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Thu April 17, 2014
'Miserable' Doctors Prescribe A Different Career
Originally published on Thu April 17, 2014 11:38 am
CELESTE HEADLEE, HOST:
This is TELL ME MORE from NPR News. I'm Celeste Headlee. Michel Martin is away. It used to be that doctor was a profession many people aspired to - it brought prestige, money of course, a sense of purpose, bragging rights for your parents. But now a growing number of physicians say it's not really all it's cracked up to be.
The Daily Beast recently reported that many doctors are discouraging others from joining the profession. There are still doctors out there who are happy with their choice, though. So here to talk about it is Dr. Stephen Schimpff, author and former CEO of University of Maryland Medical Center. He was featured in The Daily Beast article. Also with us is Dr. Marilyn McPherson-Corder. She's a pediatrician and a professor of pediatrics at Howard University and the University of Maryland. Welcome to both of you.
STEPHEN SCHIMPFF: Great to be with you.
MARILYN MCPHERSON-CORDER: Thank you for having me.
HEADLEE: So I don't want to simplify this down to happy doctor and unhappy doctor, but, Dr. Schimpff, you agreed with the author of The Daily Beast piece that many doctors are in kind of a miserable state. Why did you say that?
SCHIMPFF: I don't think I ever said miserable, but certainly there's a lot of frustration. And the biggest frustration is a frustration with not enough time, time with your patients. So not enough time to really listen carefully, not enough time to - well, to think, not enough time to do really very good preventive care.
And then for patients with chronic illnesses, they need a lot of care coordination, and not enough time to do that. So that's the biggest frustration is time.
HEADLEE: So a professional frustration. Dr. Corder, you're of the opinion that doctors are not in general unhappy - why do you say that?
MCPHERSON-CORDER: Well, I'm of the opinion that when we go into the field of medicine it is truly serving the community. And I will say that there are many frustrations, I agree. But what you have to do and what I find myself doing as primary care is to try to continue as you were taught and, you know, you fight the insurance companies, the HMOs, as well as the demands.
But you do what you have to do. And certainly, anyone who wants to go into medicine, I tell them from the beginning, I call it Mother Theresa, in terms of really doing a community service and it's long hours. But if it's something that you really want to do, then we do need more doctors, more committed medical students and young people going into the field.
HEADLEE: So, Dr. Schimpff, what difference does it make the type of doctor that you are? In other words, a specialist versus a surgeon, versus maybe a rural GP?
SCHIMPFF: Well, I guess one of the differences is that - is you make a lot more money as a specialist than as a GP - as a generalist - it's about 100 percent more, twice as much. But when you talk to generalists as I've - I'm working on a new book about primary care, I'm calling it "The Crisis of Primary Care" - and what they tell me is I didn't go into this for money, I went into this because I want to make the world a better place, I really like the opportunity to serve people, to have a relationship with people.
So when you say, you know, what is it about medicine that you really like among folks who are in primary care, the answer is pretty consistent - I like to be able to help. I like to be able to develop a real relationship with my patients. So I know the patient, I know the patient's family, and that I can - I can do good.
HEADLEE: So, Dr. Corder, let's branch off a little bit more and talk about doctors who are in an urban setting versus a rural setting - doctors who are part of a larger group as opposed to maybe a doctor who's the only one in a town and is responsible - you know, acting alone in his or her own office. Does it matter if you have colleagues surrounding you or how many patients you're serving?
MCPHERSON-CORDER: Well, when you're in a larger group you have more independence and, you know, you have more freedom in terms of schedules as well as your private life. When you are the only one, then you will have more demands, more patient load and lives to take care of.
And I agree with my colleague there that most of my colleagues that I speak to say the same thing - they're not in it for the money, but the frustration has been the HMOs or the corporate mandating or not allowing our care and the doctors to decide and make sure that this is done for our patients in a timely manner, as well as what we feel we need to have done.
HEADLEE: If you're just joining us, we're talking about the crisis of enthusiasm in the medical profession. Our guests are Dr. Stephen Schimpff, an author and an internist. And also with us, pediatrician Dr. Marilyn McPherson-Corder. I wonder, Dr. Schimpff, if it's different now, if something has changed?
I mean, I would imagine for many professions, it's never going to be what you thought, right? Certainly, journalism is not what I thought it was going to be, it's a very different job than you imagine when you're in school. And I can't imagine that's any different than it was for doctor's in the 1950s, '60s or '70s.
SCHIMPFF: No, you're right. Things change and change for the good. But then there's also change which, at least among physicians, feels like it's not for the good. And perhaps you could just describe as to many people it feels like it's becoming a business. And listen, I was a CEO of a hospital. I understand no money, no mission, even if you're a not-for-profit. But Dr. Corder just said, there's so much frustrations with the insurers, and you have to call to say get a CAT scan or an MRI. Things get disapproved and so on.
It becomes very frustrating. But I just found another survey, which comes up to a different answer and says that 68 percent of physicians, primary care physicians, say they would do it all over again. So maybe, yeah, I guess maybe it depends on who you ask and when you ask and how frustrated that person is when you ask them.
MCPHERSON-CORDER: And I would like to even say that if I had an opportunity to do it all over again, I would do it all over again.
HEADLEE: And yet, Dr. Corder, what effect does it have on a patient's health or outcomes if a doctor is very frustrated and unhappy with their job?
MCPHERSON-CORDER: Well, you know, the way that you feel about your career in general is a factor in whatever you're doing. So I think that it's very important that physicians will just kind of make a self-awareness and understand where they are, what they're there for, that vow that we take that - from the beginning and continue that. Even though they're frustrated - and I have to say, I feel that the physicians who may be in that period of frustration and overwhelmed and feel that, you know, they're least respected and it's so very demanding, are still doing the job. But they just maybe are a little more rushed.
And hopefully they will begin and be able to tailor it in a better - because the change is here, it's going to stay and we just have to make the best of it. And of course, we now know that there are physicians, different clinicians, physician assistants, nurse practitioners that will be able to share some of the access to care that the ACA - Affordable Care Act - is going to mandate in terms of more insured individuals, and we have to have our load, our patient panel increase in order to accommodate the need of wellness and prevention.
HEADLEE: And yet, we are approaching a crisis in that there are not enough doctors going into primary care and general practice to service all Americans, especially as baby boomers begin to age. I mean, that is a real concern looking forward. So I wonder, Dr. Schimpff, what can be done about it? Is this an American problem with our healthcare system? Is it different in a place, say, Canada, where it's single-payer?
SCHIMPFF: Let's not say because of single-payer. But in almost every other developed country, the ratio of primary care physicians to specialists is 70 percent, 30 percent. Here in America, it's 30 percent generalists, 70 percent specialists. And the reason for it is, again, some of these frustrations - physicians are finding that they're kind of like on a rat maze, you know. They're just running, running, running.
And so the medical student sees that and says well, gee, I could make more money as a specialist and if I go into primary care, which may be what I really wanted to do, I'm going to have to, you know, really run hard and not be able to give the level of care I want. So that's sort of that bind. And in addition, there aren't enough - we call it residency positions - for after medical school getting trained in primary care.
There just - there aren't enough of them. So even if we can get - graduate more medical students, the next step of getting them trained - that three years of residency training - we don't have more slots we call them, and that's a problem.
HEADLEE: So, Dr. Corder, do you hear these kind of concerns from - as you're teaching pediatrics at Howard University - do you hear these concerns from your students who maybe choose to become a specialist instead of a pediatrician or a general practitioner?
MCPHERSON-CORDER: Yes, I do. And I want to I underline that I do train at least 40 or 50 residents as well as medical students per year. And they see how, as they say, hard I work and, you know, they look and they say well, my goodness, through 7 a.m. to 10 p.m. and then you have paperwork and you have to answer this. And they are of a different mindset. And I agree, you know, we do need more primary care.
We certainly do because as we retire, as those of us who are getting older and we retire, we don't see enough coming in. And I try to encourage them - I still say this is something that, you know, if this is where you want to be, and you can make it work as a primary care - I also mention to them as I do teach - I do consulting, I help out on different areas of pediatrics and wellness for children beyond being in a private practice setting. So, you know, sometimes that helps them make that decision. But I still recruit as much as I can.
HEADLEE: I assume, Dr. Schimpff, you also hear from young people who are considering the medical profession. And if you're aware of these frustrations, what do you say to them? I mean, there would be one approach, which would be, look, it's better than, you know, working in a warehouse all day long, right, so suck it up and move on with your medical degree. And the other one would be, look, don't go into the medicine, it's really frustrating. Which road do you take?
SCHIMPFF: I would definitely say go into medicine. There's so many different things within medicine, it's a wonderful field to be in. And I would say go into primary care. By the way, I'm not a - I was - I'm retired now, I was not a primary care physician. I was a specialist, but I would say go into primary care, it's great.
But do it differently. Do direct primary care, don't take insurance and set up a practice or go into a practice where you can interact with your patients, be able to give them enough time and you'll earn a decent income, you're not going to get rich, but you're going to have a decent income and you're really going to enjoy yourself.
HEADLEE: And, Dr. Corder, what would be your choice between the options of suck it up or - suck it up and get on with being a doctor or you're right, it's a really tough profession.
MCPHERSON-CORDER: I am such a cheerleader for going into primary care. I speak to elementary school-goers and all the way up to medical students. And primary care, as we have been talking, we do know that that's where the wellness starts and that's where you want to be, at that front end of that patient.
As my classmates told me years ago when I finished medical school in the '70s, they said, oh, you want to be a pediatrician - don't you know that's the least paid, your patients will cry, scream, bit you and the grandmothers and parents will also look at you in disdain. But sometimes, in the end, it's worth it. And you know what? Each and every family that I touch, it has been worth it because we create a bond, and I feel like I'm part of the family.
HEADLEE: Dr. Marilyn McPherson-Corder, pediatrician and professor of pediatrics at Howard University and the University of Maryland. She joined us from our office in Washington, D.C. And Dr. Stephen Schimpff is an author and the former CEO of the University of Maryland Medical Center. He joined us from WYPR in Baltimore. Thanks so much to both of you.
MCPHERSON-CORDER: Thank you.
SCHIMPFF: Thank you. Transcript provided by NPR, Copyright NPR.