Where have all the doctors gone?

[Anonymous]

Insurance and politicians who get donations are the problem.

If I told you average income for X job was 170k in 2010, what do you expect that income to be today? Does 179K sounds normal 14 yrs later? Guess what, that is the average salary of a dentist in the US from 2010 vs Today!!! How in the world are we supposed to not squeeze in a ton of patients and work fast and brush over the complaints when we have lives that we have to pay for too?? explain this to me!!

[Anonymous]

Anonymous wrote:Insurance and politicians who get donations are the problem.

If I told you average income for X job was 170k in 2010, what do you expect that income to be today? Does 179K sounds normal 14 yrs later? Guess what, that is the average salary of a dentist in the US from 2010 vs Today!!! How in the world are we supposed to not squeeze in a ton of patients and work fast and brush over the complaints when we have lives that we have to pay for too?? explain this to me!!

Yup. And people’s insurance premiums have sure gone up more than 6% in the past 14 years. So if insurance companies are making 25% more than they did in 2010, and paying the doctors only 6% more…. tell me if you should be yelling at the doctors or the insurance companies.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Insurance and politicians who get donations are the problem.

If I told you average income for X job was 170k in 2010, what do you expect that income to be today? Does 179K sounds normal 14 yrs later? Guess what, that is the average salary of a dentist in the US from 2010 vs Today!!! How in the world are we supposed to not squeeze in a ton of patients and work fast and brush over the complaints when we have lives that we have to pay for too?? explain this to me!!

Yup. And people’s insurance premiums have sure gone up more than 6% in the past 14 years. So if insurance companies are making 25% more than they did in 2010, and paying the doctors only 6% more…. tell me if you should be yelling at the doctors or the insurance companies.

Or alternatively if you should be yelling at your fellow patients like the one who casually mentioned her multiple recent CT scans for a mystery ailment that no doctor can solve, or the lady in the other thread asking for a plastic surgeon to do surgery on her dead fingernail. Insurances have to pay those ridiculous claims for those totally wasteful visits.

[Anonymous]

I think I said this earlier but my wife mamogram got denied even though the doctor's office made sure all rules are followed. the insurance specifically said they cant collect from me and they are not paying jack for it. who get holding the bag? the admin staff, the clinical staff, the time wasted, the supplies, the person reading the scan and the doctor who ordered the scan all get $0!!! WTF kind of rule is this?? I understand that its in my benefit but come on people...dont be so damn angry. the docs are literraly eating up all the costs. when obama care came out, everyone was wondering who will pay for it and it was said there is a mandate that if you dont have coverage, you still pay....thats long gone and now the docs are covering our tabs.

[Anonymous]

Is there any state or country where a doctor shortage is not a problem? I read about shortages in the UK, France, Italy, Canada, Australia, New Zealand, USA and so on, let alone extreme shortages in developing countries.

Is part of it that medical science can do more so people are lining up for hip replacements, IVF, transplants, heart bypass surgery, miracle medications etc?

[Anonymous]

Anonymous wrote:Is there any state or country where a doctor shortage is not a problem? I read about shortages in the UK, France, Italy, Canada, Australia, New Zealand, USA and so on, let alone extreme shortages in developing countries.

Is part of it that medical science can do more so people are lining up for hip replacements, IVF, transplants, heart bypass surgery, miracle medications etc?

That’s one part of it. People expect miracles. No, demand them. They are angry if their doctor can’t get their 60 year old body back to how it was 40 years ago.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Pay has no increased in decades, docs are leaving networks or choosing to not work for Pennies on the dollar. Thank you Obama care.

All those poor, struggling doctors?

Who have a 100k in student loan debt. Doctors should be paid well to compensate for 8 years of education plus 4-6 years in residency and training working 60-70 hours a week for a lot less pay.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Pay has no increased in decades, docs are leaving networks or choosing to not work for Pennies on the dollar. Thank you Obama care.

All those poor, struggling doctors?

Who have a 100k in student loan debt. Doctors should be paid well to compensate for 8 years of education plus 4-6 years in residency and training working 60-70 hours a week for a lot less pay.

Get rid of the first bachelor degree? I don't understand someone with a four year CS or English degree being able to apply. Why not require a year of applicable sciences then straight into medical school. That's how other countries do it

[Anonymous]

Anonymous wrote:

Anonymous wrote:Every time I read this threads I feel discouraged about becoming a doctor and feel like despite whatever I do it’s not worth it to anyone. That’s def making me consider retiring/ cutting back early. Also more women are entering medicine and they tend to have a higher attrition. I get it- I’m a mom and having to have emotional labor placed on me by patients and my family is tough. At the end of the day, I’ll pick my family over mg patients.

What was your vision when you started your studies? I imagine doctors see a lot of people at their unhappiest.

I can't imagine being a psychiatrist listening to people complaining all day.

I was a nontraditional medical school applicant. I worked for several years in public policy and thought I could make a bigger difference in medicine. I think the hardest part is the amount of administrative burden. The way things work now, we spend less time with our patients (one study found that we spend more time waiting for the elevators with with patients while working inpatient). We have to write tons of notes for even a brief patient interaction, coordinate care which requires a lot of back and forth and messages, and it bleeds into our life outside of the hospital. Not to mention we have the administration double booking patients and adding more and more workload which equals more and more paperwork( and less and less time with patients). Maybe AI can help but otherwise - it’s feels like I make very little difference.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Insurance and politicians who get donations are the problem.

If I told you average income for X job was 170k in 2010, what do you expect that income to be today? Does 179K sounds normal 14 yrs later? Guess what, that is the average salary of a dentist in the US from 2010 vs Today!!! How in the world are we supposed to not squeeze in a ton of patients and work fast and brush over the complaints when we have lives that we have to pay for too?? explain this to me!!

Yup. And people’s insurance premiums have sure gone up more than 6% in the past 14 years. So if insurance companies are making 25% more than they did in 2010, and paying the doctors only 6% more…. tell me if you should be yelling at the doctors or the insurance companies.

Or alternatively if you should be yelling at your fellow patients like the one who casually mentioned her multiple recent CT scans for a mystery ailment that no doctor can solve, or the lady in the other thread asking for a plastic surgeon to do surgery on her dead fingernail. Insurances have to pay those ridiculous claims for those totally wasteful visits.

You mean me... the CT scan (a repeat) showed things getting worse. It's a lung issue. It's clear what it is via google and a virtual doctor but the incompetent primary care and pulmonologists have me suffering for several years. Thank goodness I got some random primary care who repeated the CT to help me prove someone is wrong. (needless to say I changed primary care).

These doctors need to be held accountable for poor care. A simple breathing issue that is easily shown on a CT shouldn't take several years to diagnose (and if anyone knows a good pulmonologist please share).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Every time I read this threads I feel discouraged about becoming a doctor and feel like despite whatever I do it’s not worth it to anyone. That’s def making me consider retiring/ cutting back early. Also more women are entering medicine and they tend to have a higher attrition. I get it- I’m a mom and having to have emotional labor placed on me by patients and my family is tough. At the end of the day, I’ll pick my family over mg patients.

What was your vision when you started your studies? I imagine doctors see a lot of people at their unhappiest.

I can't imagine being a psychiatrist listening to people complaining all day.

I was a nontraditional medical school applicant. I worked for several years in public policy and thought I could make a bigger difference in medicine. I think the hardest part is the amount of administrative burden. The way things work now, we spend less time with our patients (one study found that we spend more time waiting for the elevators with with patients while working inpatient). We have to write tons of notes for even a brief patient interaction, coordinate care which requires a lot of back and forth and messages, and it bleeds into our life outside of the hospital. Not to mention we have the administration double booking patients and adding more and more workload which equals more and more paperwork( and less and less time with patients). Maybe AI can help but otherwise - it’s feels like I make very little difference.

My doctors do notes during the visits.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Pay has no increased in decades, docs are leaving networks or choosing to not work for Pennies on the dollar. Thank you Obama care.

All those poor, struggling doctors?

Who have a 100k in student loan debt. Doctors should be paid well to compensate for 8 years of education plus 4-6 years in residency and training working 60-70 hours a week for a lot less pay.

They are well compensated. They want to be put on a pedestal for being a doctor and those days are long gone.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Pay has no increased in decades, docs are leaving networks or choosing to not work for Pennies on the dollar. Thank you Obama care.

All those poor, struggling doctors?

Who have a 100k in student loan debt. Doctors should be paid well to compensate for 8 years of education plus 4-6 years in residency and training working 60-70 hours a week for a lot less pay.

They are well compensated. They want to be put on a pedestal for being a doctor and those days are long gone.

Sure, but some doctors, like radiologists and dermatologists, get paid too much, while others- namely, PCPs- get paid too little.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Pay has no increased in decades, docs are leaving networks or choosing to not work for Pennies on the dollar. Thank you Obama care.

All those poor, struggling doctors?

Who have a 100k in student loan debt. Doctors should be paid well to compensate for 8 years of education plus 4-6 years in residency and training working 60-70 hours a week for a lot less pay.

They are well compensated. They want to be put on a pedestal for being a doctor and those days are long gone.

Sure, but some doctors, like radiologists and dermatologists, get paid too much, while others- namely, PCPs- get paid too little.

PCPs choose their job. If they want more pay they should do more specialties.

[Anonymous]

Anonymous wrote:We have a broken healthcare system and doctors are reaching the breaking point in many cases:

Since Obamacare, many more people have insurance, so many people are using the system and getting appointments.

Many more people are doctor shopping, looking for doctors who will prescribe self-diagnosed treatments. During the opioid epidemic, the number of people who started doctor shopping, looking for the doctors who would prescribe opiods. That then started the trend which continued during the pandemic with people looking for doctors who were willing to prescribe pandemic related medications. The upshot is that with insurance, many more people were willing to pay a co-pay just to see a doctor and try to get what they wanted.

Insurance is paying lower rates that do not keep up with inflation. For every insurance holding patient, doctors get paid less and less per hour due to the rates that insurance companies are paying for similar service. Worse, insurance companies require extensive documentation and so the doctors have to work more to document everything for the insurance companies, which again decreases their hourly income because they are getting less money for more work. I know some doctors who have added 2-3 hours of documentation to every work day. So they see patients for 8 hours and then spend 11 hours working every day.

Doctors have more and more no-shows and a no-show is essentially lost money. So, to combat no-shows, doctors add 2-3 more patients in an hour to ensure that when a patient fails to show, that they definitely have aother patient waiting and ready to see, so they don't lose money for lost time. This, however, increases the wait time for patients due to multi-booking. The alternative is not to overbook, but then to charge penalties to patients who no-show, but many patients complain about that, too. No-win situation for doctors.

More doctors are leaving private practice and looking for positions that pay more consistently and better. So, many doctors have left private practice and gone into hospital practice. I know several who created doctor services who provide specialty consulting for local hospitals, especially ones that do not have that specialty in their hospital. For example, my twins were delivered and monitored by a NICU practice that had 7 neonatologists who supported three hospitals that did not have on-staff neonatologists. The hospitals were spread around and they doctors rotated around and each essentially covered 3 days in each hospital, had a day or two off, then rotated to another hospital. With the doctors and the rotation, they had a more normal work schedule and they as a team covered the three hospitals which found it easier to contract out that work than to have doctors on staff. The contract agency handled all of their benefits and assorted staffing overhead.

I know several doctors who left private PCP to become concierge doctors. The concierge fees cover their basic expenses and ensure that they aren't making less and less per patient and per hour due to the overhead of insurance costs. They can spend more time per patient and not lose income. It's a much better deal for patients.

Essentially without fully socialized healthcare, the impact of Obamacare type insurance is more care available for more people at the expense of doctors. Doctors are finding ways to not bear the brunt of this and as a result, care for the masses is getting harder and harder to come by.

I liked how you tried to spin it as a defense of Obamacare. Heathcare pretty much went *south* for most people after Obamacare without necessarily adding that many more people to the system. Prior to Obamacare it was around 15% uninsured but even much of that was younger people who rarely saw doctors. We now have far higher deductibles, most of the best doctors are now in concierge practices, the administrative bloat is staggering. And yes, everything is much more expensive.

I don't have a solution but I can clearly point to Obamacare as when the quality and accessibility took a noticeable dive.