Folks:
I’ve posted a guest article by a friend who is a trained emergency room doctor. She is explains why she chose to give up medicine. See http://philip.greenspun.com/careers/why-i-gave-up-practicing-medicine
Comments would be welcome.
18 thoughts on “Article by one physician on why she gave up practicing medicine”
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This is not news.. really ! We all know our Health Care System s**ks and every party, including Doctors have a vested interest. Doctors vested interests are primarily a result of the High 6 figure or is it 7 figures now ? education, so I cannot really blame them. More vested are the insurance companies, trial lawyers and conglomorated hospital systems each with slightly different interests. I dont expect it to be fixed unless a universal free health system provides some competition to commerical interests who would be relegated to providing premium health care. Meanwhile a few more medical colleges with free education based solely on real merit (and not what you did last summer in europe) would help alleviate this.
I dated a trauma surgeon for a while. She was a great person, and we had a lot in common…but the hours of her job, the stress involved, and the whole “on call” thing meant that the job could never be compatible with a real relationship.
I’ve worked at startups, and currently own my own company. I’m not a stranger to hard work or long hours.
…but the insane limits on MD production that the AMA put in place to keep the compensation to guild members high results in guild members working insane hours.
USMLE.
Just let foreign doctors practice. They are not idiots.
And what’s the point of certification if you have to have malpractice insurance anyway?
The AMA seems like a textbook example of a lobby group mentioned in Mancur Olson’s Rise and Decline of Nations. It took them until, what, 2006 to admit that what with the greying of the population that there might be some need for more medical schools. Either they have a vested interest or they’re idiots.
The article itself almost seems like it is written by a person who expected otherwise from a profession that is known for wrapping up individual in stress wrap in a room filled with giant stress magnets. The things that gave her pause are generally things one would assume outright are associated with the job. I’m certainly not knocking her choice, computer programmers have no room to talk, but it doesn’t seem like something that was up her alley in the first place. Or perhaps it’s a case of it all getting to her, not related to any specific profession – you could probably find the same story written by a farmer or coal miner.
Anecdotes related to (in the opposite way) but not about article.
One of my oldest friend’s dad has five kids, owns his own practice (and I believe is partners in another), works obscene hours, but I doubt would give it up for anything. He’s been at it for at least 25 years.
For years now I’ve been reading a number of doctors in particular, associated with skeptic sites that probably have around 100 years experience between them, all have families, and all have probably experienced all the same types of stress this doctor has. However, they also perform a vast education service with extra writing, podcasts, conferences, and other outreach work they do. (All four work in hospitals, one now retired, but runs Quackwatch.org.)
Maybe the people I read and know (which are certainly few) are the outliers and your friend is the usual. I don’t know.
Josh: You don’t know my friend (the author)! She was in the PhD program in EECS at MIT and was better at everything than any of the rest of us, though she was simultaneously attending medical school and also serving as a den mother to a group of about 40 MIT undergraduates living in a dormitory. Nothing would stop Chris from handling the job of emergency medicine and also being a mom to three young children. But she has alternatives that are more attractive to continuing in hands-on care.
It seems like the problems with medical practice in the United States is a fig leaf for her wanting to spend more time with her kids.
I worked in medicine (not as an MD, but as an Respiratory Therapist) for many years, and was shocked that managing and maintaining life support for patients in Intensive Care (and in Emergency Rooms, and in regular wards) paid less than slinging HTML and JavaScript. I can do either, but one is a bit more fun, most of the time, and errors seldom result in mortality or morbidity.
I’d be interested to know whether the author would consider working as a physician in another context – either a different speciality, or perhaps in health care systems, as in the UK or France, who have different care foci than the US in their EDs.
This has been in the works for nearly 20 years. I remember how flabbergasted I was when in 1994 or so, Hillary Clinton and I think, NY state, proudly announced that in order to keep health costs low, they were cutting the number of MDs they would graduate, per year. How would that reduce healthcare costs? It is like a person who wants to lose weight, deciding to have a leg amputated…
Joe: I’m sure that she does want to spend time with her kids (even I like spending time with her kids; they are great kids). But she outlines some serious problems with working part-time as a doctor, e.g., the fixed annual insurance premium that is the same for doctors working full-time and for a doctor working part-time (pushes docs out of the work force if they won’t or can’t work full time).
She apparently enjoys working part-time since she does work part-time. She just doesn’t find it practical or attractive to work part-time as a physician treating patients. That’s a problem in a country where there aren’t many doctors and 50 percent of the medical students are female and presumably capable of becoming mothers who will enjoy spending time with their children.
It sounds to me like your friend has made the calculations for her case and made a hard, good decision.
It sounds like to me the points being made are:
1. Emergency departments are hectic and stressful
2. Shifts for ER docs tend to be long
3. Malpractice insurers are unfair to part-time ER MDs by enforcing flat rate premiums
4. It is preferable to work a low-stress, higher paying PT job than a high-stress, high paying job
5. If you don’t see patients you are no longer a “real doctor”
1, 2, and 4 seem fairly obvious. 3 is the only data point I’ve not heard of and seems unfair. 3 also may be part of a sexist or professional bias against women and/or emergency doctors who work part time. 5 matters depending on how much identity is tied into profession/vocation.
I wonder if your friend has considered another specialty: Anesthesiologist and Intensivist come to mind for an ER doc.
Some familiar issues here… My wife is an MD (pediatric hospitalist) in the process of tapering off into retirement. Her malpractice insurance premiums, part of the group policy with her partnership, are the same regardless of whether she works full time, half time, or a couple days per month. @JoeCrawford, I don’t think that’s anything specific to women.
My friends that are ER docs enjoy being able to leave at the end of their shift and not carry a pager, even if it takes some time to unwind from the stress of the ER environment. Nasty ungrateful patients (or, in my wife’s case, nasty ungrateful parents of patients) seem to take more of a psychic toll than the high-stress medicine.
Sounds to me there is a market for entrepreneurial insurance companies to cater to part time docs since the pricing is out of whack. Fewer patients should equal fewer malpractice cases, n’est-ce pas?
Sounds to me like she has been killing herself her whole life overachieving and she just finally realized (thanks to her kids?) that it’s not that fulfilling. Relax, get some balance and enjoy your family / friends / interests – whatever your occupation!
I totally see where she’s coming from. However, I question her conclusion about the need to train more doctors. If the stressful work environment is the result of seeing more patients to keep the compensation high, should we:
A) train more doctors to keep up with demand or
B) train less doctors to raise the compensation per hour and improve work environment.
At some point, if doctors are so rare, couldn’t they demand high pay and short hours? Sounds to me the invisible hand is doing its work. Those with better alternatives are leaving thus reducing supply.
Thoughts?
I suspect that being a mother of young children (with some financial flexibility) had a lot to do with her decision.
So why is it still so hard to get into med school?
I didn’t mean anything by it, Phil. I know of a few old acquaintances who were pretty much as the “smart kids” who would go places, yet went off to college only to come back home after a semester even that much stress was too much for them to handle. Just the way the article was written made it come off the same way, and with my experiences reading others or knowing a few MDs in real life made it seem like the stress was out of control. Like I said – I highly doubt I could even do half of what your friend has gone through.
After reading the piece, I am confused. Did this person not realize what was involved with being an MD when she entered the profession and had kids?
Sorta sounds like she (finally) decided to be a mother before being a career-led achiever. Not particularly remarkable in my opinion. Also, knowing that she was trying to pursue her PhD in engineering (sounds like she never got it) while she was simultaneously in Med school makes her come off as a VERY career minded gal who figured out that having and raising kids at the same time was simply too much.
Again, nothing remarkable, more like common sense ultimately prevailing.
Things change, no matter one’s potential, no matter one’s responsibility to society, no matter one’s gender. There will always be those ready, willing, and able to fill your shoes when you step away, not that you know it at the time. You can only hope it turns out well. For me, stepping away from a top ten percent position from another “what will we do without them” type job, with everyone telling me to wear shades (bright future and all) was not fun at the time. 20/20 hindsight says it was the right decision, as the past fifteen years have been incredibly rewarding, albeit in a very different way. People (one a very close friend) have, in fact, stepped in to continue the mission, and while I miss the old life, I would miss the new life equally. More importantly, life as we know it has not ended, although there is still that whole Mayan calendar thing to deal with . . .