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Second Opinion: Keeping Doctors in Practice

Leap, Edwin MD

doi: 10.1097/01.EEM.0000445651.50700.c1
Second Opinion

Dr. Leap is a member of Blue Ridge Emergency Physicians, an emergency physician at Oconee Memorial Hospital in Seneca, SC, a member of the board of directors for the South Carolina College of Emergency Physicians, and an op-ed columnist for The Greenville News. He is also the author of three books, Working Knights, Cats Don't Hike, and The Practice Test, all available at , and of his own blog, Follow him @edwinleap. Read his past columns at . This article first appeared in The Greenville News.



The Greenville News, my local newspaper and one for which I write a column, recently ran an in-depth story on the current and pending shortage of physicians in South Carolina. I quite enjoyed it. It gave detailed statistics and discussed the ways that the Palmetto State is hoping to address the looming absence of qualified DOs and MDs.

The problem is more complex, however, than adding warm bodies in lab coats. I am finding over the years that more and more physicians, relatively fresh from training, express their frustration with practice. They express a sense of burnout as early as residency training.

Why is this? Surely it isn't poor screening in college or medical school. I've had the inestimable privilege of lecturing pre-med and medical students in South Carolina, and of recently touring the University of South Carolina School of Medicine. The students are incredible, and frankly I'm glad I'm not competing with them for my medical school spot!

The problem isn't likely to be the rigors of residency training (depending on one's specialty, of course), which has been made kinder and gentler with rules to limit work hours. So we're left with practice itself. What makes older physicians leave early (a well-documented phenomenon) and younger physicians want to leave sooner than ever?

Is it the actual work? Seldom. Most men and women who enter medicine love what they do. They enjoy caring for the sick and injured, providing preventive care, meeting and knowing patients, and making a difference. What they don't love is the endless top-down control so typical of modern medicine.

They find themselves increasingly crushed under the weight of immense government regulations, as small armies of hospital administrators stand over their shoulders with pens and clipboards at the ready. They are endlessly reminded of customer satisfaction surveys that use notoriously poor techniques to determine good or bad care, or of the next meeting, initiative, program, consultancy report, or business plan. Ask your physician friends if I speak the truth, but health care suffers from the same administrative imbalance as higher education. Too many chiefs, too many stressed-out Indians.

Physicians are driven away by the cost of practice as well. It's the reason so many young doctors opt to be employees rather than to open practices or open offices that only accept cash. But whatever model a young physician uses, many have as much as $250,000 in student loan debt on graduation plus interest, thank you very much. That new physician will also be paying at least $20,000 per year in malpractice insurance (on the low end). If that physician takes call in a hospital and sees a significant number of uninsured (or underinsured) patients, then financial stresses are unavoidable, especially because those who are not hospital employees will be paying for health insurance, disability, and other costs for themselves and their employees.



Of course, other issues abound. The much-touted wonder of electronic medical records has made physicians into data-entry clerks who, according to recent research, spend more time at the screen than at the bedside. Pay attention next time you're in the office, ED, or hospital. The mouse is more integral to modern medicine than the stethoscope ever was, and the result is a complex chart designed for billing and data capture but almost indecipherable as a means of communicating useful information. That's not to mention other troubling issues such as epidemic narcotic addiction and Maintenance of Certification, a cash cow that costs physicians huge amounts to be certified by various bodies calling themselves nonprofits but collecting very large sums each year.

In short, students enter medicine to use science and compassion to help the sick, heal the injured, save or comfort the dying, and, of course, make a good living. But now they face a monstrosity, a conglomeration of huge debt controlled by external forces and regulations that treat them more like criminals on parole than caring providers of health care who sacrificed their 20s (and much of their 30s) to do their jobs.

After reading this, some may consider me just another whining doctor in need of a new career. But what I'm actually trying to do is help us prepare for the future. I'll need doctors, too, you know; as will my children and grandchildren. This matters to me.

I'm confident we can keep adding physicians in South Carolina and around the country. The real question is for how long and in what manner they will practice. To borrow from our legal friends, the jury is still out.

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