HOW PHYSICIAN’S
CAREER PATHS ARE
EVOLVING
INTRODUCTION //
5
OBAMACARE FOR DOCTORS: 4 WARNING SIGNS THAT AFFECT YOUR CAREER //
3
WHAT THEY DON’T TEACH YOU IN MED SCHOOL: 3 REASONS FOR DOCTOR BURNOUT //
10
5 REASONS IN HOME HEALTHCARE IS AMERICA’S FUTURE //
22
CHAPTER 1
ObamaCare for Doctors: 4 Warning Signs
that Affect Your Career
83% of doctors today have considered leaving their practices and switching careers because of Obamacare, according to a survey released by the Doctor Patient Medical Association. Many doctors are fearing the negative repercussions of Obama’s Affordable Health Care Act and are weighing their options to determine whether or not continuing a career in medicine is worth the risk. In addition, the American Association of Medical Colleges estimates that by 2020, the growing medical demand of the United States will necessitate an additional 91,500 doctors. Former President of the American Medical Association, Dr. Donald J. Palmisano, was quoted to have said, “Today, we are perilously close to a true crisis as newly insured Americans enter the health care system and our population continues to age.”
These startling facts clearly pose a serious risk for the medical future of our country. A risk that is only going to be compounded as doctors become more and more negatively affected by the Affordable Health Care act (or commonly known as Obamacare).
According to an article in Forbes by Scott Gottlieb, “The Obama Administration’s underlying assumption, all along, has been that doctors earn too much.”
This assumption very clearly reflects the results of a study in the Journal of Health Affairs created in part by Sherry A. Glied, one of the administration’s former assistant health secretaries. The study compares the pre-tax income for primary care doctors in France ($95,000) to that of primary care doctors in the United States ($186,000).
However, what the study does not cover is the difference in quality of care between the two nations or the nations’ differences in relative wealth. The same study pin points American doctors’ salaries as “the main drivers of higher U.S. spending” on health care. As the United States heads in the direction of European-style healthcare, doctors’ compensation rates are bound to follow suit.
The colossal 2,572 page Affordable Health Care Act brings with it a slew of additional complications and regulations for doctors.
This translates to more time spent on staying up to speed with the legalities and management of healthcare, and less time spent on reading the latest research, treatments, and studies taking place in the medical field.
Among the most debilitating of said complications
is Obamacare’s paperless medical record mandate. This part of the law forces physicians to convert their traditional handwritten files into electronic medical records.
Though the Affordable Health Care Act promises to offer compensation for doctors who are able to complete this conversion process and use the electronic files in a meaningful way, the substantial cost of making the switch completely negates this “reward.”
In fact, the process is so costly that some older physicians have found it more beneficial for them to retire early than convert their decades of handwritten files to electronic records
Starting in 2014, Obamacare will add an estimated additional 19.6 million patients into Medicaid.
With the average Medicaid physician payment being only 56 percent that of private insurance, doctors who accept the plan will be faced with receiving lower payments from a growing population of patients.
As more and more doctors begin declining to see patients on Medicaid, these patients will be forced to consult with physicians assistants and nurses, increasing their potential of receiving sub-standard care.
With the increased amount of time that doctors will need to spend focusing on government rules and regulations, the time that doctors will be able to invest into their patients’ healthcare needs will see a dramatic decrease.
For doctors who decide to refrain from seeing patients with Medicaid, many long time patients will be lost. Doctors who continue to see patients under Medicaid run the risk of overcrowding their practices. These doctors will be forced to see more patients than they should in the average day in order to maintain profits, which will result in less one-on- one time with each patient and overall lower quality of care.
In spite of the many hurdles and hoops doctors will be facing under Obamacare, there are some aspects of the plan that have the potential to benefit doctors.
•Yearly physicals covered. Under the Affordable Health Care Act, yearly physicals are now covered by insurance. As a result, doctors can expect to see an increased number of patients showing up for their yearly check-up appointments, which could lead to a rise in business and profitability. In addition, doctors may be able to detect health concerns in their patients early on, potentially preventing larger health issues down the road.
•Free “well baby” visits. In many of Obamacare’s family plans, pediatrician visits including immunizations and developmental screenings are covered for families. Because of this, pediatricians can expect to see an increased amount these visits from families who would normally not be able to afford a co-pay.
• No lifetime cap. According to Dr. Steven Kairys, Medical Director of the New Jersey Chapter of the American Association of Pediatricians, the ban on lifetime caps in insurance policies will make a huge difference for pediatricians treating children with chronic illnesses. In the past, this cap has led to many tough decisions for pediatricians when treating patients who already reached their lifetime cap in childhood.
Only time will tell just how large of an impact the new legislation will have on doctors and their practices (although the early warning signs are troubling). The best thing that doctors can do right now is to stay informed and up to date on America’s ever-changing healthcare plan.
Because the more you understand the implications, the better you can prepare to mitigate the risks and capitalize on the new opportunities.
CHAPTER 2
What They Don’t Teach You in Med
Loss of enthusiasm. Feelings of Cynicism. Low sense of personal accomplishment.
According to a national survey published in the Archives of Internal Medicine in 2012, 45.8% of physicians are currently experiencing one or more of these symptoms.
Even anesthesiologists, who are typically among the highest paid within the medical realm, ranked sixth among the 10 specialties that reported the highest rate of burnout with 42% expressing a serious lack of vigor for their profession. The job of the doctor is without question a difficult one. It is both physically and mentally exhausting and often consists of long workdays with little time left over to spend with family and friends.
After four years of undergrad collegiate studies, four years of medical school and another few years of residency, most doctors are already experiencing symptoms of burnout before even officially beginning careers.
Once most medical professionals make it out of school and start practicing medicine full time, these symptoms are compounded by the general stress associated with the position (like an onslaught of paperwork, and less time to spend with patients).
And it’s only going to get worse. Many believe that the Affordable Health Care Act (or ObamaCare) will further provoke many of the stresses that doctors are already facing on a daily basis.
“Too many bureaucratic tasks” ranked in as the number one cause for burnout according to a MedScape survey that links physician lifestyles to burnout.
Doctors typically spend approximately one third of their workday filling out paperwork and documentation. Unfortunately, individuals who got into the medical field with visions of spending the majority of their time dealing directly with patients are now finding themselves drowning in charting, ordering, and billing.
The colossal 2,572 page Affordable Health Care Act brings with it a slew of additional complications and regulations for doctors. This translates to more time spent on staying up to speed with the legalities and management of healthcare and less time spent on reading the latest research, treatments, and studies taking place in the medical field.
Among the most debilitating of said complications is Obamacare’s paperless medical record mandate. This part of the law forces physicians to convert their traditional handwritten files into electronic medical records.
The mandatory overhaul of all paper health documentations to be converted to an electronic system is so exhaustive and costly that many older physicians are deciding to retire rather than go through the process.
Although electronic medical records have undoubtedly increased efficiency in many ways, they have also caused loads of potentially problematic circumstances within the medical profession. All too often, doctors who are in a hurry will rely more heavily on electronic notes from previous medical records instead of taking the time to speak with the patient directly. If a patient is referred to a specialist or sees another physician, his or her records may end up with inconsistencies as a result of misinformation that was pieced together by rushed physicians.
According to an article in the New York Times, “A doctor’s note turns into a cut-and-paste collage instead of an accurate and personalized narrative of illness; and documentation becomes an electronic and potentially dangerous version of the game ‘Telephone.’”
Needless to say, the potential dangers associated with this game of “telephone” and the increase in bureaucratic tasks altogether are not to be taken lightly.
Doctors want to help their patients. They want to be able to devote the necessary time and energy to each patient in order to see his or her health improve.
According to a study, the ability to provide high quality health care is a primary driver of job satisfaction among physicians. Consequentially, obstacles that prevent doctors from providing this high level of care are a source of stress and dissatisfaction.
A survey conducted by researchers at John Hopkins University reported that “nearly half of doctors in the United States consider excessive workloads to be undermining of the safety of their patients and the cause of a significant number of medical errors.”
Pretty scary stuff, considering the potential consequences of these errors.
The same survey reported that 40 percent of doctors believe that the number of patients they had seen over a period of one month exceeded safe levels far too often. “Excessively increasing the workload may lead to suboptimal care and less direct patient care time, which may paradoxically increase, rather than decrease costs,” said the authors of the survey. “Hospitals frequently reported that excess workload prevented them from fully discussing treatment options, caused delay in patient admissions and/or discharges, and worsened patient satisfaction. Over 20 percent reported that their average workload likely contributed to patient transfers, morbidity, or even mortality.”
Each year, roughly 98,000 people die in the hospital due to preventable medical errors. Heavy workloads that prevent physicians from spending necessary time with patients may be responsible for 5 percent of these deaths, according to the survey.
“Income not high enough” ranked among the top five reasons on the causes of burnout in Medscape’s survey.
Though physician compensation has been largely on the rise according to another Medscape study, many physicians believe that their salaries are still not high enough to justify the demanding nature of the job.
In 2013, only 48% of doctors reported feeling that they were fairly compensated, compared to 51% in 2012 and 53% in 2011.
With the implications of the Affordable Health Care Act, these numbers will continue to dwindle at an increased rate. According to an article in Forbes by Scott Gottlieb, “The Obama Administration’s underlying assumption, all along, has been that doctors earn too much.”
This assumption very clearly reflects the results of
a study in the Journal of Health Affairs created in part by Sherry A. Glied, one of the administration’s former assistant health secretaries. The study compares the pre-tax income for primary care doctors in France ($95,000) to that of primary care doctors in the United States ($186,000). As the United States heads in the direction of European-style healthcare, doctors’ compensation rates are bound to follow suit.
Unfortunately, there doesn’t seem to be much of a silver lining for those experiencing burnout in the medical industry. However, there is still a slowly diminishing minority of medical professionals who are not experiencing symptoms of burnout, proving that there is hope for those practicing medicine to be happy and fulfilled by their careers.
According to a survey released by the Doctor Patient Medical Association, 83% of doctors have considered leaving their practices and switching careers because of ObamaCare, according to a survey released by the Doctor Patient Medical Association. But surprisingly, this sentiment is far from unexpected.
The Affordable Care Act is the latest in a long line of issues that physician’s are dealing with on a daily basis. And it’s another consideration in managing doctor burnout.
A recent study by Medscape shows that new legislation like ObamaCare is among the leading causes of burnout, in addition to too many bureaucratic tasks, excessive hours and little fulfillment.
Barely half are satisfied with their doctor career path. But that number’s even lower for anesthesiologists, who reported only 39% would stick with medicine if they had to do it all over again.
Sharon Grouper is an anesthesiologist from Illinois, and he was gracious enough to indulge some of our questions around physician happiness, burnout, and the future of medicine.
Question #1. According to a recent Medscape report, only 39% of anesthesiologists would choose medicine as a career path again. Would you (a) choose medicine as a career path if you had to do it all over again? And (b) what would you tell future pre-med students about a career in medicine or anesthesiology?
“(A) Yes, I would choose a career in medicine if I had to do it all over again because medicine is ever-evolving and intellectually challenging. I think it’s a unique occupation that allows both instant and delayed gratification simultaneously.” “However, I would make sure I factor in the various and always personal factors that determine whether a given physician will enjoy a long and satisfying career in medicine when the specific specialty choice is made.”
“(B) Follow your passions. Work hard. Don’t look back. Choose a specialty based on where you see yourself at age 50 not just at age 30. “
with a career in anesthesiology (according to the same report). In that light, how will ObamaCare impact physician’s lives? And is it a net positive for physicians? Why or why not?
“It’s difficult to predict with precision how Obama care will play itself out since we are still in the early stages of its implementation.”
“However, I feel as though the long term trends are towards consolidation in every field of medicine and that will probably reduce the burnout rate indirectly as there will be less independence and more mechanical guidelines to follow.”
“By the same token, physicians are notoriously unhappy when they feel high infringement factor. Things will play themselves out as I said. “
personal opinions on how to improve the healthcare system?
“I am not sure if there is a simple fix or even a complex fix. It’s a loaded question. I think physicians by nature, as I alluded to in a previous question, thrive in independent environments that allow for self direction and maximal control.”
“We need a Laze Faire system in this country which follows capitalistic principles and not socialistic undercurrents. The very principles this country was founded on.”
CHAPTER 3
5 Reasons Why In-Home Healthcare is
America’s Future
burnout. The political landscape of medicine is creating a situation in which doctors make less and patients pay more. The solution? Home health care.
With more than 8,000 people turning 65 every day and a senior population that is projected to hit 49 million by the end of 2013, growth in the home health care industry is inevitable.
But seniors aren’t the only ones who will contribute to this growth. A number of conditions including questionable insurance coverage for patients, rising healthcare costs, and the need for more convenient care all contribute to the impending growth in the home health care industry.
A hundred years ago, people had no choice but to have their healthcare needs tended to at home. Babies were birthed at home, infections were treated at home, and fulfilling doctor/patient relationships were the norm.
As society grew and the pace of life quickened drastically, the realm of healthcare was flipped upside down to accommodate changing times. Care switched from the home to doctors’ offices and hospitals.
This was seen as an efficient shift to accommodate a growing population and more urbanized society. Because patients were now traveling to the doctor, he or she would be able to see more patients in a day and equipment was always close at hand.
It sounds fine and well, until 45.8 % of physicians began suffering from burnout as a result of mounting bureaucratic tasks, long workdays, compassion fatigue, and more. These serious concerns were drastically less common a century ago. Our current economic environment has never been more conducive to an in-home health care system. Below are five reasons why more and more Americans will choose in- home care over conventional physicians’ offices and hospitals.
1. Cost and Sustainability. $1,660 per day is the difference in cost of one day’s stay in a hospital compared to one day of receiving health care at home. Home health care costs less than one tenth of hospital care and a third of the cost of care in a skilled nursing facility and is a practical alternative to the rising costs of traditional healthcare.
Less and less people want to become doctors each year. Less and less doctors want to continue being doctors each year. The medical field as a whole is experiencing vast amounts of uncertainty and financially instability. Home health care, on the other hand, is doing incredibly well. In July of 2013, 3,900 new jobs were created in the home healthcare sector compared to 4,400 jobs lost in hospitals and only 300 new jobs in nursing and residential care facilities.
This combination of low maintenance costs and high demand will continue to spur growth in the home healthcare industry for years to come.
2. Quality of care. According to a study, the ability to provide high quality health care is a primary driver of job satisfaction among physicians. Consequentially, obstacles that prevent doctors from providing this level of care are a source of stress and dissatisfaction. With the increasing amount of bureaucratic tasks associated with being a physician and less time to spend focusing on the patient, more and more doctors are finding it difficult to provide high quality healthcare to patients.
Another survey conducted by researchers at John Hopkins University reported that “nearly half of doctors in the United States consider excessive workloads to be undermining of the safety of their patients and the cause of a significant number of medical errors.”
3. Obamacare. According to a survey released by the Doctor Patient Medical Association, 83% of doctors today have considered leaving their practices and switching careers because of Obamacare.
On top of the general stress that doctors deal with on a daily basis (saving lives, prescribing medications, keeping up with current medical research, etc.), Obamacare opens up a black hole of additional concerns. The biggest of these stressors being pay cuts, more headaches, additional Medicaid patients, and worse relationships with patients.
Fortunately, most or all of these undesirable circumstances can be avoided by doctors switching to providing in-home health care. By cutting out the middle man (Obamacare), doctors have the freedom to be more selective in how many patients they serve and what types of insurance they accept.
4. Better relationships. When a doctor makes a home visit, he or she is able to see a much more complete and personal picture of the patient than ever would have been possible in a doctor’s office or hospital.
Because doctors who see patients in their homes tend to see less patients per day as a result, it is less likely for that doctor to suffer from compassion fatigue and more likely for the physician to develop a greater amount of compassion for the patient and invest more into his or her health.
5. Convenience. When someone is not well, the thought of getting up to prepare a meal (much less travel outside of the home to see a doctor), can seem like an extremely burdensome task. For elderly patients, this process is even more difficult and time consuming.
Not only is it just inconvenient; it can also be unsafe. Spending 30 minutes in a waiting room full of sick people whose immune systems are all compromised from whatever potentially contagious ailments they are suffering from can be a recipe for disaster.
In-home healthcare takes away the discomfort and stress of leaving the home to receive care and treatment. As the negative effects of stress on unwell individuals has been well documented, receiving care at home is naturally the healthier and safer option for most people.
These five factors and more will contribute greatly to the future growth of in-home healthcare in America for years to come. In the midst of all of the negativity spiraling around our current healthcare system, in-home healthcare will emerge as an economical and practical option for both doctors and patients.
Individual disability income insurance helps protect your ability to work and earn an income. Consider these facts:
• One in 10 Americans between the ages of 18 and 64 have a disability, and a disabling injury in the home happens every second.
• Group benefits only cover 60% of gross income and the benefits are taxable. Could you survive on 58% pay cut (after taxes)?
• Only 35% of the 2.8 million workers who apply for Security Disability Insurance were approved in 2009, and the maximum benefit for someone making $100,000 is only $16,800 a year.
