Wednesday, August 03, 2005

Paid More and Punished Less

There is a doctor shortage in Arizona. Is this a harbinger of things to come for the rest of the United States as more doctors retire (from aging) or quit (from burnout), and the Baby Boomers of yesterday gradually becomes the Greying Boomers of today?
When Barbara Straining learned it would be more than a month to see a doctor for another bout of bronchitis, she called her physician "back home" in New Jersey to ask him to phone in two prescriptions to a Valley pharmacy.

The quick-fix strategy worked, and the 54-year-old Straining quickly recovered.

But Straining, who moved to Paradise Valley in September with her husband, remains frustrated by the long waits to see a physician and the number of doctors who aren't taking new patients.

Arizona has a large number of health maintenance organizations, or managed-care plans. In fact, about 60 percent of the state's residents who are insured commercially are in managed-care plans, according to the Jim Hertel, publisher of the Arizona Managed Care Newsletter.

Many doctors complain that low reimbursement rates from these plans hurt physicians' income, forcing them to pack in more patients per day and increasing burnout and early retirements.

Still, Dr. Sebastian Lopez, a Phoenix surgeon, said his malpractice premium of $80,000 is hard to swallow in light of low reimbursement rates.

"The answer to the doctor shortage? The answer is we need to get paid more, and we need to get punished less. You can't have somebody who is overworked, underpaid and abused," he said.

Those complaints are being heard in medical schools, where doctors-in-training are choosing non-traditional fields to avoid areas like family practice or delivering babies.

I remember hearing the predictions back in the 80s that there would be a glut of doctors. I never understood why they said that, and now I guess it was just plain wrong.

Unfortunately, medicine is a tough field to go into these days. You have to study hard, get high grades, go to school for at least 11 years (usually while racking up a lot of debt). Then when you get out, you are expected to see a lot of patients, work long hours, manage complex problems, struggle to convince people to change their habits, stay on top of medical advances, deal with mounds of paperwork, have your medical decisions second-guessed by insurance administrators, all while making sure you don't screwup and get sued.

Most of the primary care doctors that I've talked to lately are dissatisfied. One family doctor I met said he works from 7AM and doesn't get home until 11PM, and only sees his family awake every few days. Another family doctor I know came home from work one day to find that his wife of many years had packed up the kids and left him because he was spending so much time working. Medicine is still a noble profession, but altruism can only go so far in attracting new doctors in this kind of environment.

I agree with the suggestion in the article above, that in order to attract more people into the medical profession, doctors need to get paid more and punished less. American society is going to have to give people more reasons to go into (and stay in) medicine and less reasons to avoid it as a profession. Otherwise, what's happening in Arizona will eventually be coming to your town, too.