Sunday, March 21, 2010

Will PCP's Quit?

A survey going around this week projected that if President Obama’s Health Care Reform passed 46% of primary care physicians would quit. Several sites stated that the survey was reprinted in the New England Journal of Medicine though when I searched their site I’m unable to find it. I did find a survery that quotes a figure closer to 33%.

Regardless of the exact number I personally believe a large block of PCPs really would quit.

No, it’s not likely going to happen in the short run. Obviously a lot of hard work and training goes into becoming a doctor and finding a career with similar income levels is going to take some doing. So, again, in the short run most won’t quit. But what about 2, 3 or even 5 years out? Then I would say yes.

First off you have those that could retire. The 50-55+ group. Many of them could simply retire or branch off into another field. Many physicians in this group have older children that are done with college and have left home. Many have made wise investments. Therefore, I’d venture to guess many of them might simply decide it’s not worth it to practice anymore and up and quit.

Secondly, many will probably quickly look for a change such as an administrative position, an academic position or becoming a hospitalist. I’ve personally witnessed this already. There were four of us that were friends in medical school that went into primary care. Of those four I’m the only one left; albeit hanging by a thread. One went into ER and the other two are hospitalists.

Finally, many can and will find new career paths. I’ll never forget the first talent show I went to at my medical school in Cincinnati Ohio. Anyway, every year we had a talent show put on by the students. I staggered out of the auditorium. The amount of talent many of my classmates exhibited just blew me away. I remember thinking had they not wanted to be doctors they surely would have been successful in other areas. Just to name a few, there was the award winning violinist that graduated from West Point, an opera singer and a professional illusionist. This last guy had paid his way by working gigs now and then. Outside of this we had a guy in our class that quit pro-football, a pharmacist and another classmate that was a model. We had numerous engineers. These are intelligent, motivated people with means. If the rules change to the point it no longer makes sense to practice medicine, they can and will change.

This is not new or unique to primary care. I remember commenting to my wife about this very topic, way back 11 years ago in my first year of practice. I had been sitting in the doctor’s lounge at the hospital doing paperwork and was just sort of randomly listening to conversations. I remember going home and telling her that I’d never seen a profession that took so long to achieve your position yet so many were trying to get out.

Don't think it’s just about money. Quality of life has tanked also. Doctors have seen their autonomy and prestige systematically stripped away. Endless forms now need to be filled out for everything from a prior authorization for a medicine to a new set of batteries for a scooter. Rules regarding documentation keep getting ratcheted up and enforced. Medicare uses ex-IRS auditors to look over physician charts. Some insurance companies, under the rouge of increasing quality, rank physicians using dubious means. Most physicians will tell you they are spending more and more time doing paperwork and less seeing patients. EMR’s and e-prescribing are great for tracking diseases and reducing errors but they are expensive and time consuming.

And what about the money? Incomes keep going down. Medicare again has frozen reimbursement, which is in all actuality a pay cut when you factor in inflation and the rising costs to do business. And don’t forget the staggering debt loads. I’ve seen statistics that greater than ten percent of the medical students graduating from a state school today are over two hundred thousand dollars in debt. If this is paid back over 10-15 years it will typically balloon to 1.5 times the principal or three hundred thousand dollars. Do the math, that’s $1667 a month for fifteen years or $2500 a month for ten. This doesn’t include private schools or undergraduate debt.

The final straw will be on the supply side. The percentage of medical students going into primary care has already plummeted. This will only get worse and I suspect will spill over into the specialties.

Medicine will cease to attract the best and brightest students. You figure out the rest

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