This recent blog post at the Daily Beast does a really nice job summarizing the challenges to being a physician.
I don't find my job as a physician miserable, but I used to. To be more accurate, I used to find being a physician a mix of both the incredibly rewarding and completely unsatisfying, and I suspect that is true of most physicians.
In order to optimize my happiness, I had to make a dramatic shift, and that was leave my former job and large corporate medicine in general, and join a great partner, Garrett Hyman, who is invested in our mutual happiness as a tool to improve patient care. The Daily Beast above highlights how that this is not the norm- physicians feel increasingly obligated to join large corporations as employees because of the burden of compliance with regulations.
Unfortunately, I know some friends and colleagues who are resigning mid-career because of the misery of being a physician in the current climate, and that is both unfortunate and expensive.
The Daily Beast article touches on some of the burdensome frustrations of being a doctor and how this hurts patients, but I'll give another specific one- Meaningful Use.
Meaningful Use is a requirement of CMS (the Centers for Medicare and Medicaid Services) that verifies that not only are we using an electronic medical record (EMR, or EHR for electronic health record), but that we are using it in a "Meaningful" way. To get physicians to comply, they withhold part of our payment, and then give it back if we jump through the appropriate hoops.
Last year, I lost $8000 because of Meaningful Use penalties. I actually met all of the criteria, but because I switched jobs last year, I was not able to present the data to CMS in the format they required. It was basically an $8000 tax because of a logistical quirk of switching employers. Very frustrating and expensive, but it is what it is. These days, it is not uncommon for physicians to just have to "suck it up" and take on these kinds of costs as part of the cost of doing business.
One of the criteria this year is that we have secured communications with patients via our EMR. Now this is where the logistics of CMS becomes super annoying. I am very clearly in the upper 1% of physicians in terms of electronic communication. For most visits, I send patients a secured-email summary of their visit, along with pertinent articles and links to our blog on related topics (e.g., this article on the use of suspension straps, where I have photos and instructions on how to perform the exercises). This very clearly meets the intent of the requirement, BUT because I am sending this information outside of my electronic medical record, it doesn't count.
So I have a choice- use an inferior alternative that pays me more, or take the penalty and communicate in a way that I know patients prefer. I choose to take the penalty. But it comes with a cost- $8000 this year, and the costs escalate over time.
The number of these criteria are not small. For example- we do NOT get paid to counsel our patients about exercise. Rather, we get paid to CLICK A BUTTON that says we did. It's an important difference.
This button pushing is pretty miserable, so why do I refuse to give in and be miserable? Because I perceive that I have a choice. Garrett and I have decided we are going to live by our mission statement, which is KPA- Keep People Active. If something helps patients KPA, we do it. If it doesn't KPA, then we don't. That choice is the difference between being happy and being miserable.
Now, what should a patient do? The thing I'd recommend is become your physician's advocate. It's all about the golden rule- treat others the way you'd want them to treat you. If you want your physician to be free to listen to you, guide you along your journey of being more active, vote in ways that free us to be YOUR advocate.
Because good doctors are disappearing, and it's accelerating. I'd hate to be having this same conversation in a few years when you can't find a doctor to take care of you.
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