Anonymous
Post 03/26/2024 12:22     Subject: Where have all the doctors gone?
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:Quality healthcare still exists but you have to know how to navigate the healthcare system.

Former physician here who went to top schools and training programs. I no longer see patients but rather do different work that is more interesting to me.


So how does that help us regular folks who don’t know how to navigate the system the same way a doctor does? For us, quality healthcare is out of reach.


Just like any other complex system. You figure it out. I’m not a doctor and I manage to navigate it just fine. It isn’t optimal, but nothing in life is optimal.

I also don’t roll into my PCP appt with 10,000 complaints and a stack of pub med citations. So that helps.

That works only if you are not struggling with your health.

Anonymous
Post 03/26/2024 12:21     Subject: Where have all the doctors gone?
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.


If women have higher attrition rates, shouldn't medical schools be admitting more students?

From this thread we've learned that there are more insured patients creating more demand, there are more women entering medicine who are more likely to work part-time, older doctors are retiring, and electronic records and insurance demands are a drain on time. Have medical colleges and residency programs increased the number of graduates to address doctors shortages or is the supply of new doctors capped?
Anonymous
Post 03/26/2024 12:12     Subject: Where have all the doctors gone?
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:I think a lot went to telemedicine.


No, that doesn't pay very well. That is almost always done as a side job when it is done outside their normal practice.


It pays the same.


Not even close, particularly if you're in a specialty area. The pandemic-era billing policies are gone, so reimbursement for telehealth is back to being terrible.


No, the one I use has 3-4 appointments an hour per doctor. They get paid decently when they have zero overhead and working at home.


3 or 4 patients per hour isn't very many. In an office settings most doctors will see at least that many.

A PCP might be able to make a similar amount switching to telehealth, but even that isn't clear. There are different billing levels for visits, and telehealth effectively limits you to the lowest one. And almost any specialist would take a huge pay cut.

It’s 15min per patient including documentation, prescriptions, etc And it’s ALL DAY so all of those “quick” portal questions you send also need to be addressed. If you have a 3k patient panel and each one sends 3 portal messages a year that’s 9k portal messages over 365 days. You do the math.


Our doctors office doesn't answer email. The nurses or techs do. They don't even see them.


And that probably makes a lot of patients really mad. “Can’t I just ask my doctor??? Can’t you just send the message along to them?” And I don’t disagree. But patients sometimes expect too much from doctors who are practicing in the system we have. And expecting the doctor to be able to see a patient every 15 minutes, finish the charts, send the scripts, coordinate care with the specialists, and answer 30ish portal questions each day, is not realistic. But since it’s your health/ your most valuable commodity/ of course you want your doctor to do all that and more for you. It makes total sense. But they can’t.


Are you a doctor? Cuz if you are you sound like a compassionate doctor who is trying their best. Thank you. In the end it’s not the patient’s fault. It’s the system that sucks. But you have many doctors who blame their patients not recognizing that care has become so disjointed and confusing that they are just trying their best to get the care they need.
Anonymous
Post 03/26/2024 11:41     Subject: Where have all the doctors gone?
NP. I'm an MD. I like my job and take insurance in private practice. But the insurance companies have refused to increase what they pay me since I originally negotiated the first contract with them many years ago. There is no cost of living adjustment. The market is now flooded with midlevels whom they can pay less, so they have no incentive to keep up with inflation for MD-level care. I mostly just work because I enjoy it, and have a partner with a good income and no debt. If I needed to make a lot of money, it would be a major issue. Also, there's an increase in for-profit startups that provide really poor quality care. Some of these work with insurance companies, so the insurance company has even less incentive to pay for real doctors.
Anonymous
Post 03/26/2024 11:24     Subject: Where have all the doctors gone?
Anonymous wrote:
Anonymous wrote:Part of it is, patients are more and more expecting- demanding!- that doctors put them back to perfect health, well into their 40s, 50s, and beyond. I’m sorry you have chronic low back pain. I’m sorry the only possible solution at this point is a surgery that may or may not help. I’m sorry about XYZ problems. But- you’re 50 years old and your body is never going to be 22 again. Stop expecting miracles. People get old , things don’t work as well, a million expensive MRIs and visits with every specialist on earth aren’t going to change that.


Was it ever satisfying? Did you regret studying medicine?





Yes/ it’s frequently satisfying. Most patients are reasonable and normal. Recently, the stagnant pay combines with squeezing so many patients and extra admin work into my schedule makes work less satisfying. The patients are usually the bright spot. I like using my knowledge to help people. But when a patient is a total dick and blames me for the system that I am trying mg hardest to navigate well for them, yes, I get the visit over with quickly and move on. They’re never going to be happy with my care, they can go elsewhere, and we will both be better off.
Anonymous
Post 03/26/2024 11:15     Subject: Where have all the doctors gone?
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.
Anonymous
Post 03/26/2024 11:10     Subject: Where have all the doctors gone?
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.
Anonymous
Post 03/26/2024 11:06     Subject: Where have all the doctors gone?
Anonymous wrote:Part of it is, patients are more and more expecting- demanding!- that doctors put them back to perfect health, well into their 40s, 50s, and beyond. I’m sorry you have chronic low back pain. I’m sorry the only possible solution at this point is a surgery that may or may not help. I’m sorry about XYZ problems. But- you’re 50 years old and your body is never going to be 22 again. Stop expecting miracles. People get old , things don’t work as well, a million expensive MRIs and visits with every specialist on earth aren’t going to change that.


Was it ever satisfying? Did you regret studying medicine?



Anonymous
Post 03/26/2024 10:50     Subject: Where have all the doctors gone?
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:Cut back to 24hr a week now that med school loans are paid off. Enjoying having a life again. I’d work 40 hours if patients weren’t so miserable and management didn’t try to cram my schedule way past full.


What makes the patients miserable? I mean, specifics in terms of behavior thet shouldn't be doing.


Just angry about wait times in the office (that I can’t control), having a lot of things that they “insist “ on being tested for despite it not being relevant for their symptoms - and some tests will yield a lot of false positives if you test everyone for them. It sounds wrong- like, “if I test positive, and the test is 99% accurate, then it’s a real positive!” but google the Bayes Theorum and you’ll see that’s actually wrong. But patients INSIST on testing for things. And it muddies the waters and makes my job harder and doesn’t make their symptoms go away because now they’re convinced they have, for example, chronic Lyme disease and they won’t consider that their fatigue is actually probably from sleep apnea or depression. Anyways I’m ranting.


None of that sounds miserable to me. It sounds human. It sounds like humans who are struggling and are asking doctors to help them feel better.


Yes, people are trying to self advocate because care has become so abbreviated and disjointed


But without any nuanced understanding of the tests they insist on! Did you know that if chances are really low that you have a disorder (and you don’t meet criteria for testing for it), but you test for it anyways , and get a positive result, if that test is 99% accurate, it means that there is only a 1 in 10 chance your positive result is real? #mathdoesntlie


This article detailing how often doctors miss life threatening pulmonary embolisms is terrifying:
https://www.sciencedirect.com/science/article/pii/S2772632022000113


And what do you think the morbidity and mortality would be if every patient who might, on a very off chance, have a PE is given a pulmonary angiogram which is the gold standard for diagnosis?

Or even “just” a chest CT?

I’m not talking about cost, even. Or availability of practitioners and machines to run all these tests on every single patient with some shortness of breath. I’m talking about harm to patients that results from doing the test.


What harm? Ignoring the problems is the true harm.


Ok,
I’ll play. A pulmonary angiogram is an invasive procedure which can lead to disability or death.
A chest CT has so much radiation that the risk of it CAUSING cancer has to be weighed against any possible benefit of using it.


I've had multiple CT's lately trying to figure out what's going on. The newer machines don't have that much radiation and it's better to know and get treated than suffer. Be thankful you don't need it or have serious struggles with your health.

Maybe if doctors put more effort into helping than blowing me off, I wouldn't need them.


As a doctor I would caution you that doctors are human beings too and when faced with a person who is figuratively (or literally) attacking them, they will do always what they can and should, but you certainly won't get anyone to go the EXTRA mile for you. Unfortunately, you might need someone to go the extra mile and you won't get it this way with this attitude. When patients are nice and we have a good trusting rapport, we will go above and beyond to try and help them when something isn't clear cut (eg talk with specialists again, do more in depth research, ponder the problem...). You are a phenotype that is driving physicians to hate medicine some days.


Except most doctors will not even go an inch and try. They do a five minute appointment to get you out with no help.


I’m definitely in and out as fast as possible with patients like you that’s for sure


Fund a new profession and stop wasting peoples time with your incompetence. Ironic you can post here during the work day but cannot take the time to help someone.


I’m retired! From medicine! Thank the lord! See the title of this thread.


That’s good to hear. Wonder how many people you harmed with your laziness.


What a loser you are!!! This is one of the problems with the sytem, crazy patients!
Anonymous
Post 03/26/2024 10:42     Subject: Re:Where have all the doctors gone?
Was just discussing this with a friend who manages her dr husband's practice (internal medicine). They went concierge because of insurance. They live in a fairly high COL college town but because the town is in a rural area they only get reimbursed at "rural" rates, well below what is reasonable. Also her husband likes to spend more time with patients and actually address all their issues but insurance will only reimburse for the primary reason for the visit. That's why if you go to the dr about X but also want to discuss Y they will often force you to make another appointment. They reached the point where the only financially feasible options were sell to a big medical conglomerate and get paid as an employee and still have to deal with the current insurance environment or switch to concierge. They still keep on some grandfathered-in elderly patients but have enough people willing to pay for concierge.

It is just not a good work experience for primary care doctors. I was looking up something at the pediatrician we've gone to for years (now transitioning out because kids are in college) and noticed that there was only one doctor I recognized at the large practice. Must have been a big wave of retirements.
Anonymous
Post 03/26/2024 10:31     Subject: Where have all the doctors gone?
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:Cut back to 24hr a week now that med school loans are paid off. Enjoying having a life again. I’d work 40 hours if patients weren’t so miserable and management didn’t try to cram my schedule way past full.


What makes the patients miserable? I mean, specifics in terms of behavior thet shouldn't be doing.


Just angry about wait times in the office (that I can’t control), having a lot of things that they “insist “ on being tested for despite it not being relevant for their symptoms - and some tests will yield a lot of false positives if you test everyone for them. It sounds wrong- like, “if I test positive, and the test is 99% accurate, then it’s a real positive!” but google the Bayes Theorum and you’ll see that’s actually wrong. But patients INSIST on testing for things. And it muddies the waters and makes my job harder and doesn’t make their symptoms go away because now they’re convinced they have, for example, chronic Lyme disease and they won’t consider that their fatigue is actually probably from sleep apnea or depression. Anyways I’m ranting.


None of that sounds miserable to me. It sounds human. It sounds like humans who are struggling and are asking doctors to help them feel better.


Yes, people are trying to self advocate because care has become so abbreviated and disjointed


But without any nuanced understanding of the tests they insist on! Did you know that if chances are really low that you have a disorder (and you don’t meet criteria for testing for it), but you test for it anyways , and get a positive result, if that test is 99% accurate, it means that there is only a 1 in 10 chance your positive result is real? #mathdoesntlie


This article detailing how often doctors miss life threatening pulmonary embolisms is terrifying:
https://www.sciencedirect.com/science/article/pii/S2772632022000113


And what do you think the morbidity and mortality would be if every patient who might, on a very off chance, have a PE is given a pulmonary angiogram which is the gold standard for diagnosis?

Or even “just” a chest CT?

I’m not talking about cost, even. Or availability of practitioners and machines to run all these tests on every single patient with some shortness of breath. I’m talking about harm to patients that results from doing the test.


What harm? Ignoring the problems is the true harm.


Ok,
I’ll play. A pulmonary angiogram is an invasive procedure which can lead to disability or death.
A chest CT has so much radiation that the risk of it CAUSING cancer has to be weighed against any possible benefit of using it.


I've had multiple CT's lately trying to figure out what's going on. The newer machines don't have that much radiation and it's better to know and get treated than suffer. Be thankful you don't need it or have serious struggles with your health.

Maybe if doctors put more effort into helping than blowing me off, I wouldn't need them.


As a doctor I would caution you that doctors are human beings too and when faced with a person who is figuratively (or literally) attacking them, they will do always what they can and should, but you certainly won't get anyone to go the EXTRA mile for you. Unfortunately, you might need someone to go the extra mile and you won't get it this way with this attitude. When patients are nice and we have a good trusting rapport, we will go above and beyond to try and help them when something isn't clear cut (eg talk with specialists again, do more in depth research, ponder the problem...). You are a phenotype that is driving physicians to hate medicine some days.


Except most doctors will not even go an inch and try. They do a five minute appointment to get you out with no help.


I’m definitely in and out as fast as possible with patients like you that’s for sure


Fund a new profession and stop wasting peoples time with your incompetence. Ironic you can post here during the work day but cannot take the time to help someone.


I’m retired! From medicine! Thank the lord! See the title of this thread.


That’s good to hear. Wonder how many people you harmed with your laziness.


Not the poster you are responding to. But this is rich.

Invariably the ones complaining the most are the ones whose time is worth the least. Want more specific care, go develop a skill that makes your time worth more money so you can go out onto the open market and buy whatever attention you want. Stop being so lazy and low rent.
Anonymous
Post 03/26/2024 10:29     Subject: Where have all the doctors gone?
Anonymous wrote:
Anonymous wrote:Quality healthcare still exists but you have to know how to navigate the healthcare system.

Former physician here who went to top schools and training programs. I no longer see patients but rather do different work that is more interesting to me.


So how does that help us regular folks who don’t know how to navigate the system the same way a doctor does? For us, quality healthcare is out of reach.


Just like any other complex system. You figure it out. I’m not a doctor and I manage to navigate it just fine. It isn’t optimal, but nothing in life is optimal.

I also don’t roll into my PCP appt with 10,000 complaints and a stack of pub med citations. So that helps.

Anonymous
Post 03/26/2024 10:23     Subject: Where have all the doctors gone?
Anonymous wrote:We need more medical schools with student loan forgiveness programs for drs that go into low paying areas and a transparent process of who wants to be a dr and isn't getting to get the training. there are many qualified people who do not get into med school yet somehow almost everyone i know who's dad was a dr gets into a med school


Other countries have students enter medical school as undergrads. Do you really have to spend four years doing an undergrad degree before you can even apply to med school?
Anonymous
Post 03/26/2024 10:22     Subject: Where have all the doctors gone?
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:Cut back to 24hr a week now that med school loans are paid off. Enjoying having a life again. I’d work 40 hours if patients weren’t so miserable and management didn’t try to cram my schedule way past full.


What makes the patients miserable? I mean, specifics in terms of behavior thet shouldn't be doing.


Just angry about wait times in the office (that I can’t control), having a lot of things that they “insist “ on being tested for despite it not being relevant for their symptoms - and some tests will yield a lot of false positives if you test everyone for them. It sounds wrong- like, “if I test positive, and the test is 99% accurate, then it’s a real positive!” but google the Bayes Theorum and you’ll see that’s actually wrong. But patients INSIST on testing for things. And it muddies the waters and makes my job harder and doesn’t make their symptoms go away because now they’re convinced they have, for example, chronic Lyme disease and they won’t consider that their fatigue is actually probably from sleep apnea or depression. Anyways I’m ranting.


None of that sounds miserable to me. It sounds human. It sounds like humans who are struggling and are asking doctors to help them feel better.


Yes, people are trying to self advocate because care has become so abbreviated and disjointed


But without any nuanced understanding of the tests they insist on! Did you know that if chances are really low that you have a disorder (and you don’t meet criteria for testing for it), but you test for it anyways , and get a positive result, if that test is 99% accurate, it means that there is only a 1 in 10 chance your positive result is real? #mathdoesntlie


This article detailing how often doctors miss life threatening pulmonary embolisms is terrifying:
https://www.sciencedirect.com/science/article/pii/S2772632022000113


And what do you think the morbidity and mortality would be if every patient who might, on a very off chance, have a PE is given a pulmonary angiogram which is the gold standard for diagnosis?

Or even “just” a chest CT?

I’m not talking about cost, even. Or availability of practitioners and machines to run all these tests on every single patient with some shortness of breath. I’m talking about harm to patients that results from doing the test.


What harm? Ignoring the problems is the true harm.


Ok,
I’ll play. A pulmonary angiogram is an invasive procedure which can lead to disability or death.
A chest CT has so much radiation that the risk of it CAUSING cancer has to be weighed against any possible benefit of using it.


I've had multiple CT's lately trying to figure out what's going on. The newer machines don't have that much radiation and it's better to know and get treated than suffer. Be thankful you don't need it or have serious struggles with your health.

Maybe if doctors put more effort into helping than blowing me off, I wouldn't need them.


As a doctor I would caution you that doctors are human beings too and when faced with a person who is figuratively (or literally) attacking them, they will do always what they can and should, but you certainly won't get anyone to go the EXTRA mile for you. Unfortunately, you might need someone to go the extra mile and you won't get it this way with this attitude. When patients are nice and we have a good trusting rapport, we will go above and beyond to try and help them when something isn't clear cut (eg talk with specialists again, do more in depth research, ponder the problem...). You are a phenotype that is driving physicians to hate medicine some days.


Except most doctors will not even go an inch and try. They do a five minute appointment to get you out with no help.


I’m definitely in and out as fast as possible with patients like you that’s for sure


Fund a new profession and stop wasting peoples time with your incompetence. Ironic you can post here during the work day but cannot take the time to help someone.


I’m retired! From medicine! Thank the lord! See the title of this thread.


That’s good to hear. Wonder how many people you harmed with your laziness.


Only the a@@holes, don’t worry
Anonymous
Post 03/26/2024 10:21     Subject: Where have all the doctors gone?
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:Cut back to 24hr a week now that med school loans are paid off. Enjoying having a life again. I’d work 40 hours if patients weren’t so miserable and management didn’t try to cram my schedule way past full.


What makes the patients miserable? I mean, specifics in terms of behavior thet shouldn't be doing.


Just angry about wait times in the office (that I can’t control), having a lot of things that they “insist “ on being tested for despite it not being relevant for their symptoms - and some tests will yield a lot of false positives if you test everyone for them. It sounds wrong- like, “if I test positive, and the test is 99% accurate, then it’s a real positive!” but google the Bayes Theorum and you’ll see that’s actually wrong. But patients INSIST on testing for things. And it muddies the waters and makes my job harder and doesn’t make their symptoms go away because now they’re convinced they have, for example, chronic Lyme disease and they won’t consider that their fatigue is actually probably from sleep apnea or depression. Anyways I’m ranting.


None of that sounds miserable to me. It sounds human. It sounds like humans who are struggling and are asking doctors to help them feel better.


Yes, people are trying to self advocate because care has become so abbreviated and disjointed


But without any nuanced understanding of the tests they insist on! Did you know that if chances are really low that you have a disorder (and you don’t meet criteria for testing for it), but you test for it anyways , and get a positive result, if that test is 99% accurate, it means that there is only a 1 in 10 chance your positive result is real? #mathdoesntlie


This article detailing how often doctors miss life threatening pulmonary embolisms is terrifying:
https://www.sciencedirect.com/science/article/pii/S2772632022000113


And what do you think the morbidity and mortality would be if every patient who might, on a very off chance, have a PE is given a pulmonary angiogram which is the gold standard for diagnosis?

Or even “just” a chest CT?

I’m not talking about cost, even. Or availability of practitioners and machines to run all these tests on every single patient with some shortness of breath. I’m talking about harm to patients that results from doing the test.


What harm? Ignoring the problems is the true harm.


Ok,
I’ll play. A pulmonary angiogram is an invasive procedure which can lead to disability or death.
A chest CT has so much radiation that the risk of it CAUSING cancer has to be weighed against any possible benefit of using it.


I've had multiple CT's lately trying to figure out what's going on. The newer machines don't have that much radiation and it's better to know and get treated than suffer. Be thankful you don't need it or have serious struggles with your health.

Maybe if doctors put more effort into helping than blowing me off, I wouldn't need them.


As a doctor I would caution you that doctors are human beings too and when faced with a person who is figuratively (or literally) attacking them, they will do always what they can and should, but you certainly won't get anyone to go the EXTRA mile for you. Unfortunately, you might need someone to go the extra mile and you won't get it this way with this attitude. When patients are nice and we have a good trusting rapport, we will go above and beyond to try and help them when something isn't clear cut (eg talk with specialists again, do more in depth research, ponder the problem...). You are a phenotype that is driving physicians to hate medicine some days.


Except most doctors will not even go an inch and try. They do a five minute appointment to get you out with no help.


I’m definitely in and out as fast as possible with patients like you that’s for sure


Fund a new profession and stop wasting peoples time with your incompetence. Ironic you can post here during the work day but cannot take the time to help someone.


I’m retired! From medicine! Thank the lord! See the title of this thread.


That’s good to hear. Wonder how many people you harmed with your laziness.