The Modern Physician: Just Another Job

Scott Sturman

fliesinyoureyes.com

Zhangmu (Chinese name), Tibet - photo by JoAnn Sturman

There is a disturbing trend in medicine.  An increasing number of doctors are perfectly content to work for someone else rather for themselves and their own patients.  It is not uncommon for the press to portray those in private practice as out of touch, money driven, and non collaborative.  Conversely, those willing to work as employees are extolled as balanced, tech savvy professionals, whose occupation may as well be a hobby as a calling.  It is as if the well rested, non stressed, feel good physician has ascended to the pinnacle medical profession.  One hopes this new paradigm will be able to handle a life threatening emergency at 3 AM, if they are not too tired, that is.

Parallels abound in the business world, too.  Why subject oneself to the pressures of making decisions day and night, hiring and firing, paying payroll and rent, and maneuvering through a morass of regulations, when simply working for someone else avoids the angst?  As foreign as it may seem to the pampered, dependent class, there are those among us who insist upon being their own boss and enjoy the added responsibility and the pleasures which go along with it.

What is provoking this outburst?  A front page article with the ho hum title, “Today’s Doctors Want More Balanced Lives Than Elders” in Pravda’s local subsidiary The Fresno Bee is the culprit.  The reader is reassured today’s physicians are not forced to work long hours like previous generations, and they can look forward to a career of punching a time clock, all in the name of being team players.  Much of this good news is possible due to the hype and inflated expectations surrounding the electronic medical record and visions of doctors at the patient’s bedside entering data on their iPads.  No need for eye contact or holding a hand, a good bedside manner was always over rated.

There is some data which supports the changing scope of medicine:

• A 2011 survey by the recruitment firm Merritt Hawkins found only 1% of physicians seek a solo practice.

• In 1977 20% of medical school graduates were female.  Now it is 50%.

• As recently as 2005 7% of male doctors and 29% of female doctors worked part time.  Now the percentages have risen to 20% and 44% respectively.

• In 2003 medical residents were restricted to an 80 hour work week with maximum shifts of 16 hours.

Medical schools are selecting for a different type of physician: a physician who clearly has no problem being an employee and who will not have to undergo the rigorous training requirements of prior generations in order to do so.  Young physicians are duped into looking at their noble career as a part time job where early retirement is the norm and empathy and the traditional physician patient relationship are secondary to technology.  In this new world patients are a number, not a name, and their physicians as passionate about their work as a short order cook slapping a beef patty on a toasted bun.

The part time physician mindset contributes to the persistent shortage of physicians; many simply do not practice long enough to justify the length and expense of training.  Talented and qualified as they may be, it is a misallocation of resources to spend 12-17 years in training  and to assume $250,000 - $500,000 of debt, then to decide in one’s 30s or early 40s to throw in the towel.  It is not difficult to understand the insouciance of physicians when it comes to defending their profession, when years of one’s life and hundreds of thousands of dollars worth of investment is cast away like an old pair of shoes.  

To be fair, many young aspiring physicians have the motivation, talent, and confidence to call the shots after completion of their formal education, but whereas my generation had the option of doing so, this opportunity is increasingly more difficult to be found.  The system has been reconstructed to discourage the establishment of independent practices by permitting insurance companies and government agencies to control medical economics and patient access to care.  The mass of paperwork and diminishing reimbursements serve as a powerful disincentive for any physician wishing to practice free of outside interference.  Innovative solutions like medical savings accounts, where the patient maintains control of medical finances and is free to enter into non coercive professional relationships with their doctors, has been stymied at every turn by bureaucrats and the insurance industry alike.   

Ayn Rand talked about the degradation of the medical profession in her book Atlas Shrugged.  When men and women trained in society’s most crucial profession acquiesce to politicians by capitulating to their demands and accepting the premise that others have a right to their services, then the independent, free thinking physician ceases to exist. 

Khasa (Nepali name), Tibet - photo by JoAnn Sturman