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Thursday
Dec092010

Is Medicine Destroying Our Young Physicians?

I came across a blog post not long ago that's a great read. The title of the blog is the Traveling Medicine Show and the specific post is entitled, What Could Possibly Go Wrong?Leaving Medicine the First Time.

This post is a very interesting and humorous story about how the author—a first-year Neurology resident at the time—decides to leave his residency on an impulse after a spontaneous marriage to his girlfriend.  The story is well-written and quite funny, and it's easy to identify with the author who is so frustrated with medicine but can't seem to quite find a life outside of medicine either.  Here's how it begins:

After the third month of my neurology residency in Chicago, I took a trip out to New Mexico and never came back.

No one leaves medicine. It’s just not done. Or rarely. There was the guy in my medical school who was so twisted, that even after repeated reprimands for being inappropriate with female patients and colleagues, he couldn’t get it together. Though not by choice, he left. Or the anesthesiology resident found dead of an overdose in his call room, a surreptitious IV catheter still taped to his ankle. He left. These were the role models.

I had fantasized about leaving medicine for years. By my second year of med school, I had the feeling that I had boarded the wrong train, but I kept on clunking down the wrong track, hoping things would improve as I passed into each new stage of training. Things would be better when I was in the clinical years. Clunk. Clunk. When I get to my internship. Clunk Clunk. I couldn’t find the strength to leave something that seemed so successful, even noble. Anyway, the ticket had been so exorbitant, and soon so many miles had flown by that getting off was simply not an option.

I won't ruin the story and tell you how it all ends, but suffice it to say that it is worth reading.  I know many physicians who have felt, and still feel, like this author but only discuss these feelings behind closed doors to their closest confidants, if at all.

What's particularly poignant about this post, however, are the comments at the end.  The post was written in 2007, but the comments have been building since then and emote a sense of desperation amongst the writers. "Glad to know I'm not the only one who feels this way," reads one comment.  "I wish I had never done [medical school]—just look what they make you give," reads another. 

The comments continue: "I just left residency after two years of medicine...," and "I'm in my first semester of med school and I hate it," and "I’m a family doc, have been practicing for eight years. Recently hit with two meritless, frivolous, ridiculous lawsuits… both still pending, one I’ve fought for two years now... I'm getting out."

There are more comments, but you get the point.

What most disturbs me about these comments is that they are all from individuals at the beginning of their careers in medicine. It's one thing to have a cohort of physicians towards the end of their careers, complaining about changes in medicine and longing for "the good old days." But these writers are all young, early in their careers—and desperate to get out.

Our colleague Dr. Ryan Flesher produced an entire documentary film on this subject entitled The Vanishing Oath.  Ryan's film sheds light on the problem of early burnout in young physicians, and after watching his film, it caused me to be seriously concerned whether there would be anyone left in medicine to care for my family and me when we're older.

When I read comments like the ones mentioned earlier, or see a film like The Vanishing Oath, or speak to colleagues who are overwhelmed by their careers and stressed to the hilt, it makes me even more committed to what we're doing here at Freelance MD.  

You see, I come from a family of medical people. Between the stories I've personally heard and the stories told to me by other family members, I have had a growing concern that the practice of medicine is becoming increasingly toxic to those who practice it. Medicine is devouring its young.

This unfortunate truth is why Freelance MD and the Medical Fusion Conference were developed—to help physicians navigate the now treacherous waters of modern medicine.  

We'll be discussing physician burnout and other indicators of the problems in medicine in more depth, but our hope is that the discussion won't simply digress into a complaint session. We've created this site as a place not to simply document the obvious problems in medicine, but to offer direction for those who are struggling and connect them to leaders who can help them progress into a career that is fulfilling.

So take advantage of the resources here at Freelance MD and begin building towards a better career.  

We need you in medicine.

Reader Comments (5)

Young docs bailing comes as no surprise to me. The other day I ran across a medical student who is now the CEO of a healthcare IT startup. He is finishing our MD/MBA program, has a background in IT before starting med school, and has no interest in practicing clinical medicine. This simply reflects a changing landscape, and , like every other change, introduces oportunities for those who see them. My view of new normal looks like this:

1. About 10-15% of medical students will have no intention of practiciing clinical medicine. Better than the 50% of graduating law school students who don't practice law.
2. 10-15% of clinical care will be done virtually, outside of the office using a face-to-face encounter. Thinks e-commerce in medicine.
3. There will be continuing friction between the traditionalists who insist on accepting only "real docs" and those who accept those who want to do something else with their medical credentials and education.
4. Whenever there is major change in an organization or company, you can expect about 20% of the people to leave. The same holds true for USAMedicine,Inc. The question is how do you keep the one's you want and get rid of the ones you don't.
5. The sooner we make allowances for non-conformists to have a place at the table, the better able we will be in a position to harness their enormous energy and passion.

"The sooner we make allowances for non-conformists to have a place at the table, the better able we will be in a position to harness their enormous energy and passion." - This is really the case with most orgs. Medicine has real challenges and there are new thinkers who have real solutions if we can give them enough room to breathe and contribute.

I agree with both of you. It will be interesting to see what happens. Many young physicians who I know have a very different take on clinical practice and what Arlen calls "USAMedicine, Inc," that their more senior colleagues. Some feel betrayed by the very organizations and societies that supposedly exist to protect them. I hope as a profession we can adjust to accomodate these "non-comformists," but my concern is that a significant number could be lost to medicine, and ultimately, patients will be the ones who suffer this loss the most.

Organized medicine and the medical research-education-industrial complex needs to get their arms around this. Right now they have their heads in the sand. Make your voices heard.

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A recent survey of U.S. physicians found:
60% said health reform will compel them to close or significantly restrict their practices to certain categories of patients.
Of the above, 93% said they will be forced to close or significantly restrict their practices to Medicaid patients, while 87% said they would be forced to close or significantly restrict their practices to Medicare patients.
40% of physicians said they would drop out of patient care in the next one to three years, either by retiring, seeking a non-clinical job within healthcare, or by seeking a non-healthcare related job.
59% said health reform will cause them to spend less time with patients.
While over half of physicians said health reform will cause patient volumes in their practices to increase, 69% said they no longer have the time or resources to see additional patients in their practices while still maintaining quality of care.
Source: "Health Reform and the Decline of Physician Private Practice," The Physicians Foundation, October 2010, http://www.physiciansfoundation.org/uploadedFiles/Health%20Reform%20and%20the%20Decline%20of%20Physician%20Private%20Practice.pdf

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