“I want to be a doctor.”
It’s a bold decision. Some people make the choice when they are in elementary school, and realize how much they love playing “Operation,” and some people will make the same decision when they have long since finished college. People may choose to practice medicine because of a love for science, parental influence, a simple desire to help people, or many other reasons. But many of those who follow this path through residency will not end up happy. For many people, becoming a medical professional will be very rewarding. But for an increasing number of people, the job is miserable.
Nobody expects a doctor’s job to be easy, and hopefully, if they choose to take on such a demanding position, doctors must enjoy their work. However, in a 2008 survey of nearly 12,000 doctors, 45 percent say they’d retire if they could afford to. Nine out of ten doctors wouldn’t even recommend becoming a doctor. Doctors do so much for us, but the current healthcare system is failing them, and in turn, making matters worse for their patients. Why is this happening?
Primary care doctors are the first people to see patients with unknown health problems, and they are the most discontent of all physicians. Dr. Greg Polites directs WUSTL’s MedPrep program, which is designed for two things: firstly, to encourage students to consider whether they will truly enjoy practicing medicine, and secondly, to better prepare them to enter the medical field if they remain set on their course. Polites cites the shortage of physicians as a major problem, especially for primary care doctors who must see an overwhelming number of patients. “You have to see more patients in order to be able to not only have a good income but to really have a successful practice,” Polites says.
In 2014, as millions of people become newly insured under the Affordable Care Act, the demand for primary care doctors is greater than ever. At the same time, primary care subspecialties are becoming less popular fields for medical school graduates; In 2009, while 35 of doctors worked in primary care, only about 20 percent of medical students were choosing this path.
Picture that: fewer and fewer medical school graduates choose to be primary care doctors, while more and more people need primary care. As a result, doctors have less time to meet with each patient. To make matters worse, physicians also need to make time for an escalating number of non-clinical duties, from insurance paperwork to prescription forms. The average clinic visit has been reduced to 12 minutes per patient. Dr. Amy Loden, an internist at Barnes-Jewish Hospital, expresses that, while she and her coworkers generally enjoy their work, she finds paperwork and regulations on her practice troubling. “I shouldn’t have to be burdened with insurance requirements or government requirements in order to have a conversation with my patient,” Loden asserts. “Insurance companies need to not be involved in the care.”
Loden emphasizes that when physicians have to rush from patient to patient, the patient feels neglected, rushed, and unheard. A minority of doctors report having enough time to interact with every patient. Medicine is a two-way street; doctor-patient relationships with mutual understanding can directly impact the quality of care that physicians provide.
Primary care doctors are also not as paid as well as medical specialists, such as surgeons or eye doctors. Polites believes that primary care physicians experience lower reimbursements for what they do than specialists. A shocking 62 percent of physicians said declining salaries for their work is the largest burden to properly taking care of their patients, with 53 percent saying that finances have caused them to close some practices to certain categories of patients.
Along with physician shortages, excessive paperwork, and low reimbursements, doctors carry many other burdens with their practice. One WUSTL student who aims to become a doctor explained in an anonymous survey that “malpractice insurance is huge…medical school tuition is huge…training is so long and rigorous…the current healthcare industry is completely changing.”
So what is the solution? Polites believes that with the current overcomplicated healthcare system, we cannot forget the simple idea of giving physicians time to treat their patients. Loden describes the ideal hospital environment as one where the staff works in teams, with each team including the patient, physicians, nurse practitioner or physician assistant, nurse, medical assistant, pharmacist, and social worker. All of these workers should interact with each patient, so that the patient can see the right person at the right time, rather than a physician doing all the work. “Teams of medicine is the future of medicine,” Loden proclaims, mentioning that, while this model is in place at some institutions, improvements still need to be made, especially in the office or clinic setting.
This is not to dissuade anyone who has a strong passion for medicine from following that path. It is important that students understand the challenges they will face, and decide whether or not they are passionate enough to face them. Altruism should never be more important than a passion for the field; as the aforementioned anonymous premed WUSTL student puts it “wanting to help people is a major part of it…but a love for medicine may be actually more important.” If you are considering becoming a doctor, Dr. Polites would advise you to “think about what it is that’s going to make you happy in 20 or 30 or 40 years…Ask [yourself], why is it that you want a career in medicine?…Take the time to investigate what physicians really do on a day-to-day basis…[realize] that all the sacrifices are something that you consider secondary to your overall passion.”