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Center for Health Journalism

Whether retiring or fleeing, doctors are leaving health care

Whether retiring or fleeing, doctors are leaving health care

Picture of R. Jan Gurley

In practical terms, we doctors are a fairly elderly bunch. Nationwide, despite churning out roughly 20,000 newly-minted medical school graduates a year, one in three doctors is over 50, and one in four is over 60.

One reason doctors are older than you think -- the training alone takes so many years. Or, as one uber-specialized colleague of mine said, “It’s hard to explain to your five-year-old son, without making him petrified to start kindergarten, that you’re actually in thirty-fifth grade.”

Knowing that one in four doctors will reach retirement age in five years is cause for enough concern. Then, there’s the well-documented doctor shortage coming down the pipe simply because not enough new doctors are being trained to meet the needs of the U.S. population. But do impending changes within the medical industry stand to drive doctors into early retirement? There’s evidence to indicate that it will.

In my previous post, I explained how Electronic Health Records (EHRs) have not materialized as the great panacea that would streamline and improve health care. Doctors have felt the weight of EHRs and are letting people know they are not happy, maybe even unhappy enough to leave the profession. During the Doccupy protest about the implementation of the EPIC EHR in Contra Costa County California’s safety net health system, a mass exodus was reported: “‘Six doctors have left this year,’ said Dr. Keith White, a 22-year pediatrician. ‘We were not ready for EPIC and EPIC was not ready for us,’ White told supervisors. ‘As a result, the providers are struggling to provide safe and effective care for 100,000 citizens of the county, many of whom are very ill. We often feel that we are failing. We are very tired ... many doctors have left and all are considering leaving.’” [emphasis mine]

Was this just one person’s exaggerated viewpoint?

Apparently not. Deloitte’s 2013 survey of over 20,000 physicians notes 62% say that “it is likely that many physicians will retire earlier than planned in the next one to three years. This perception is fairly uniform among all physicians, irrespective of age, gender, or medical specialty.”

And if they’re not retiring outright, doctors say they believe physicians will “scale back practice hours (55 percent) based on how the future of medicine is changing.” None of this is surprising when Deloitte reports that “[s]ix in 10 physicians (57 percent) say that the practice of medicine is in jeopardy.”

Retirement may be more of a problem in safety net systems, and in certain types of specialties, like primary care, where both the workload and the reimbursement rates are worse than other fields of medicine. But fleeing from a field with very high burnout rates is not unique to physicians.

Studies have shown that the idea of replacing primary care physicians with nurse practitioners has one fatal flaw - nurse practitioners, not surprisingly, burn out the same as physicians do when placed in high-stress positions. In the last year, I have personally seen an accelerated rate of both talented doctors and talented nurse practitioners retire early in safety net systems, rather than face the combined worsening workloads and impact of EHR rollouts on patient care.

Accelerated early retirement also leads to a critical mass effect: staff retire early, safety net positions are hard to fill, and the remaining smaller staff of providers tries to shoulder a now-even-more-expanded workload. A vicious downward spiral occurs with even faster burnout, more early retirements.

The fleeing of health care providers, especially in primary care and safety net systems, means that we are rapidly losing large chunks of irreplaceable workforce, even before the expansion of health care coverage occurs. Accelerating staff loss means that the remaining staff are even more at risk, as is patient safety.

How big are these combined effects? What does this mean for your community? Here are some questions for reporters to ask:

1)  How vulnerable is your community? Take a brief survey of your safety net and primary care systems. How many of those providers - doctors and physicians assistants and nurse practitioners - are over 50? Over 60? Is it a larger or smaller proportion than the national average?

2)  How fast is your system crumbling? How many people have retired in the last year? In the last two years?

3)  How replaceable are the losses? Does your community start with an appropriate rate of primary care providers per capita, or not? How long does it take to fill a primary care position in your local system? Is the rate keeping up with the losses? What is being done if there is an issue?

4)  How shaky is patient safety? What happens when a provider retires in your area and there’s no replacement? What are the patients’ stories? How many stories can you find of emergency care being necessary, or poor outcomes occurring, due to provider loss?

5)  What about in other fields - like psychiatrists in safety net systems who care for the profoundly mentally ill, and whose EHRs are supposed to be even more onerous to use? What is their rate of staff loss, and how is patient/staff safety holding up?

6)  Why are your local primary care and safety net providers leaving? Is there any exit interview process whose information you can access? If not - particularly for large health systems - why is no one doing exit interviews? You may want to find and interview providers who retired early. There could be a compelling story there. People who have left in crisis are often more willing to openly discuss the problems that led them to remove themselves from a health system.

This image by juhansonin via Flickr has been cropped.

Comments

Picture of <span class="username">Guest (not verified)</span>

I am skeptical of these surveys of physicians who claim that they will retire if they don't get more money, tort reform, deregulation and less paperwork. The data too conveniently support their cause.

Here's a presentation, http://www.lewin.com/~/media/Lewin/Site_Sections/Publications/3027.pdf Physician Retirement Intentions and Trends, by Thomas R. Konrad, U. North Carolina, with a chart, "Findings: AMA data suggests a possible trend toward lower retirement ages since 1996," based on the AMA Physician Masterfile and other sources, which shows that between 1996 and 2001 doctors were *less* likely to retire between age 60 and 70 than in previous years starting in 1981.

Intention is not actual retirement. The pollster Robert Blendon said that polls were good at determining peoples' feelings, but not at determining what people are actually going to do.

This sounds like the claim that Canadian doctors were moving to the U.S., which turned out to be false.

Fortunately, according to the Deloitte survey, only 5% of doctors are motivated by money. Most of them are motivated by the satisfaction of helping patients.

Picture of <span class="username">Guest (not verified)</span>

I am a 44 year old Family Practice doctor living in Fort Smith, Arkansas. I said I was going to leave medicine for good if Obamacare passed. Obamacare passed and I left for good. I stopped seeing patients in February of 2014. I am now teaching myself computer programming and smartphone app development. Some of us are actually walking the walk.

Picture of <span class="username">Guest (not verified)</span>

I retired from a critical specialty at 57.
How's that for action.

Picture of <span class="username">Guest (not verified)</span>

never thought about getting out until about 4 years ago. always thought I'd retire after 70 or so. now I'm getting out at 64. don't have much savings but I want a position where people are happy. I'd like to deliver pizzas or flowers. I had a family practice and the pay sucked and the government treats you like they own you and insurance companies treat you like dirt. tried urgent care and more and more patients keep coming...sometimes the days are 14 to 15 hours. enough is enough already. bye

Picture of <span class="username">Guest (not verified)</span>

Wow, are you kidding?
Most physicians (especially us Pediatricians) LOVE what we do. The suggestion that I, for instance, closed my practice because I care more about making money than about caring for patients is absurd!
The fact is that supporting a private practice, stocking vaccines, paying taxes and employees costs a lot. Add to that the new costs of EHR programming, training, and implementation; new requirements to hire an Information Technology company and a Quality Assurance Manager; and complexities that increase the need to hire a Biller, a Payroll company, a CPA, a referral coordinator, and etc. The costs begin to skyrocket. Consider at the Same Time, that insurances are paying less, patient medication coverage is being denied, procedure pharmacy and Insurance company contracts are in a state of flux; malpractice insurance costs are up, and etc.

So suddenly you have a lot of money going out, buy little coming in; a ton of paperwork time and very little time to see your patients.

THAT is why so many physicians are closing their practices!

Picture of <span class="username">Guest (not verified)</span>

I know several good physicians who have retired in their late 50s or early 60s in the past 18 months. I know a few more who left practice for private industry or teaching. This IS happening; it is happening now.

It will likely accelerate in the next few years.

And patients are noticing. I had a patient today ask for referral to a new primary care doctor who would "spend more than 30 seconds talking to me." Sadly, I did not know what to tell him, as it is not about personalities as much as it is the system. Those who are leaving are those who feel strongly that the system is dysfunctional, and is interfering with the doctor-patient relationship.

Picture of <span class="username">Guest (not verified)</span>

That's an interesting observation. Is there any hard data? Has a peer-reviewed journal ever published something on doctors leaving the profession (not just saying in surveys that they were planning to leave)?

Picture of <span class="username">Guest (not verified)</span>

Yes It's true. The USA government, in it's wisdom, hired the Rand Corporation to plot the future of Health Care. They have created unmanageable electronic medical records and all matter of cook book criteria and penalties in many aspects. I am a physician and I work hard and really don't have the time or energy to add 20% to my workload to meet government mandated criteria.
Of course we couldn't have a rational national project to produce an effective medical record system, that task has to be left to the sacred free market -- where we now have several hundred competing inadequate systems.
Yes, I do think about retiring sooner than planned!

Picture of <span class="username">Guest (not verified)</span>

I have meetings with North Texas doctors on a regular basis and see they initially resist electronic records but once well versed they come to love them. Most doctors converted over 10 years ago in my area and are seeing safer and much more organized and less cost related record keeping and the big advantage is that Drs enter directly into the e file for change in meds and treatment and it is done, right then. Faster that before and less likely to cause misunderstanding from the old system when Dr would right down on a paper chart lots of scribbles that nurses are later expected to turn into meaningful and accurate life saving correspondence between the two of them. Less bad interpretations has been the cause of less law suits , not to mention much healthier and happier patience. Less time is involved in the exam room and transference of that data to main frame is instantaneous. Options on drugs are right at doctors fingertips and they no longer need to retreat to their private office to look in the PDR for treatments and the info they receive is the most up to date there is, unlike in the volumes of hard backs that might be decades old. So if you have a Dr complaining of having to carry a pad instead of a chart you have a Dr that is well beyond his time in our fast changing technology world. As a professional man in my 60s I work hard to keep up with positive changes and are as competitive in the market as ever and much more organized and accurate. What I read here is disturbing and is highly suspect to being untrue. Doctors are very intelligent people and change in technology is nothing new to them and I cant see many of them would run away from advancements. Medical advancements is exactly what they live their lives in search of.

Picture of <span class="username">Guest (not verified)</span>

Thank you for your comment.

Picture of <span class="username">Guest (not verified)</span>

The main element missing from this person's argument is TIME. Most of my colleagues are seeing half as many patients as they used to. We discuss this every day in the hospitals' lunchrooms.

This person is not a doctor, clearly. (The indignance he expresses is therefore even further removed from reality than his ideas.) You cannot understand the system very well from the outside, if at all; only inasmuch as you find yourself getting inferior care or no care.

A fact, in 2015: Most doctors are seeing HALF the amount of pts. we were before the implementation of heavy EMR. This is an indisputable fact. The proof is the spill-over into the ERs all around the nation. For many people the ER is becoming the only option for care.

If a doctor does not hire a scribe to do his or her EMR work (my scribe follows me around and her salary costs me $40k a year), or is seeing a pt. for more than a few minutes (30 seconds is no longer outrageous for a visit -- something I could never have imagined a few years ago), then you can assume that a doctor's workload has been reduced by a third to (more likely) a half because there is no time to do both!!

Doctors can embrace tech changer that works. Of course we can. The citing of EMR advantages listed in the above comment is flat-out ignorant -- not that some advantages can come with a good EMR system. Of course they can.

But the overwhelming truth that puts all else is the dust is that EMR is bureaucratic and wasteful and eats up all of our time -- just as most of the comments in this section by MDs state. The burden of bureaucratic EMR (the reality of it as it now exists) also completely disrespects our education and our commitment to our profession.

I like the remark in this thread, "The Revenge of the D students on the A students."

See book: The Decline and Fall of American Medicine: Finding a Cure for a Terminal System (2012, NY Editors)

The below quotations is from an op-ed I also submitted with a colleague to the NY Times last year, when the Ebola pt. died in TX. I blamed EMR.

START QUOTE: A top neurologist, who prefers privacy, had this to say:

"Under Obamacare, the bureaucratic regulations have soared and are debilitating. They hammer the ability of any serious person to navigate and work through the system."

He got quiet for a moment, and then added: "What scares the daylights out of me is what if bureaucrats manage to break the system? How would you put it back together, something so intricate."

That is, our medical system with its deep reservoir of specialists, the best in the world and at its peak only about a decade ago -- accrued over so many decades inside a culture more fixed in science and learning, and less in federal control and bureaucracy.

Let us all heed the saying, "Once the glass is broken, it is hard to put it back together."

EHR as it now exists is a nightmare for doctors, and a disadvantage for patients. Could it be a good thing? Yes, if it gets redesigned by doctors who work with it every day.

For now, the greed of billion dollar businesses and their paid politicians and court intellectuals seems to have prevailed, and a nurse is now dying of Ebola in an isolation ward in Dallas.

At the start of this article we wrote, "The problem lies not with individuals, but with a system embraced by those in power with little or no direct clinical experience."

To fill that in: the arrogance of those who make the policies the rest of us have to live with, the ones David Halberstam once called "the best and the brightest" must have said to themselves, "How can we establish control and use our wonderful, brilliant knowledge base to bring order to the rest of the disordered world?" And they applied this logic to American Health Care.
When you start with that kind of arrogance, you get rubbish as the result. You get the last few weeks in Dallas. And then you get the mind numbing realization that this same excessive, and, for now, horribly flawed system is in place all over the country.

(END QUOTE )

Picture of <span class="username">Guest (not verified)</span>

This person is not a doctor, clearly. (The indignence found in his comments is even further removed from reality than his ideas.) You cannot understand the system well from the outside, as a non-provider; only inasmuch as you find yourself getting inferior care or no care.

A fact, in 2015: Most doctors are seeing HALF the amount of pts. we were before the implementation of heavy EMR. This is an indisputable fact. The proof is the spill-over into the ERs all around the nation. For many people the ER is becoming the only option for care.

If a doctor does not hire a scribe to do his or her EMR work (my scribe follows me around and her salary costs me $40k a year), or is seeing a pt. for more than a few minutes (30 seconds is no longer outrageous for a visit -- something I cold never have imagined a few years ago), then you can assume that a doctor's workload has been reduced by a third to (more likely) a half because there is no time to do both!!

Doctors can embrace tech changer that works. Of course we can. The citing of EMR advantages listed in the above comment is flat-out ignorant -- not that some advantages can with a good EMR system. Of course they can.

But the overwhelming truth that puts all else is the dust is that EMR is bureaucratic and wasteful and eats up all of our time -- just as most of the comments in this section written by MDs state. The burden of bureaucratic EMR (the actual reality of it as it now exists) also completely disrespects our education and the sacrifices we went through to get it, and our commitment to our profession.

I like the remark in this thread, "The Revenge of the D students on the A students."

See concise, accurate book: The Decline and Fall of American Medicine: Finding a Cure for a Terminal System (2012, NY Editors)

The below quotation is from an op-ed I also submitted with a colleague to the NY Times last year when the Ebola pt. died in TX:

START QUOTE:

A top neurologist, who prefers privacy, had this to say: "Under Obamacare, the bureaucratic regulations have soared and are debilitating. They hammer the ability of any serious person to navigate and work through the system."

He got quiet for a moment, and then added: "What scares the daylights out of me is what if bureaucrats manage to break the system? How would you put it back together, something so intricate."

That is, our medical system with its deep reservoir of specialists, the best in the world and at its peak only about a decade ago -- accrued over so many decades inside a culture more fixed in science and learning, and less in federal control and bureaucracy.

Let us all heed the saying, "Once the glass is broken, it is hard to put it back together."

EHR as it now exists is a nightmare for doctors, and a disadvantage for patients. Could it be a good thing? Yes, if it gets redesigned by doctors who work with it every day.

For now, the greed of billion dollar businesses and their paid politicians and court intellectuals seems to have prevailed, and a nurse is now dying of Ebola in an isolation ward in Dallas.

At the start of this article we wrote, "The problem lies not with individuals, but with a system embraced by those in power with little or no direct clinical experience."

To fill that in: the arrogance of those who make the policies the rest of us have to live with, the ones David Halberstam once called "the best and the brightest" must have said to themselves, "How can we establish control and use our wonderful, brilliant knowledge base to bring order to the rest of the disordered world?" And they applied this logic to American Health Care.
When you start with that kind of arrogance, you get rubbish as the result. You get the last few weeks in Dallas. And then you get the mind numbing realization that this same excessive, and, for now, horribly flawed system is in place all over the country.

(END QUOTE )

Picture of <span class="username">Guest (not verified)</span>

FACTS:

The average doc spends an average of 12 to 15 minutes documenting (swiping, checking boxes, then revising -- since there are so many scenarios that need "explaining" because not everything fits into a neat little box) -- the average patient encounter.

The average doc spends an average of 3 to 4 minutes dictating (talking into a recording device) the average patient encounter.

EHR documentation takes up a LOT more of the physician's valuable time. That's why they HATE being reduced to clerical work that cuts into their face time with patients.

EHRs are RIFE with problems. I found out that my OWN record was wrong because the nurse practitioner inadvertently swiped that I was DNR (Do Not Resuscitate). This was a HUGE error with the potential of ENDING MY LIFE! When I phoned the office manager about it, she just giggled and said, "Well you know it's easy to do, swiping the wrong thing!" I insisted that documentation that the error had been corrected be mailed to me. Then I changed practices since the entire event made me so uncomfortable and distrusting. I am sure these ERRORS happen all the time!! People, you need to CHECK YOUR MEDICAL RECORDS FOR ACCURACY.

Picture of <span class="username">Guest (not verified)</span>

Yes, the government mandates which are burdensome, costly and most importantly are interfering with the doctor patient relationship, are driving me to retirement at the age of 55. I call this mess the revenge of the D students on the A students.

Picture of <span class="username">Guest (not verified)</span>

Waiting to see if there is going to be a sharp spike in Doctor giving up and leaving the medical practice because of the costs associated with the mandated electronic medical records which is going to be costly for smaller practices and specialists.How can they pass this cost on when the money they are paid for procedures and treatment are being drastically reduced by the Government price setting?.

Picture of <span class="username">Guest (not verified)</span>

My wife is a 53 year old Medical Oncologist and we are making plans for her to scale back her patient hours if possible and retire just as soon as we can. We have 2 high school age kids and fortunately have well funded college investments and are debt-free. This helps our cause but it will still be age 60 before our financial plan would support full retirement. This crazy EMR mess has changed my wife's schedule dramatically and it's hard to imagine it getting much better anytime soon. She enjoys working with patients most of the time but the hassles, shrinking income, and clerical nightmare of EMR has her seriously considering other options. And she is not alone . . .

Picture of <span class="username">Guest (not verified)</span>

The only primary care physicians in our community who have not fled into clinics or retirement are now in 'concierge' practices, i.e., cash practices opting of Medicare (as a temporary way of avoiding reimbursement cuts, EHR, PQRS, MUC's, etc). Specialists are rapidly following suit.

The public understands very little about how many hours physicians work or how much they actually earn per hour. The media continue to engender an entitlement culture regarding health care, without consideration of its cost.

It might help to inform the public about the following:

1) Medicare is underfunded, not because health care costs too much, but because a) the birth rate has declined steadily since 1965 -- the ratio of taxpayers contributing to Medicare vs. Medicare recipients in 1964 was 4 to 1; it is currently 2.1 to 1; by 2029, it will be @ 1:1; b) Americans are living @ 10 years longer now than in 1964 (when Medicare was created), meaning over 400% increase in Medicare utilization per American; and c) the economy has not grown steadily since 1964 -- so the 2.9% Medicare payroll tax represents a smaller annual dollar amount than anticipated.

2) Congress has imposed physician reimbursement cuts in an effort to contain costs, in some specialties more than 33% since 2010. Many practices are unable to cover their overhead expenses.

3) Congress has imposed EHR's PQRS, and MUC to discourage utilization. Time consumed by EHR's is not reimbursed. The cost of utilizing EHR's is significant, and PQRS adds an additional tier of expense and time consumption.

4) The frightening subtext to the increased demands for documentation and reduced reimbursement is that it reflects a devaluation of human life and health in our culture. An unwillingness to adequately pay those who take care of our health suggests a disregard for our well-being.

Picture of <span class="username">Guest (not verified)</span>

There are careers where service to the public is the driving force behind professional life choices as opposed to money. I chose to teach in a state that pays beginner teachers $28,000. Then came the Common Core State Standards which had EVERY teacher in 48 states change EVERYTHING that they have been doing to teach a nationally synchronized set of standards. Oh, yeah and now you have to digitize and record your every move, oh yeah and here are an additional 10 students for you, oh yeah and we are taking away your teaching assistants, funding, and resources-oh yeah and your tenure------

Our we complaining about the poor teachers who have 3 and 4 college degrees who cannot afford rent let alone a mortgage. But in our contract it states, "that I will take as much time, and as many hours as needed to fulfill my duties".

I CHOSE TO SERVE MY COMMUNITY, not to be rich, or even monetarily secure, I guess.

Medicine is a career of service to your community-I'm sorry you have to retire at 50 and 60. Old teachers are tired too, and retire because they chose not to adapt or change!

I feel like this article is very subjective

Picture of <span class="username">Guest (not verified)</span>

I have had other public service jobs prior to becoming a physician, some earning minimum wage and involving very long hours. Some involved teaching in schools. It was not comparable to working as a physician. I don't know if it is quite possible to understand it unless you have been a physician. I actually never give money a thought in my day to day activities. It's just a general feeling that the job is getting more and more impossible to do given all the expectations and regulations, no matter how much time I spend on it. I feel physicians can complain all they want, but all anyone else will hear is that we want more money, and our other concerns generally are not well understood. There is a lot of suspicion/distrust of physicians these days as well, and we can feel that.
In general I believe physicians are a dedicated group with a lot invested in their profession, and it takes a lot to make us leave. I have the utmost respect for teachers though, it is a tough job.

Picture of <span class="username">Guest (not verified)</span>

I Teaching has become a nightmare, with 12 hour days, even on weekends,
BUT - I thought I would loose my husband because of EMR. (I AM talking about his LIFE.) He worked 18 hour days, seven days a week. He was one of the doctors that wanted to make sure that everything was correct and that the lab reports were read, etc.. He helped plenty of patients, but he would have died at that pace. Some of the other doctors got away with not doing their records. Sometimes they would be banned from being paid by an insurance company because they had not done their records. Some of them cut and paste. There are all kinds of ways to cheat on time, but it also cheats the patient's care! Listen to the doctor that said his Do Not Resuscitate block had been checked. It is not about doctor's pay as much as it is patient care. It takes 43 mouse clicks to get a flu shot.
None of these computer systems are compatible, so no one shares records. If the computer system changes, your history is flushed.
I could go on about the horrors, but it is something you have to be close up and personal.
On a side note, I teach special education. My case load has tripled, and the paperwork for each student has quadrupled. The counties around me need the following: 30 special education teachers, 9 special education teachers, another just said multiple special education teachers at each school. We are hiring unlicensed teachers in many open slots, just to get a body.
Still, 12 hours a day is better than 18, and yes I worked every day during my winter break, (even Christmas), trying to get the paperwork done. They charge that time as my leave!.
ANOTHER MISCONCEPTION is that this is OBAMA CARE'S fault. My husband knew that they were going to be forced into EHR five years before Obama became elected. It just turned into the perfect storm.
My husband only takes part time work that have paper charting. We saw this coming and paid everything off.
You have to be there to understand! It has hit PRIMARY CARE very hard.

.

Picture of <span class="username">Guest (not verified)</span>

I lived in a country with socialized medicine for years. How they managed to sell this broken-down concept here in the U.S. still boggles my mind. Here's my guess as to how. The vast majority of Americans have never lived under socialized medicine. Those that have, have no voice in this country. Few will read this post or listen to the millions that have lives under that totally failed system.

Picture of <span class="username">Guest (not verified)</span>

Guido, I don't know where you came up with socialized medicine, since nobody on this discussion mentioned it. Canadian doctors told me that they practice fee-for-service medicine. The Canadian government's single-payer system assumes the role that private insurance companies play here, except they do it with lower administrative costs, and no one is excluded for lack of ability to pay. And they spend about half as much for the same outcomes.

But since you bring it up, there are countries with socialized medicine, like Sweden, that have outcomes and patient satisfaction equal to or better than ours.

When epidemiologists compare the American health care system to other systems, they have to divide it into wealthy and poor Americans, or black and white Americans, because poor and black Americans have significantly worse outcomes than wealthy and white Americans. The Commonwealth Fund published the most recent study to support this. http://www.nejm.org/doi/full/10.1056/NEJMp1406707

This is what happens to Americans who can't afford health care http://www.wsj.com/articles/SB118781024289705455 http://www.nejm.org/doi/full/10.1056/NEJMp1312793 Don't you think people like that would be better off in a Canadian- or British-type system?

I wonder what kind of medical practices you are familiar with and what the socioeconomic mix is. If you have a Park Avenue practice, with affluent patients, American health care looks pretty good. But if you are in a low-income area where people are turned away because they can't afford to pay, or where people lose all their assets to medical costs and go bankrupt, American health care doesn't look too good.

Picture of <span class="username">Guest (not verified)</span>

You are incorrect. There is no monolithic "Canadian health system." It is a hodepodge and operates on a province-by-province basis. E.g., Alberta's system mirrors the U.S. system pre Obamacare. In Saskatchewan it's "socialized" medicine.

Picture of <span class="username">Guest (not verified)</span>

I attempted to return to practice after recovering from a life-threatening illness, feeling that I had been an exemplary physician who had a lot to give. The patient care was rewarding but the EHR crap was a soul-killing waste of time. NOT entering a chart note that could be shared with others but the multitudinous other clicks that ate up hours.
The government mandated EHR and allowed it to be developed by a nurse who became a multi-multi-millionaire (if not a billionaire) by destroying the medical profession, turning highly educated physicians into clerks. Rather than be a force for good, railing against physicians and "big pharm," the government became a supporter of "big programmer." All under the guise of what is basically socialized medicine.
I'm now hoping we all get our food, housing, and transportation government controlled so we can live as well as the Russians in the Soviet times. (As for Sweden as for most European countries, they're beginning to find their medical systems unsupportable financially. Oh, well, nothing lasts forever)

Picture of <span class="username">Guest (not verified)</span>

Hey Norman, try to find a psychiatrist in northern kentucky. Since i left 2 weeks ago, I terminated 3,000 patients due to massive cost overruns because of obamacare. His lies regarding helping me with computer finances was just that. $175,000 with NO government support, but demanded by government. I simply can't afford to work due to massive costs due to obama, massive tax increases, very significant reductions in reimbursement, with lies everywhere..."If you like your doctor..."

Now the government can come in and care for everyone. I was averaging 8 requests a day for disability papers, for over 4 years. I am 1 physician, I fought - if you're fat, clean, came to the appointment by yourself, you are NOT disabled. If you just put that energy into getting a job...

Picture of <span class="username">Guest (not verified)</span>

Listen, I'm a Health Care consumer, too. When I was in my early forties, NO legit Health Insurance Company would Cover me, because of a few minor preexisting conditions. Outrageous!! And folks who worked independently or for small firms (and sometimes Fortune 500 companies) were not covered. So I supported Obama Both times. The HMOs made beaucoup extra work for us, too, and everything had to be preauthorized. EHRs?? The one at the VA I found to be quite adequate (although many OTHER things at the VA are not) but some of the ones floating around out there Do SUCK and this must be corrected. Like other MDs I don't write too well, and dictation is quite cumbersome.

The Problem is we need TRUE reform with Medicare Single Payer. We also need a National Pharmacopia. The Drug prices are still too high and some Generics have actually gone UP in price. CVS and Walgreen's Always overcharge. Rite Aid is not too good, either.

Picture of <span class="username">Guest (not verified)</span>

"There is no such thing as a well-adjusted slave"...Abraham Maslow.

No one likes to be told what to do all day.... and still have to make a 100% on the test, with both hands tied behind your back.

The exodus is coming....as soon as Docs find more meaningful ways to spend their time. Bye bye....and to the Docs out there, start reading Buddhism and learning to live simply. Freedom is essential. Life is short.

Picture of <span class="username">Guest (not verified)</span>

I agree with many of the posts that the private practice of medicine has been killed. I had a thriving internal medicine and geriatrics practice for 16 years. In the past, I loved the practice of medicine. I worked hard, took great care of my patients and earned a nice living. All that changed with obamacare. Increasing patient volume to 30 patients per day could still not support the increasing costs of running a practice. I burnt out from typical 16 hour work days spending many hours per day dealing with beaurocratic headaches an an EMR that was not designed to help me or my patients. I felt the only way to save my life was to leave practice. How can docs take care of everyone in a system that does not take care of us? I had gained weight with no time to exercise or enjoy time with my family. So I closed my practice, became a medical director of a health plan. Now I work 8 hours per day, exercise everyday, eat right and have time with family. I sometimes think to myself, I no longer am saving lives, but leaving practice saved my own life! Obama has ruined our health system. I predict more docs will do as I did.

Picture of <span class="username">Guest (not verified)</span>

I talked about it for a couple of years and I wanted to reach a preset limit to my "net worth". Having paid my kids' college education, and even helping with post college education; Having no mortgage to worry about, and I have a wife that want to keep working on growing her business, I have decided to pull the trigger and start the slow down process. Personally and professionally I was fulfilled. The late hours are the killer. Add to that, the organizational proclivity to place more decision making power in the hands of non-providers who profit by cutting the number of providers. Compounded by the number of "climbers" who figure out how to make more money in management than they made in patient care. I will find a way to keep my lifestyle and not come home exhausted, feet pounding, back aching.

Picture of <span class="username">Guest (not verified)</span>

To all my physician colleagues who actually SEE patients every day:

Yes, non-physician administrators have turned us all in to glorified data entry clerks. My big joke is I took very difficult medical school classes, studied like a maniac, and stayed up all night with sick patients for years, but the most important move I ever made was to take a typing class!

Laugh if you want. But we physicians are SICK TO DEATH of typing all day. Even the hospital, that last bastion of picking up the telephone and dictating a long H&P into it (took about 3-5 minutes), has been replaced by a "new, better" systems of pull-down menus and, you guessed it, typing! Now I need 20-25 minutes at least to crank out an inferior H&P by typing it. What if I get 10 admissions on a Friday night? Arrrhhhggg! I'm typing for 3 hours!!

Not only that, but with the "pull-down-menu-typing" H&P, every section is TIME-STAMPED, meaning the administrators are tracking your every move. And the time-stamping can be used against you legally in court.

Welcome to the brave new world of hospital inpatient work. Got paged at 2 a.m. but didn't do data-entry orders from home on the computer at 2:15 a.m? What? You needed a few hours sleep? You say you need a little rest before getting to the office to see 35 non-compliant patients demanding Xanax, Percocet, and antibiotics?

Well, too bad. The nurses don't accept verbal orders over the phone anymore. It has to be in the infernal computer, TYPED IN BY A DOCTOR.

Don't you feel great now that you assumed all that debt, took all that risk, and lost all those years to be a DATA-ENTRY CLERK???

To be ridiculed and questioned by any and everyone from the receptionist, to the MA, to the LPN, to the RN, to non-physician administrators, don't you just LOVE it?

Don't you dare voice your legitimate concerns, though. You'll be tagged as a "problem" doctor with an attitude problem. You will be reported to administrators by "anonymous" envious complainers via an anonymous computer portal. You WILL be presumed guilty and will in no way to able to address your accuser in person.

Re-read Kafka's Metamorphosis. Once you are a cockroach, you will be stamped on and slammed from then on. No one will be there to defend you. Your colleagues who are generally good guys are too exhausted to try to help you. You're on your own.

See you at McDonalds, flipping burgers. I'll be working the drive-through...with a smile on my face

If all this sound exaggerated, it means you're not practicing medicine on a daily basis with real live patients. Period.

Picture of <span class="username">Guest (not verified)</span>

After almost 30 years of practice in general internal medicine, I'm retiring at ripe age of 59.

Why?

1. Because I have the financial means to do so. (most important)

2. For my health. I'm in good physical condition, but mentally spent and burned out.

3. More free time. When I retire, everyday is Saturday!

4. Spend more time with my family

5. Reduce my liability. No more worries about getting sued!

Picture of <span class="username">Guest (not verified)</span>

No more suboxone patients from my side. The 100 I got will have to look for other physicisns.

Abandonment? Not really. I just left!!

I'm going to get into exercise physiology and medical writing.

Good luck to all fellow docs no matter what. Remember though: don't be miserable. Don't be a victim and NEVER let anyone else denigrate your past.

Picture of <span class="username">Guest (not verified)</span>

I just turned 50, make high 6 figure income and will be done this year. I no longer want to spend 80% of my time typing, checking boxes and regulatory paperwork. I saved up and I am walking away. Medicine is not what it was 10 years ago. Every physician saw this coming. The only ones left will be the ones who can't afford to walk away or the ones who don't want to give up their lifestyle. Unfortunately, that is all that will be left to take care of the rest of us.

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