Only 6 percent of doctors are happy with their jobs, according to one survey. They commit suicide at twice the rate of the general population. Over half are unsure they would recommend the practice of medicine to young people.
So whats going on?
These are a few things you will discover in Sandeep Jauhars new memoir Doctored. Its being reviewed everywherefor example by The New York Times and Sarah Kliff. Jauhar has his own editorial in the Wall Street Journal. (Ungated version here.) The thesis for most reviewers is that doctors have become like everyone else: insecure, discontent and scared about the future.
But hold on. Doctors arent like other people. Theyre not even like other professionals. Most lawyers, accountants and other professionals I know are quite happy with their jobs. I even know doctors who are happy with their jobs. But these are doctors who have opted out of the third party payer system. That means, they arent dealing with insurance companies, employers or government. Like other professionals, they are just dealing with clients.
Granted, doctors face a kind of stress other professionals are not likely to face. One doctor in residency wrote in The New York Times:
There is a strange machismo that pervades medicine. Doctors, especially fledgling doctors like me, feel pressure to project intellectual, emotional and physical prowess beyond what we truly possess.
He went on to say:
This drastic increase in responsibility can and does overwhelm most interns. Despite the support of my supervisors, my first two months were marked by severe fatigue, numerous clinical errors (that were promptly caught by my supervisors), a constant and haunting fear of hurting my patients and an inescapable sense of inadequacy. I kept up a charade of composure and humor to blend in with my talented colleagues, believing that I was struggling alone. Inside, however, I felt as if I would be found out all too soon.
But these stresses have always been part of the practice of medicine. Whats new is the role of the third party payers.
Just listen to what other doctors have to say. In Letters to the Editor of theWall Street Journal, one doctor wrote about practicing medicine without third-party payers:
I briefly worked in a clinic in Macau where patients paid for everything out of pocket. I had patients ask to postpone tests I had ordered until they got paid, forcing me to have a better conversation about what they needed and when, and why they needed it (or in some cases, didnt really need it at all). As a consequence, they were more engaged in the process, and I believe they received better care.
While Medicare is essentially now requiring electronic medical records (EMR), the redundancy of myriad practitioners entering the same patient details is not only frustrating but costly because almost all independent practices cannot share or transfer information as simple as a patients medications. Moreover, Medicare EMR requirements arent specialty specific, thereby requiring me to record irrelevant information that I have never been trained to assess, yet alone treat. These requirements not only necessitate the hiring and training of additional employees, but also expose me to legal liability.
Why should you care? Unhappy doctors make for unhappy patients, writes Jauhar. He explains:
Patients today are increasingly disenchanted with a medical system that is often indifferent toward their needs. Patients used to talk about my doctor. Now, in a given year, Medicare patients see on average two primary care physicians and five specialists, working in four separate practices. For many of us it is rare to find a primary care physician who can remember us from visit to visit, let alone come to know us in depth or with any meaning or relevancy... Insensitivity in patient-doctor interactions had become almost normal.
So where can you find doctors who are happy with the practice of medicine? I suspect that most doctorscertainly older doctorswould like to practice the way Marcus Welby (of 1970s TV) practiced. They have ended up with something akin to Lucille Balls predicament in the chocolate factory.
Some are finding a way out with what is sometimes called concierge medicine or direct care. This is practiced by doctors who step outside the traditional health insurance system. As I wrote previously:
In most cases, they give their patients same day or next day service. They talk to their patients by phone and email. If their patients have to go to the emergency room, they are likely to meet them there. They serve as agents for their patients in dealing with the rest of the system: ordering tests, getting appointments with specialists, etc.
Further, I think concierge medicine is not for the elite few. We all could have a concierge doctor if we freed doctors and patients to relate the way other professionals and their clients relate.