demonizing doctors, doctors are human too, patient satisfaction, primary care

There’s a shortage of primary care doctors. Who is responsible for solving this problem?

According to Medical Economics, in their article “How can physicians combat industry shortages and meet patient demands,” the existing primary care workforce bears sole responsibility for this.

The article doesn’t start off too badly.  It says that by 2025, there will be a shortage of 46,000 to 90,000 primary care docs. It then states that one of the reasons for the shortage is the relatively low pay that primary care docs get. This is true. Most primary care practices are consistently in the red due to low insurance payments, which is why there are very few independent practices anymore. Most are owned by hospital systems, who can absorb the loss.

That’s about where the sanity of this piece ends.  According to it, the second reason for the shortage is that we have not “embraced technological advancements.”  The article tells us that we need to deliver services via telemedicine and apps.

No matter that technology for this is still substandard.

No matter that there are serious concerns about cybersecurity and the safety of patient info.

No matter that using these technologies requires a substantial financial investments, of which no primary care doctor can afford.

No matter that there is absolutely no guarantee that insurers will actually pay for these services.
The article then goes on to give this sage advice:

Expand Office Locations: Research market trends and population changes across surrounding areas. Opening office locations in underserved areas experiencing population growth asserts your presence before other practices follow suit.”

And who the heck is going to staff these other locations? I thought they just said we’ve got a shortage of doctors! Maybe the staff of Medical Economics has discovered the secrets of cloning and can be in two places at once, but I haven’t figured it out yet.

It goes on to say:

Reevaluate office hours. Take a look at appointment patterns. Do most of your patients prefer appointments later in the day or earlier in the morning? Should you offer weekend hours? What about extending services later in the evening, when people are out of work? Instead of becoming complacent with standard office hours, test new hours and see how patients respond. Tailoring hours by office location will better serve patients while maximizing your staff’s time and resources.

See, here’s the thing.  My schedule is full during standard office hours. Do I have patients that would love evening or weekend hours? Sure. But am I supposed to work 24 hours a day, 7 days a week? It’s not like I sit around twiddling my thumbs from the hours of 9-5. I’m seeing patients for just about every minute of that time, and doing paperwork during any time I’m not seeing patients (and after hours and on weekends, too).  You can’t claim that there’s a shortage of doctors and too many patients to go around in one breath, and then claim that the doctors are the ones that need to be more accommodating in the next.  Supply and demand, people.

 

Here’s the thing, Medical Economics. The reasons for the primary care shortage are many. Low pay. Low prestige. Too much paperwork. Every-increasing government and insurance regulations and requirements. And, most important of all, not enough residency spots for training doctors.  There are only a certain amount of residency spots a year to train graduating MDs. If a doctor graduates from medical school but does not complete a residency, they can’t practice. They can’t get a license.  Their education is, in essence, wasted.  These are not bad students. There are just not enough spots.  Every year, almost 10,000 doctors do not match! Most of these doctors have gone to international schools.  All of them would do just about anything for the chance to practice medicine here.

It takes a 3 year residency to train a primary care doctor.  If those 10,000 doctors a year were able to do an internal medicine, pediatrics, or family medicine residency, our shortage would be non-existent in less than a decade.

Medicare needs to fund more residency spots.  Period. The way to solve a physician shortage is to make more physicians. It’s that simple, really.

The way to solve a physician shortage is not to place the responsiblity for it on the backs of those already bearing its brunt.

 

doctors are human too, humor, primary care

I’m a real doctor, I don’t play one on TV

I was watching TV this past weekend when a commercial for another latest-and-greatest drug came on. Have you ever noticed that on TV a doctor’s office always looks something like this?

Neat and beautiful, with framed diplomas on the wall.  The TV doc is always in a crisp white coat, which matches his (and it usually is a man) distinguished white hair.  He peers out earnestly from behind his desk, comforting his nervous patient who sits before him (sometimes with adoring, anxious spouse).

But in real life…well, not so much.  Of course, no one is ever going to mistake me for a distinguished genteelly graying gentleman.  As a matter of fact, I once had a patient walk out of my office because I “look too young.”  Here’s my desk:

Shoved against a wall, no room for patients to sit in awe before me…I’m clearly doing something wrong.

No diplomas on my wall! Instead, we’re featuring portraits.

Looks just like me, right?

No sedate, distinguished globe and pen holder for me!  Instead we have this:

The true essentials- lots of lip balm, hand cream, dental floss, and silly putty.  I know what’s important to have at hand.

Wanna know where my diploma is?

It’s crammed into a corner in the home office, on the floor next to the dog crate.  That’s actually a step up for it- up until a few weeks ago it was in a closet in the basement.  Maybe one of these days I’ll actually get around to hanging it up.  
But maybe not.  I’m in no rush.  Because it’s not about appearances and outward trappings.  The fancy desk doesn’t mean a thing.  I have to earn the respect and trust of my patients, because they deserve nothing less.
doctors are human too, primary care

It’s All Right to Cry

I’m a crier.  I always have been.

I well up during television commercials.  Many a book has been returned to the library somewhat waterlogged by my teardrops.

I cry when I’m sad, when I’m happy, and when I’m angry.  I cry when I laugh.

And I cry in front of patients.

I used to be embarrassed by this.  I’d hide my tears with a tissue and a muttered excuse of “allergies.”  Or I’d turn my back to wash my hands at the sink, furtively giving my eyes a swipe.

But sometime in the past few years, I stopped being ashamed of my tears.  My patients come to me and share both their happiest and their most terrible moments.  I’ve been honored to tell many patients that they’re pregnant.  Why shouldn’t I cry with happiness at the beginning of a new life?

I’ve also had to tell too many patients that they are dying.  I’ve sat with them and their families during their final hours.  And if they’ve allowed me into such a sacred time in their life, why should I hide my tears from them?

I care about my patients, deeply.  Some say that it’s wrong for doctors to show emotion, and that caring so much can lead to burnout.  I say that’s a load of bunk.

For me, the day I stop caring enough to cry with a patient is the day I hang up my white coat and find another profession.