Why Some Physicians Give up Practicing

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The medical school graduates of the United States and Canada are among the best and brightest of their generation. Why they choose the lofty profession may be for reasons known but to them; although the old standbys of altruism, excitement, profit, and status probably lead the list. The bigger question is why physicians of any age would leave their chosen profession.

Older docs who practiced through the “golden age” of medicine can recall when they were an honored part of the community in a much less litigious society. They could spend their 15 minutes or longer with a patient, hear their complaints, and even discuss their families. They could prescribe treatments, medicine, and tests without getting the consent of a clerk at the insurance company. They worked long, hard hours and were paid for their efforts.

The advent of HMOs and insurance oversight has created a behemoth industry that went astray. They now control how many patients a physician must see in a day, what their remuneration will be, make demands for redundant documents, and limit their ability to practice. Warm and fuzzy is a thing of the past. It is one of the most frequent reasons cited by physicians leaving practice before reaching retirement.

There have been countless stories through the years of physicians facing disenchantment with the managed care system that has become so popular among employers and even state governments for their Medicaid population. Many docs have decided it is far better to treat an indigent patient for free rather than accept government funds and the plethora of paper accompanying it. Physicians regularly explain that they must hire another staff member just to process the mountains of requests and demands of oversight. One chart analyst hired to copy pertinent data from Medicare charts for an insurance contractor, came away in disgust; explaining a full one third of the files are filled with requests for what she deemed “busy work”. The insurance company required the physician to document all the glucose levels drawn, so that a company employee could assure the treatment was acceptable. It is anecdotal; but typical.

When it comes to younger practitioners, JAMA estimates 83.2% need finance their education with a mean debt of $80,000. That’s a number that continues to rise. While they may be less sensitive to the radical changes in the profession over the recent decade, some will practice long enough to discharge their financial obligations to work off government grants and loan forgiveness; then move into the more lucrative and growing business of medicine. Others find the practice of medicine lacks the challenge they envisioned, that it requires more business acumen than they are willing to devote, and the never ending politics of hospital life does nothing to retain their idealistic hopes when deciding to become a physician. There are far less stressful occupations with greater rewards of time, money, and status.

Though doctors are leaving the practice, not all are abandoning patients. A larger number of graduates can be found with M.D.-PhD credentials. They are frequently involved in research and are making even greater strides for the medical community. Opportunities to use their skills are expanding.

As for medical school admissions, there are now more opportunities in other fields that draw the interest of applicants. Technical fields are as prestigious as medicine once was; and business alternatives lack the heavy regulatory mandates of medicine. However, there is one thing patients may take comfort in: those who decide to practice know what they want and it is to care for others despite the inconveniences.

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