Still Want to be an MD

In the letters to the editor section of today’s (9/16/08) USA Today, there was a grim quote that I thought worth repeating. It was in response to their article on “Boomers May See Doctor Shortage” and is by a Dr. JA McErlean.

“Imagine how many applicants would apply for this job description: ‘Idealistic Generation X/Y overachievers with low- to mid-six-figure student loans to work in imploding health care system currently subject to runaway entitlement spending. Future salary to be subject to government whim and guaranteed not to keep up with inflation. Will be subject to unreasonable expectations of patients and held responsible for less-than-perfect outcomes by consumer advocates and trial lawyers. Must be able to work 70-80 hours per week, not including on-call duties, and place family obligations a distant second to career pursuits.'”

This points out so many issues that I am not sure how to respond:

  • Student loans and college tuition – a runaway issue that seems to be getting better as colleges are more willing to allocate their funds to support students with grants.
  • Imploding system – clearly a system in turmoil, but aren’t most. Just look at our financial system here in the US with Lehman Brothers filing for bankruptcy.
  • Entitlement spending – not my best area of knowledge so I won’t comment.
  • Payment schedule – definitely an issue. How to compensate physicians and motivate physicians to drive outcomes is a complex problem which has to be fixed. What is appropriate compensation for an hour of work is a complex problem looking across how teachers, doctors, CEOs, line auto workers, and others get paid.
  • Patient expectations – not sure on this one. I think I could find people in every line of business from professional athlete to landscaping that would complain about customer expectations. I think some of this gets back to a better system (technology) and the right incentives. No more limiting the interaction to 15 minutes.
  • Perfect outcomes and litigation – obvious physicians aren’t the only one responsible for outcomes. Medicine isn’t an exact science (yet). Patients have a lot of responsibility for adherence and diet among other things. Litigation is and has been an issue for years.
  • Working long hours – I think lots of people suffer from this. I agree that generally physicians work more hours than lots of people which seems risky to me since that has to increase to probability of an error.
  • Balance – anyone pursuing a career with a family has this tradeoff and balance issue to deal with.

I guess it all depends on what you want out of life and your career. We would all like to find the well paid job with average hours which allowed us to control our schedule had understanding customers and where we are doing work that we are passionate about. I think physicians do have it hard, but I would expect that many hard-working Americans who can’t even make ends meet working two jobs won’t be real empathetic.

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