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Telling it like it is in matters of child and adolescent mental health.
About Me
- Dr. A
- I am an M.D. who is a child and adolescent psychiatrist practicing in the Mid-Atlantic region.
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A Symptom of a Flawed Health Care System
Lately in the media, others have said and expressed concern about the progressive and future shortage of primary care doctors, most notably. Typically, the main reason stated for this shortage is lack of pay of this particular specialty compared with other specialties chosen by potential physicians.
Yet considering the additional attention of shortages of students in some medical schools, one could posit as to whether or not others wish to seek the profession of a doctor, considering the present state of the health care system in the United States. This reason alone is understandable, regardless of other possible reasons, such as the pay issue along with having to spend about a third of your life training for this vocation.
There is also the issue or concern of long hours typically associated with working as a doctor with many specialties. Furthermore, doctors lately find themselves employed by health care systems and are required to see a certain number of patients a day. Furthermore, these doctors receive a monetary bonus if this expectation is exceeded. It seems that most doctors are members of such health care systems presently for reasons such as receiving malpractice insurance and other benefits. Yet requirements by these health care systems of thier doctors not only could possibly be a catalyst for the doctor becoming demoralized or burned out from thier profession, along with such requirements from thier employers are viewed by many as being very demeaning to the doctor, who also has lost the control the doctor is not only entitled to regarding patient care, but is a necessity for quality treatment of thier patients to occur. This is why doctors tolerate such a large amount of training and experience to be a doctor.
Relief from being overworked has been found by the recent increases in hospitalists, who are those doctors that are usually Internal Medicine doctors who specialize only in patients presently under hospital care, and they have lessened the load for all doctor specialties for the work they do that these admitting doctors would have to do without the presence of hospitalists. This in itself makes a doctor possibly more effective and efficient in their practice outside of the medical institution.
All doctors, I presume, face a high degree of emotional and physical stress associated with their profession, as stated in the previous paragraph, for example. And this is not to mention the incredible stress associated with patient care in the first place, with some patient cases causing more stress than others for the doctor. Then there is also the large amount of debt many doctors have after thier training is complete, which is another stress factor for them.
Doctors, due to the changes that have occurred recently in the U.S. health care system, not only have the issue of money to deal with, but also a loss of autonomy regarding patient care combined with loss of respect that may be due in large part to others dictating on how they practice medicine. Ironically and often, these others are not as qualified as the doctor in the first place who instruct doctors regarding the care they give thier patients. This is complicated by the perception of members of the public, with some who view doctors as having the easy life with their pay and profession, which does not seem to be the case presently.
Doctors are burdened more by malpractice issues than others consider, possibly. Some have said about 90 percent of malpractice cases against a doctor are baseless and without merit, so they are unsuccessful for the plaintiff, yet this still affects the rate the doctor has to pay for malpractice insurance. I understand that simply filing a lawsuit against a doctor, as frivolous as it may be, still increases the malpractice premium of that doctor. This is combined with the amount the doctor has to spend to defend themselves in such cases, which approaches about 100,000 dollars over the course of about 4 years for such cases. A tort reform in Texas in 2004 resulted in annual malpractice premiums reduced by about a third of what they were. Soon afterwards, claims against doctors remarkably dropped by about 50 percent. Some specialties of doctors pay more premiums for malpractice than others. For example, OB/GYN doctors have been known to pay around 300 thousand dollars a year for thier malpractice insurance. Certain types of surgeons experience a similar high rate of malpractice premiums.
Also, about a third of the U.S. is insured by Medicare, which progressively has lowered at times what they will reimburse a doctor for regarding the care they give a patient they treat. This fact is recognized by other insurance companies who will eventually follow the recommendations of Medicare, usually, regarding the reimbursement issue, so it seems. This will lead to a doctor having to see even more patients in order to make it financially with their profession, as this has resulted in the overall income of a doctor experiencing a decline of about 10 percent over the last decade, some have concluded.
Furthermore, as mentioned earlier, doctors normally have to pay off the debt acquired from attending medical school, which averages well over 100,000 dollars today after their training. About 20 years ago, that debt was only about a fifth of what it is today. Paying this debt off is typically about 2 thousand dollars a month that doctors on average that they have to pay in order to eliminate this debt in a timely fashion. There are some who believe that doctors in the U.S. are over-paid. This may be true, but they are not absent of financial concerns as with any other profession.
Most doctors do not recommend their profession to others for such reasons stated in this article, and perhaps others reasons not mentioned. This is somewhat understandable, yet extremely unfortunate for the health of the public in the future, especially. There have been cases where doctors do in fact change careers, and get into vocational fields such as medical communications or become employees of corporate medical companies. Also, expert witnessing is another consideration for those who choose to leave their profession. Finally, other choices considered include consulting and research. The training of doctors fortunately leaves them with options not involved directly with the flaws of medical care, but this is bad for us as citizens, overall.
Not all doctors are saints. Like others, some are greedy and corrupt, which complicates others in this profession. Personally, I believe that the intentions of most physicians are bonafide. Yet in time, due to the nature of the current health care system, doctors frequently become cynical and apathetic, and this may be considered a significant concern to the well-being of those in need of restoration of their health who may be thier patients receiving treatment from who may be quite vexed and angry health care providers.
Not long ago, the medical profession that has been discussed had honor and an element of nobility. Such traits are not as visible anymore, which saddens many intimate with the profession that is greatly needed by many.
“In nothing do men more nearly approach the Gods then in giving health to men.”
--- Cicero
Dan Abshear
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