The disenchanted practice of medicine is often found to encompass those who have been at it for many years.  Then there are the newbies, not yet out of medical school, encountering the dynamics of clinical rotations, but eyes and ears wide open to get a clearer understanding of how to select a residency training program to best suit their lifelong careers in medicine.  Now, more than ever, the voices of mentors and far less senior clinicians are having greater impact on the future career decisions of medical school grads and early retirement of others.  There is mounting intolerance to corporate directives, second to the short-sighted corporate decisions made on their behalf by administrators.  It is far more challenging and uncertain as to how to plan for the future.  One cannot just go with what one’s heart and inherent talents lead one to, but rather how to hopefully align with the future state of health care.  

There is an increasing shift in health care toward primary care, the same trend spoken of when I was graduating from medical school in the late 1990s.  The number of new medical school grads going into primary care has gone up.  The number of medical students committing to primary care rather than specialties increased for the fourth straight year.  However, the majority of those are foreign medical graduates.  U.S. students filled only about 50% of the primary care jobs, which typically pay less than specialties and also have longer work hours. Refer to Match Day: More medical graduates entering primary care by Janice Lloyd, USA TODAY 2:16 p.m. EDT March 15, 2013.

The more relevant factoid is that there are more physicians leaving the practice of medicine at a time when there is greater demand.  With government expansion of health care and the aging population, there will be a tremendous shortage of doctors in the next decade.  There will be a greater impetus placed on physicians to crank out patient encounters, where their income is largely based on relative value units (RVUs) and prodded by administrators looking at a computer screen at corporate hundreds of miles away.  This is a failing business methodology as it relates to quality health care.  It eviscerates the essence and excellence of medical school training, undermines those who have chosen to dedicate their lives to practicing medicine, and is an outright shame.  “Something has to change, or the plight of doctors will get even worse.”  Refer to The Conversation: Responses and Reverberation by Frank L. Urban, MD, MBA, The Atlantic, Jan/Feb 2015, p.14.  Dr. Urbano further states that what many physicians experience far sooner into their careers and thereafter is that “We are paid to see as many patients as possible in as little time as possible … We are increasingly under pressure to work for less and for less pay.  What begins as true dedication ends up being unrecognizable.”  The push for rapid office visits and high-tech diagnostics driven by insurers, medical-malpractice litigation and healthcare organizations does not serve the needs of patients or physicians appropriately.  Read Doctors Tell All – and It’s Bad by Meghan O’ Rourke, The Atlantic, Oct. 14, 2014

It is not necessary to always be a player to be a coach when making key decisions, but you must be present.  Holistically sound business strategies can be well aligned with delivering excellent health care while maintaining the integrity, passion and dedication of physicians.  Currently, corporatization of the U.S. healthcare system remains well suited as a means to make money in the stock market and far less so in offering quality and easy access to preventative care, improved maternal-fetal wellness or simply overall longevity.  Read The Healing of America:  A Global Quest for Better, Cheaper, and Fairer Health Care by T.R. Reid, 2010.

Mentoring through membership with collegial support while growing physician leaders and physician administrators can make a difference. 


Lukas Kolm, MD, MPH

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