’t need the headaches anymore. Her salary was pathetic and the satisfaction was absent. Insurance companies tell us how to practice medicine and how much they are willing to pay us (please tell me of another profession where someone else tells me how much I can charge for my services). The government can’t run medicine…they can’t even deliver my mail properly or get my taxes correct. I’ve been in practice for 3 years, and really can’t imagine another 25-30 years of this. Things need to change drastically and fast, or I may join my wife as one of the ex-doctors.

The practice of medicine is certainly becoming less enjoyable, and this is in no small part due to government regulation, medicare/medicaid beauracracy, and a sundry of other detrimental changes to our medical system. I find it also troubling that the patient focus has changed into more of an entitlement of care rather than respect and appreciation. As a practicing emergency physician, I often question how much longer I want to do this job. I am stressed out by our medical malpractice environment, the amount of time I spend on patient documentation rather than patient care, and increased government focus on healthcare. I’m not sure that I can see anything but further degradation of the system with increased government involvement. Insurance has never done anything but drive up the cost of care as more hands dip into the pot. Everytime malpractice reform is mentioned to a politician, it’s dismissed quicker than an afterthought. As the expectations and demands on primary care are increased, the burden on Emergency Departments increase, and an ultimate collapse of the medical system is of real concern. I hope to be out of the way if it happens.

So, if a lot of doctors get out of medicine … what will they do? How will they maintain their lifestyle? Many are used to big $$$ — if they don’t practice medicine, how can they make the same (or more) money?

Tonight, you go home to your family and retreat from the day’s worries. Your boss may have made your day intolerable or a colleague may have agitated you to no end; however, you’re able to remove yourself from your work environment and sink into that one thing that takes you away from the world which is your job.
For doctors, there’s no such removal from the day’s worries. Each and every day our hard working, dedicated physicians bring home with them the tribulations of what it means to be a caregiver. They bring home with them the single mother of three young children of whom they’ve had to inform has an incurable cancer and only has six months with which to spend the rest of her days. They bring home the HMO that tells them they can’t practice medicine as they deem necessary for the benefit of the patient because it does not fit the “protocol” some hoity, pencil pusher has come up with. They bring home with them the patient, who despite the physician’s best efforts to care for, looks the physician in the eye and and tells him he is going to sue him. They bring home with them a paycheck that is 40% of what their actual work load is worth.
Fox’s article leads with the title, “Doctors Sick of Work”. I beg your pardon, but doctors are not sick of work they are sick of the bureaucracy, the red tape, and those who would stand in the way of doctors doing what they do best…and that is being doctors (i.e. and caring for the sick and healthy alike).

One thing is correct about the article, physicians will seek other things to do with their time rather than be pushed around by those who know absolutely nothing about caring for and treating a patient.

Of course MDs are tired and want to quit. There is No professional freedom in the job now. Medicare has promised too much to Seniors, and they can’t pay for it. What that means is that they continue paying less and less for difficult cases. Third parties control the admission, payment and discharge. Malpractice payments are outragious, and the lawyers are “swimming” around waiting for something to happen with a difficult case that we don’t get paid for the extra work.
Most people think doctors get paid thousands for their operations. Not true. For example to save someone’s life by doing a three vessel coronary bypass and take care of the patient for three months, surgeons get paid about $2,000.00. A lawyer gets paid that for handing a client a boiler plate form for a specific job.
What’s more society has lost faith in MDs. They will switch doctors for a $10 reduction in insurance payment per month.
Finally, the hospitals are sinking under the poor reimbursement from the third parties, and the nurses are working their bottoms off filling out documentstion (for the attorneys), and don’t have time to take care of the patients.
Twenty years I was paid a decent amount for each surgery I preformed. Today, I am being robbed of my time and my talent by the System. I love my patients, however, and they are the only reason to become a physician.

Well, now, let’s see …

First the doctors charged so much money that no one could afford them and people had to join HMOs, and then the doctors found they didn’t have patients unless THEY joined HMOs and/or took charity cases and were reimbursed by the state, or by insurance companies who were not about to put up with their inflated fees.

“Isn’t getting better worth a lot of money?”

My dear friends, yes;–but what if I JUST DON’T HAVE IT?

Too many doctors too frequently in that case said, “Then, to hell with you!”

Such “men,” such “doctors”–what did they EXPECT they were doing to their profession?

Sure Obama will reform healthcare. He will tax the doctors to fund the system and they will make even less

The reason many primary care docs are opting out(or going into other specialities) has to do with the increasing burdens all sectors of society are placing on them, such as:1) increasing govt. oversight including constantly changing regulations, vigilante-like Boards of Medicine and Registration who are primarily consumer advocates and doc-averse;2) Insurance companies which are putting more and more emphasis on details which only delay payments to docs; 3) a public which is becoming ever-more unrealistic and demanding, leading to 4) an increasingly litigious society. ALL THIS LEADS TO A VERY, VERY LOUSY DAY AT THE OFFICE DOING SOMETHING WHICH WE THOUGHT IN THE BEGINNING WE WOULD CHERISH!!! It gets so darn hard that it’s not worth it anymore. And that leads John Q. Public to become a doc-hater because he cant find one who wants to take his crap. But it’s too late for changes, and it’s a joke to think that Prof. Obama will be able or willing to make my life easier. PS: I (and many others) left the Peoples’ Republic of Massachusetts after 25 years because I knew I was better than a galley slave. Cheers.

So who is going to pay for Obama’s EHR mandate?

“One of the most common complaints I get from physicians, nurses and general medical personnel, is the tremendous amount of paperwork that is required in today’s heavily regulated industry”

Once Hussein B Obama and Hillary get in there you haven’t seen ANYTHING yet. The Govt can’t deliver the mail correctly, why would I expect them to provide health care???

Obama will do nothing more than increase the presence of government within the healthcare sector.

Number 4 on that list will definitely get worse, and I don’t know how he’d go about accomplishing #3…or #2 for that matter…

Give me a break. There may be a few exceptions, but the doctors I know work less than anybody I know and, of course, make more money than anybody else. They feel overworked only because their having to work 25 hours a week instead of 20 or because maybe one of their 2 golf days are being interfered with. Many of us truly have to work 50-60 hours per week including time on weekends to make it in our fields. If you are so overworked, let some more young people into the medical schools and quit preserving your ability to make such exteme money compared to the rest of us.

As a non primary care physician I can attest to this and that it is not limited to primary doctors. If this same survey was given to all physicians I suspect the results would be very similar. It is very laborious to document everything you need to document in this current medico-legal climate. If Mr Obama thinks that an electronic medical record is going to be a solution he is dead wrong. an EMR actually increases the amount of work while producing a far less defensible chart in the plaintiffs attorneys eyes. Furthermore an EMR has never been shown to improve patient care or reduce medical errors. In our institution the errors have actually increased.

It is sad to say, but doctors are very frustrated in their profession. I am seeing insurance companies dictate our care to patients and to doctors. The insurance industry is the MAIN cause of increased paperwork. My staff spends over 6 hours per day just with insurance based forms and requirements. Then the insurance companies dictate what they are going to pay the doctor’s office. In order for the insurance companies to show more profit, they just decrease their reimbursements to the healthcare profession. So, doctors are overburdened with much more paperwork and less reimbursement. (This equals more frustration and less patient care) Let’s place the blame where it actually belongs!!!!!!!

Med student here. I’m still idealistic (not to young though) and untainted by the lure of the big bucks, so here me out. Most of what is said here is right on. Here are my thoughts.

1. e-records are necessary. I would love to see a study that quantified how much it costs for us in unnecessary paperwork and delays/misses in treatment because there is no place where we can get our health records. The best bet, IMO, would be to put it onto a card like your ATM card. If we can carry around a bank card and hand it to waiters making minimum wage whenever we eat, surely we can give a health card to our doctor. This would have the added benefit of speaking for us if ever we are in a traumatic accident and find ourselves unresponsive and in the trauma bay.

2. Cut tuition/even out salaries. Doctors do not need to make more than the POTUS. They also do not need to graduate with $250,000 in debt. My generation of physicians signed on to be doctors knowing they would graduate with this high of a debt and that they won’t see a “pay day” for a decade. Yeah, generally speaking they have a calling like a cop or firefighter does. The problem is that there is still a generation of doctors who graduated with $25,000 in debt and many are making a killing. We should follow europe’s model on compensation and make up for it with lowered debt. Better yet, forgive my generation’s medical debt in exchange for making us all serve in underserved areas or in underrepresented specialties.

3. Decide why we have a healthcare system. Is it to improve the overall health of the population? Or is it to provide another avenue for entrepreneurs to make a buck. I personally believe that there are plenty of ways that people can make money in the US, and they don’t need to be making a profit on your cancer. That just doesn’t seem ethical to me. This would mean that all insurance companies, pharmaceuticals, and device makers became non-profits. People would argue that this would decrease “innovation” but, believe me, we have plenty of “innovation.” What we need now is rational use of our limited resources. We do not need drugs coming to market that are no better than existing drugs, but cost more. People who are driven to help people will always strive to innovate. They always have throughout history. A profit motive is not needed here.

OK. That is enough ranting for today. I have to go back and hit the books.

Many physicians and other heath care providers and entities already have electronic chart systems in place to help expedite the very tedious task of patient treatment and maintenance; often this is required just for the capability of billing. Medicare already requires an electronic transfer of reimbursement funds into an account, in order that the funds may be reversed if they change their minds about what is covered. The actual cost of physician practice is not simply the staffing such mandates require, but the structuring of the insurance industry for non-payment. Insurance companies have become multi-layered outsourcing institutions, with multiple companies and other service contractors posturing to make the process of receiving payment so labor intensive that the physician and staff simply give up. That is likely the specific insurance company’s goal. Not payment to the physician who went to school an additional 12 years after high school and puts his profession on the line for any individual, whether they can pay or not. Don’t inquire with the primadonnas that offer medical information on the internet or other public service information; they are not physicians in the trenches and their credibility on this subject is zero. If we want better health care, it needs to be fee for service, payable to the provider at a reasonable cost. INSURANCE COMPANIES THAT PRACTICE MULTI-LAYERED OUTSOURCING STRUCTURED FOR NON-PAYMENT MUST BE MADE ILLEGAL. We might also occasionally recall that do not live forever, and if you take your car to the shop to be repaired, don’t think you will get the keys back until you pay for the service.

What killed the medical profession was when the government took healthcare (as it did with care for widows and the aged) away from the Church.

Garold Dean Spire Jr. M.D.

I’ve been an RN for 23 years and am growing weary of short staffing, poor management, and demanding families of patients. I thought that by working in intensive care that I would always have a safe nurse to patient ratio, but that’s not always the case. Our hospital forces us to call nurses off during times of low census which leaves those of us working with tough patient loads that are not conducive to good patient care. Another problem we have is poor decision making in assignment of patients. I’m not optimistic Obama can change these problems because most of the decisions are powered by greed: use fewer nurses and save a few bucks for the health system. Another huge drain on our health care system are non-paying, non-insured patients. I don’t pretend to have the answers, but I do dread growing older and maybe needing care that is understaffed and unsafe.

Just as I have tried to tell folks. Until you can guarantee that every doctor will except new patients and every type of health coverage (insurance and discount). The health care issues will not get solved. Making every business provide coverage and fining parents will not do any good without the afore mentioned issues being resolved. Check out my company website, it provides a great option for those without health coverage.

Seben Griffin
757.282.5914

Just as I have tried to tell folks. Until you can guarantee that every doctor will except new patients and every type of health coverage (insurance and discount). The health care issues will not get solved. Making every business provide coverage and fining parents will not do any good without the afore mentioned issues being resolved. Check out my company website, it provides a great option for those without health coverage.

Dr.Manny:

I am one of those physicians thinking of quitting, and I’m 35! I am a Family Physician in practice since I graduated residency in 2003. I opened my own solo start up 2yrs ago in a rural area of NJ were there is a shortage of primary care. Attempting to keep my overhead low, I am currently running a micro practice which includes one full time staff member, a budget EMR and lots of multitasking. I submit claims MYSELF. My nurse and I fight with the insurance companies. It has been an endless struggle with an overwhelming amount of paperwork and bureaucracy. I recently had to hire a PT receptionist to help with the paperwork. The reimbursements are a joke and I have to work another PT job performing aesthetic procedures in order to make ends meet. I don’t know how much longer I can do this.

While my overhead goes up, so does my fear of tort. My patients do find me to be pleasant and warm. However, as you know, we are human and mistakes occur. Recent rulings in this state are making it harder to practice. NJ recently passed a cultural competency mandate, which in theory is proper. However, when every small time doc has to pay$200/hr for an interpreter at their expense while netting $50 for that visit, hell has frozen over. When the courts allow patients to sue for punitive damages, at the threat of losing your home and wiping out the few dollars in your bank account, who in their right mind would want this job?

I work an 80hr week and I do not break six figures(the most I ever made was 120k at an urgent care). I pay $14K in malpractice a year and have $140K in med school debt to pay off. I worry about my my patients, my health and my livelihood, all with a healthy dose of malpractice fear lying underneath the surface. Those that have gone before me, ruined the system. Now my generation is left suffering with the malignancy that is health care.

I recently had the misfortune of reading the 2009 Health Care Reform white paper proposed by Senator Baucus. While all the problems are fundamentally true , and I agree with them, the solutions do not tackle major fundamental issues. I HAVE an EMR and run an efficient practice, that has not solved my problems or helped my situation. Tort needs to be changed and not glossed over. The Medical Home model is good in theory but recent evaluations have shown it has just created another level of bureaucracy and bookkeeping for the physicians currently in the pilot program. A recent survey shows that 70% have not seen a change in their reimbursements and 11% have noticed it has COST them money. I have a feeling they “just don’t get it”.

Dr.Manny, please continue your efforts in speaking out against this current system. The populus still think that their average Family Doc or Pediatrician is rolling in the dough. In reality, we are rolling in the red tape. Crisis is coming, whether we choose to ignore it or not. Physicians have had it, and we’re not going to take it anymore.

Obama’s plan will make it worse for doctors; the current level of Socialized medicine is precisely why they are overworked: they have to see more patients at the lower quasi-Socialist reimbursement rates in order to make practicing medicine worth it financially.

There is little doubt that medicine has been losing its appeal to the best and brightest college students for many years now. While the numbers of applications to medical schools across the country have continued to rise, the composition of that candidate pool has altered significantly. The top achievers from our leading institutions have been staying away from medicine in droves, choosing instead to pursue potentially more lucrative and certainly less time intensive careers such as law or business.

The calculus behind the decision is not all that complicated:

On the one hand you have four years of hard work in undergrad followed by 2 years of harder work in either business school or law school followed by a year or two of clerking/dues-paying or prepping for the bar and then a career of 60 hour work weeks with enormous potential for financial gain. No easy walk in the park, but long on upside.

On the other hand you have a profession which requires an absolute minimum 11 years of training after high school, with most doctors training for 12 to 14 years including pre-med. During this training period most doctors accrue a staggering load of student debt ranging from $100 – $400K, while logging positively inhuman work hours during medical school and residency. Four years ago the residency work hours were finally restricted to no more than 80 hours per week with no more than 30 hours in a single shift. This volume of work is simply incomprehensible to anyone that has not trained to be a physician. Furthermore, the art/science of medicine demands a 24-hour a day commitment to your profession. If you’re on a flight to Utah for vacation and the pilot comes over the intercom asking if there is a doctor onboard who can help the passenger in row 5 having chest pain, you do not have the option of sitting back and comforting yourself with the notion “I’m on vacation, I’m not a doctor right now.” No, you stand up and walk to row 5 to help the patient. That is your duty, your honor, your privelege. (How many times have you heard the pilot ask, “Is there an attorney on board? We have a legal emergency.”?) In remuneration for the years spent in training, massive student debt, and lifelong commitment, one earns, on average, $9.37 per hour while in training. After that, in the instances when you actually do get paid, you get paid precisely what medicare and the private insurers decide your work is worth, there is no consideration given to what the bill might actually be. In days gone by, there was a baseline level of respect and admiration felt by nurses, support staff, and patient for their physicians. This secondary gain helped to defray some of the less agreeable aspects of training and practice. The current culture of malpractice attorneys trolling for clients on the radio and television, nurses trained to maintain an adversarial relationship with doctors based in mutual distrust, and insurers systematically and pathologically devaluating our skills has essentially destroyed that source of validation our predecessors enjoyed. For a lucky few of us, these vicissitudes are more than offset by the joy we get from intervening meaningfully and uniquely in the lives of people to whom we have no natural obligation (meaning they’re not family). But one can easily see how a reasonable person would decide to avoid the field altogether or, still worse, abandon the field after having devoted such a valuable and irretrievable portion of their lives to it.

It would indeed be difficult to make a reasonable argument against choosing the one hand over the other.

There is little doubt that medicine has been losing its appeal to the best and brightest college students for many years now. While the numbers of applications to medical schools across the country have continued to rise, the composition of that candidate pool has altered significantly. The top achievers from our leading institutions have been staying away from medicine in droves, choosing instead to pursue potentially more lucrative and certainly less time intensive careers such as law or business.

The calculus behind the decision is not all that complicated:
On the one hand you have four years of hard work in undergrad followed by 2 years of harder work in either business school or law school followed by a year or two of clerking/dues-paying or prepping for the bar and then a career of 60 hour work weeks with enormous potential for financial gain. No easy walk in the park, but long on upside.

On the other hand you have a profession which requires an absolute minimum 11 years of training after high school, with most doctors training for 12 to 14 years including pre-med. During this training period most doctors accrue a staggering load of student debt ranging from $100 – $400K, while logging positively inhuman work hours during medical school and residency. Four years ago the residency work hours were finally restricted to no more than 80 hours per week with no more than 36 hours in a single shift. This volume of work is simply incomprehensible to anyone that has not trained to be a physician. Furthermore, the art/science of medicine demands a 24-hour a day commitment to your profession. If you’re on a flight to Arizona for vacation and the pilot comes over the intercom asking if there is a doctor onboard who can help the passenger in row 5 having chest pain, you do not have the option of sitting back and comforting yourself with the notion “I’m on vacation, I’m not a doctor right now.” No, you stand up and walk to row 5 to help the patient. That is your duty, your honor, your privelege. How many times have you heard the pilot ask, “Is there an attorney on board? We have a legal emergency.”? In remuneration for the years spent in training, massive student debt, and lifelong commitment one earns, on average, $9.37 per hour while in training. After that, in the instances when you actually do get paid, you get paid precisely what medicare and the private insurers decide your work is worth, there is no consideration given to what the bill might actually be. In days gone by, there was a baseline level of respect and admiration felt by nurses, support staff and patient for their physicians. This secondary gain helped to defray some of the less agreeable aspects of training and practice. The current culture of malpractice attorneys trolling for clients on the radio and television, nurses trained to maintain an adversarial relationship with doctors based in mutual distrust, and insurers systematically and pathologically devaluating our skills has essentially destroyed that source of validation our predecessors enjoyed. For a lucky few of us, these vicissitudes are more than offset by the joy we get from intervening meaningfully and uniquely in the lives of people to whom we have no natural obligation (meaning they’re not family). But one can easily see how a reasonable person would decide to avoid the field altogether or, still worse, abandon the field after having devoted such a valuable and irretrievable portion of their lives to it. It would be difficult to make a reasonable argument against choosing the one hand over the other.

By the PCP(primary care physicians) cutting back their hours the patient count in emergency rooms for non emergent situations will increase. By this happening the patients will just obtain more debt because, as all of us in health care know, a emergency room visit is going to be a lot more than that of a PCP visit. There for the financial situation is not being helped.

What will Obama do to (for) healthcare? He has already stated he thinks it is a basic “right”. Just how does he intend to make sure everyone’s “rights” are provided for? Unlimited access AND unlimited care? I submit that he will push for unlimited access and the government with tell you what they will or will not pay for. And if you don’t think there will be even longer lines of people waiting for their “free” healthcare, you are stupid. When the government decides they can’t afford to pay for this system, who do you think they will try to squeeze? DOCTORS. Now one last question, once the government has opened up “free” healthcare to all and doctors work twice as hard for half the pay with twice the government paperwork and oversight, what do you think many doctors will do? (Hint—retire or cut back). Will this scenario make access and care better? I think not. But the pubic will get what they deserve.

As an Internist practicing for 29 years, I’m afraid I have a poor prognosis for President elect Obama promoting the doctor’s wish list. An Obama “malpractice reform” would not likely come out helping the cost of malpractice premiums, or cut the cost of CYA lab testing, Xrays and referrals. Mr. Obama is too beholden to the American Trial Lawyers’ political and financial influence to threaten to cut their incomes with meaningful reform. Cut cost of medical education?Yes, but likely he would do it with taxpayer funds and not privatizing any component of medical education, which might have a chance of streamlining the process. Educate the consumer to have realistic expectations? Not likely, since that would also threaten the pocketbooks of our lawyer friends. Decrease bureaucracy? Mr. Obama makes it clear he believes the government is the answer to all our problems, and if it is not working now, we just haven’t got enough government commissions working on it, with rules and regulations to “fix it.” Consider Medicare part D, the program giving hundreds of billions of dollars away to seniors to buy their medicines, but somehow makes everybody mad, even the beneficiaries! Think about your health care run by the same people who run the post office and the IRS! What’s the answer? Education of the health care consumers, our congressional representatives, and Mr. Obama , who may be surprisingly willing to listen since he has little experience in this area. Privatize, don’t socialize! Give patients choices of care and promote competition. Arbitrate, don’t litigate! Innovate, don’t regulate! You get the picture.

I am not surprised at the degree of discontent with doctors. I am a family physician and after 22 yrs of practice, I would hang it up if I could! The discontent circles around relatively low pay and profound overwork- not particularly patient care, but the endless paperwork and referrals, approvals and arrangements we make. We do the majority of these pro bono, which is very irritating. Tort reform is in the hands of attorneys to decide (you can guess how that will go) and with about 2% of US grads going into primary care, there is no change for those of us in the trenches in the foreseeable future.

President-elect Obama will have his hands full with other items, and a sweeping reform (long overdue) is unlikely to make it to reality in the next 4 yrs. Changes are crucial, particularly in primary care, as those of us who are aging/retiring are not being readily replaced.

First of all, there is a huge difference in the lifestyle of the community based doctor vs that of a doctor who works in an academic institution. The community based primary care MD sees patients all day long, every day, while for the MD in an academic hospital, face to face patient care is interspersed with teaching, attending meetings, and doing research. Having worked in biotechnology for 18 years, I’ve worked with doctors from all over the country from the smallest town doc to global thought leaders at the most renowned institutions in the world. From my standpoint, academicians seem be much less stressed than community based docs, and more inclined to say that they would encourage their children to pursue a career in medicine.
That said, it is the community based guys who see the vast number of patients in the US, and who are feeling the most overburdened. My husband works for a network of doctors owned by a local hospital, and the primary care docs are leaving in droves. In the last year, they have lost 6 doctors and cannot find replacements, and this is in MA, the state with the highest number of docs per capita! All of the issues you mention, Dr. Manny, are true, but there are others as well. Many patients have no respect for their doctors, and treat them as though their time is worth the $10 co-pay. Some just don’t show for appointments. Others come in with piles of information from the internet which they expect the doctor to take the time to review. Patients with no insurance expect free care, and find it implausibe that a doctor would actually have the audacity to ask for payment for their services.
I’d like to know how Obama plans to provide care to 47 million new patients when there already exists an overstressed healthcare system. Primary care doctors are not just going to appear out of the woodwork. The pay stinks compared to certain specialties, and even with the right incentives, it will take years to build up a sufficent base of docs and PA’s and RNP’s to absorb that many new patients. Electronic record keeping is certainly the wave of the future, but the time required to learn the system is long, and takes away from patient care. And as you allude to in your article, Americans feel that they “deserve’ a certain level of care, and do not react well if their doc won’t prescribe an antibiotic for their sniffles, or if they have to wait for that coronary by-pass surgery, or can’t get that special new drug for their breast cancer. Healthcare reform could be as big a shock to Americans as the current financial crisis has been. My best to all of you primary care docs out there- you are underappreciated heroes, and from my perspective, your dedication is duly noted. http://timetorevoltamerica.blogspot.com

Honestly, medicine just sucks. I’ve been in training since I was 18. I’m turning 34 this year and am a subspecialty fellow now, essentially still in school. I’m planning on quitting and doing something else next year. Honestly, people want so much from their doctors and then think it’s their God-given right to sue them if things don’t go perfectly. Medicine has wasted my youth and destroyed my body with 30-hour workdays, way too much stress, and the requirement for continuous obsessive self-absorption necessary to make it through.

Hell no. All I can see coming out of his proposals put up so far is a large increase in people qualifying for medical assistance, whose dismal payment rates have primary care practices dropping MA at an alarming rate. In the catchment area I practice in, (north central Pennsylvania) there are no primary care practices in a 25 mile radius accepting new MA patients excepting the community health center that has a 4 month appointment backlog.
People need real insurance that pays a fair amount to their providers and covers a reasonable amount of the total cost so that patients are not put into bankrupting catastrophies if they become sick or injured.

So far President-elect Obama has focused on cost savings from electronic medical records, among other things. While I support the concept, I am doubtful that there will be significant savings or increased efficiency in the short term. Most of the EMR systems are very kludgy, and the learning curve is going to be steep. I agree with the article, in that we really need the changes that will get current practitioners to stay active and attract talented young people to the profession, or future generations will be short-changed on their healthcare needs.

Malpractice reform? Really? Do you think any Democrat is going to do anything about malpractice reform? Dream on.

Isn’t Obama in favor of nationalizing our health care industry in some form? There’s an idea. Let’s get the government involved in running our healthcare system. What a wonderful way to cut down on bureaucracy and paperwork. Who are the geniuses that came up with this strategy? Oh yeah, the Democrats. Gee, what a shock.

This comment is to Rob who thinks doctors work 25 hours a week???? You have GOT to be kidding me.

My husband (general internist) works 70-80 hours a week. He is on call alternating holidays. He get phone calls all night from people who have stuffy noses and want to know what to do.

Every year he has to see more patients just to make the same amount of money. I would gladly give up the “lifestyle of a doctor”. He was on call during all three of my childbirths. He was seldom home when the kids were little and when he was he was exhausted. I gave up my career as an Attorney to stay home with the kids because our life would be even more insane if I worked outside the home.

I would NEVER encourage my children to go to medical school. I would also never encourage them to go to law school.

Rob, you have no idea what you are talking about!

I absolutely agree with “Doctor’s Wife”. The life of a doctor is a hard one! He/She has to provide such excellent patient care all the while walking on egg shells hoping they won’t get sued. People that don’t know what a doctor’s life and career is like need to stop talking about it. You just make yourself look like a stupid socialist who wants the easy life with all the money. Guess what! Doesn’t work that way!!

Comment by GUILT BY ASSOCIATION (A NURSE AND A DOCTOR’S WIFE):

Tonight, you go home to your family and retreat from the day’s worries. Your boss may have made your day intolerable or a colleague may have agitated you to no end; however, you’re able to remove yourself from your work environment and sink into that one thing that takes you away from the world which is your job.
For doctors, there’s no such removal from the day’s worries. Each and every day our hard working, dedicated physicians bring home with them the tribulations of what it means to be a caregiver. They bring home with them the single mother of three young children of whom they’ve had to inform has an incurable cancer and only has six months with which to spend the rest of her days. They bring home the HMO that tells them they can’t practice medicine as they deem necessary for the benefit of the patient because it does not fit the “protocol” some hoity, pencil pusher has come up with. They bring home with them the patient, who despite the physician’s best efforts to care for, looks the physician in the eye and and tells him he is going to sue him. They bring home with them a paycheck that is 40% of what their actual work load is worth.
Fox’s article leads with the title, “Doctors Sick of Work”. I beg your pardon, but doctors are not sick of work they are sick of the bureaucracy, the red tape, and those who would stand in the way of doctors doing what they do best…and that is being doctors (i.e. and caring for the sick and healthy alike).

One thing is correct about the article, physicians will seek other things to do with their time rather than be pushed around by those who know absolutely nothing about caring for and treating a patient.

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Absolutely, right on point. I’m not affiliated with the medical field, but I’ve had enough work and life experience to say the government takes on too many things they know nothing about. As a grad student in accounting, I question their current efforts to bailout companies and proposed corporate and capital tax hikes. How can Congress and the Senate make decisions on a variety of topics without understanding the logic behind their decisions? Might as well flip a coin. They are the reason the medical field is fed up, but they won’t admit it. The Bureaucracy is continually expanding and we are suffering. Doctors are hurting and we’ll all feel the hurt when there’s less willing to serve the public. It’s looking like socialized medicine is not far off…God help us.

If Obama and Hillary have their way, this country’s healthcare system would be like Canada’s. Canadian doctors work less, but they also make WAY less money. Patients may have to wait months before seeing a doctor for thier ailment. Some patients may be told that thier needs aren’t prioity over another patients because doctors are only allowed to perform a certain amount of surgeries. Imagine being told “No, sorry. Maybe we can perform your surgery next year.” If I lived in Canda, I wouldn’t waste my time to become a doctor unless my intentions were to “donate” my expertise and I had a strong enough stomach to say “no” to those in need.

Healthcare, like many industries can only have two of three desirable qualities. There is cost containment, quality, and access. In this country we have quality and access at a high price. Canada has quality and cost containment with limited access. Even with the high cost, the rest of the world flocks to our shores for medical care. I don’t know what the changes coming will bring, but if the government runs it with a the American People will either have to accept lower quality of care or far less access. Either way, the lawyers will have a field day with the lawsuits that will result.

The survey was conducted by the Physican’s Fouindation, created as the result of a lawsuit settlement with the insurance industry. They sent out 320,000 surveys and got back only 12,000 responses or about 3.75% rate of return. With such scant data, no valid conclusions can be made – only political or pro-universal health propaganda headlines. I am stunned that Fox News would repeat such tripe without even questioning its validity.

I have spoke with many medical professionals and one common worry that I have encountered is the hope that Mr. Obama does not cheapen the medical profession meaning that the reward for sacrificing to become a physician is not diminished.

As far as I’m concerned, the way to fix our health care system from the provider’s side is the prompt return of the 80-20 Indemnity plan. Most doctors and therapists are working for less pay than they did 25 years ago. This is because we were all too naive to block managed care from taking over the health care system. Practitioners have to work twice as hard for one-half the pay. This needs to change. The 80-20 Indemnity plan will have less expensive co-pays for the patients and practitioners can earn a better living. The insurance companies will have to take the hit and this can be mitigated by stopping frivolous law suits against doctors and insurance companies.

American medicine is a national embarassment. Now would be a good time to fix it.

As a doctor I can say I work hard, very hard, for nothing like the money I would be making if I had chosen law or business, or some other form of paper pushing, and with much higher stress. That is not a complaint – I chose this profession and every day I have the privilege of caring for people in a very real way, which just has got to be more fulfilling than selling widgets or just about anything else I can think of. however, our system is broken and I would like to see it fixed. Here is what we need to do:

Create a single-payer system that provides care at a reasonable cost to EVERY PERSON in the U.S.

Make sure that no non-physician bureaucrat makes any more money than the lowest paid full-time primary care provider in the country.

Stop overpaying radiologists, dermatologists, and orthopaedic surgeons.

Cut out the miriad middle-men who skim off billions of dollars/year.

Stop paying pharmaceutical companies so much for drugs.

Stop spending so much on the last 3 months of people’s lives – ration critial care services. Do away with the concept of actively having to make people DNR when over 60 – rather, people should have to opt in by signing PRM (please resuscitate me) papers and agree that their estate will pay the costs when the heroic measures don’t work.

Take medical malpractice out of the hands of lawyers. Fix the tort system.

As a Registered Nurse since 1995, primarily in OBGYN/Labor and Delivery, but with a Generalist background for 4 years while Active Duty Navy, I can honestly say we are headed for the perfect storm in Health Care. All of the issues listed on this blog, Plus:

1) Such completely unrealistic patient expectation, that it borders on Fantastical( Disclaimer: I think I may have made up this word…) i.e. ACOG’s endorsement of C/sec’s on patient demand. Since when does the patient have the years of theory and experience of Fetal/Maternal Medicine to march in and demand a C/sec, because they are afraid of ruining their vagina?

2) The Aging, Obese, Sedentary life style and SAD ( Standard American Diet) causing 1/3 of our
society to be obsese with an enormous number of expensive Co Morbidities.

3) The over use of the limited health care resources used by the aforementioned group, what percentage of American’s would die without a week of their Meds, perhaps a 1/3, that’s pretty scary, especially when most of those disease states are life style preventable.

4) EMR as the answer, give me a break! I work at a large HMO in Southern Cal. and we just went to 100% EMR, Inpatient and Outpatient, and I will admit it does help tremendously with certain aspects of Bedside care, i.e instant look up of patient’s entire Medical Hx, current labs etc, it also adds about 1 to 2 hours to every 8 hour shift, in the shear volume of information, mostly useless regulatory charting requirments that you have to pick through to get what you are looking for, that it takes me 10 to 20 mins just to read all the notes, labs and etc to present the patient to my brain so I can telephone triage their complaint. Now I have this time, I am a RN, but providers in the clinic who are double and triple booked into 20 min slots, Yeah ROB, doctors work 20 hours a week? According to my math it is more like a 60 to 80 hour work week, depending on how many patient’s they see, which has to be A LOT b/o cr—y reimbursement, Would a great Hair Dresser charge anything less than $100 for a 20 min Hair Cut? Not where I live and how much education do they have? 1 year? But women pay this amount routinely. If you break down the hourly rate and thtow in overhead, I can assure you they do not make a ton, with the exception of Orthopedic and Plastic Surgeons. Compared to my Attorney brother in law who works 60 hours a week, makes $250,000 per year plus a guranteed $100,000 yearly bonus, and he does not have to nightly worry about being sued, or that he forgot something in the daily INSANE multi tasking that has to be done to stay afloat. AND I can guarantee it will not decrease Med errors.

5) Finally, this Economic crisis, which comes at the same time as the Health Care Crisis, Education Crisis, Food and Water shortages caused in part by Climate Change, and an exploding population,
and WOW, I am going to make as much money as I can now, buy a VW van and a Yurt and hope for the best. Thank You to all my fellow Care Givers who routinely put the needs of our patient’s before our own. I can’t count , the times are too numerous, how many times I have skipped lunch and breaks in a 12 hour shift and held my bladder for 10 or more hours, just to make sure that the 15 patient’s I was in charge of with just myself and a Corpsman, were medicated for their pain and calm and comfortable. How many other profession’s require this?

Sincerely, A Frustrated Nurse, Lisa

There are lot of expectations from Obama. The first step is as the proverb goes ‘Physician Heal Thyself’. The medical fraternity needs to clearly chalk out the problem areas concerning each and every medical body, to stem out a program which is a ideal solution voicing the concerns of many. It would not be a bad idea to get people from main stream into the medical training and thus weed out the pertinent shortage issue, reducing stress on the doctors. As for Obama he surely has his hands full at the moment, but he would not hesitate to spark up reforms for CHANGE……….