Posts Tagged medical training
Doctors are unhappy because the medical world is not what they expected (or dreamed about).
An essay in the Wall Street Journal today “Why Doctors Are Sick of Their Profession?” describes the feelings of many doctors. What are those feelings? What do they mean?
Most physicians cope very well and are quite successful in society. Clearly, they do not have a psychiatric disorder as a group. Yet, the WSJ article lists certain symptoms. These are feelings of:
frustration, failed aspirations, malaise, worthless sacrifice, loss of control, conspiracy of lawmakers and insurance companies, devalued work, and recurrent intrusions of unpleasant thoughts. Lawyers (the scum of the earth) make more money than they do. And, oppression is keeping them from doing things the “right way”.
If a patient complains of those symptoms the diagnosis would be: depression with underlying obsessive-compulsive and narcissistic traits. For doctors it may just be the world is not what they expected when they started 15 years of training. The job is basically good and it’s too late to start over.
Is money an issue? If a distraught patient says their anxiety has nothing to do with a “recent divorce” … it really has everything to do with the divorce. If a doctor say it “has nothing to do with money” … it’s the money.
As a group doctors have a huge capacity for delayed gratification. They go through difficult years of training by thinking it will get better later — the salary will go up, all the testing will stop, professors will go away, long hours will improve, and no one will question their decisions. Welcome to the real world: stagnant salaries, maintenance of certification tests, professors who set evidence based guidelines, long hours and insurance companies that question decisions.
Medical training is mostly to blame. It’s too long, often unfocused, minimizes teamwork and shuns consistency. The fight for doctors to follow evidence based guidelines is undermined by the constant drum beat of “cook book medicine”. In fact, most medical treatment is by the book — a stunning revelation to most. If physician expectations were better managed during training the dissatisfaction after training would not be an issue.
Many employees find their job the least stressful part of the day. Stressed physicians need to focus on their job of diagnosis and treatment — it is very rewarding. Extraneous worries can drive you crazy.
Accountable care organizations reduce physician stress by focusing physicians on the job of taking care of patients while business professionals manage the business. Perhaps increasing the structure of medical care is the solution for physicians, not the enemy.
A practicing physician can look back to answer the question: what time was wasted during training? In other words, what was not applicable and forgotten. The answer is about 50% of college, 40% of medical school, 20% of residency and 20% of specialty training. Altogether the inefficiency of training (wasted years) adds to about 3 years for primary care and 4 years for a specialist. Wasting years of time is bad for students and bad for the US health care system.
Freedom to choose a type of practice seems to be the basis for US training. Consequently, the training is designed for maximum student choice. Required courses cover all the basics until far into training when finally a choice dawns.
The illusion of choice is the student never knows what practice is like, does not know what care givers are actually needed and assumes they can practice anywhere. Sometimes they choose just based on potential income — since they do have to pay off student loans.
Some would say: the student paid for training so they are entitled to choose. The fact is they pay a very tiny fraction of training cost, which society reimburses them many times over. Reimburses with a salary after medical school, reimburses by taxes going into Medicare and Medicaid, reimburses from insurance premiums paid by individuals and business. Society is paying for health care providers in aggregate. Health care has become a utility.
Given the utility nature of healthcare providers, why should health-care students have full choice of specialty, location or fees? A proper utility should provide uniform service and access where needed.
The problem: a disconnect between the demand for manpower and the product of training.
A solution: The pay-forward system. Openings for health care training should be presented before college. The student makes a decision very early. Education can be focused and much shorter. The options might be: nursing, primary care, laboratory medicine, surgical specialties, anesthesiology,dermatology, radiology, hospital care, or medical specialties (with a similar manpower guided choice a few years later). In exchange for participating in the new system, education is free to the student — paid for by reducing the salary over the career of the provider. But, there is an obligation to practice what and where manpower demands indicate.
The advantage of focused training is the ability to go into productive work in less time:
Dermatology: 6 years (vs. 12 years)
Primary care: 7 years (vs. 11 years)
Cardiologist: 8 years. (vs. 14 years)
Neurosurgery: 12 years (vs. 18 years)
Those students who perceive the need for a more broad education could spend several years in college pursuing whatever they want before committing to the health care track. One would expect some students would not make the grade needed in the health care track — they may want to fall back on another career possibility.
The University is helped by moving health care training away from other majors. The new track would allows majors in chemistry and biology to concentrate without the competition of pre-med students who do not intend to work in those fields.
The best part is the results of training program yield the providers needed. And, the providers practice where there they are needed — without crushing debt.