No one ever said being a doctor was easy. School and training go on seemingly forever; once graduation arrives, doctors work long hours and are faced with life-and-death decisions daily.
But there were rewards. For decades, doctors earned hefty paychecks, had autonomy and respect. But those benefits are fading, and as a result, so is the number of doctors. Within the next 15 years, the United States will experience a shortage of between 90,000 to 200,000 physicians, according to the recently published Will the Last Physician in America Please Turn Off the Lights: A Look at America’s Looming Doctor Shortage.
The American Medical Association recognizes there are shortages in certain geographic areas and in certain specialties. Part of that is due to the aging population and a stagnant number of medical-school applicants.
But there are other significant reasons. They include the increasing costs of medical malpractice coverage, higher practice costs, lower insurance reimbursement rates and insurance-company restrictions resulting in less autonomy over how patients are cared for.
This is not just a question of career choice–consumers will be affected greatly by this shortage. If you think there’s a long wait for an appointment now, it could be nothing compared with 15 years down the road. The three co-authors of Will the Last Physician in America Please Turn Off the Lights, all from the physician-staffing firm Merritt, Hawkins and Associates, say the wait will jump to three to four months or more to see a doctor for a non-emergency, and a routine doctor’s visit will cost two to three times what it does now–whether you are insured or not, they say.
Insurance has become a loaded word. One-third of the country is insured by Medicare, and over the next nine years, the government program plans to cut payments to physicians by about 40%, while practice costs are projected to increase 20%, according to the American Medical Association. The first of those cuts will take place in July, when the reimbursement rate to doctors will drop by 10.6%. The next cut, of 5%, will occur in January.
It’s expected to have a trickle-down effect. “If Medicare makes a change to their reimbursement, other insurance companies follow their lead, since Medicare drives the marketplace,” says Lawrence Smarr, president of the Physician Insurers Association of America, a trade association for medical malpractice insurance companies.
But as costs continue to rise, many doctors say they need to see more patients in order to maintain their salaries and cover basic practice costs.
Are you a practicing physician? What’s your experience of the workplace today? Would you encourage your children to follow in your footsteps?
“We used to have a lot of respect for doctors, but now they seem like easy targets,” says Phillip Miller, an author of Will the Last Physician in America Please Turn off the Lights. “There’s a perception among patients that, ‘I went to a doctor’s appointment and he was 45 minutes late. He’s probably on the golf course or driving his Mercedes.’ The truth is, they’re probably busy with patients.”
The Association of American Medical Colleges projects that America needs a 30% annual increase in medical-school enrollment in order to keep up with need for doctors. In 2012, compared with 2002, medical-school enrollment will be up 21%.
But for potential physicians, there is a future of looming medical-school debt, which is higher than ever. Students who graduate from a public medical school have a median debt of $100,000; private-school students graduate with a median debt of $135,000, according to a 2003 study by the Association of American Medical Colleges. Compare that with 1984, when median debt for public-school graduates was $22,000 and private-school students was $27,000.
Monthly payment on a debt of $150,000 at the end of residency at an interest rate of 2.8% is $1,761, according to the study.
The amount of time it takes to pay off debt depends on the specialty. The average physician’s net income, adjusted for inflation, declined 7% between 1995 and 2003, according to the Center for Studying Health System Change. In order to enter the most lucrative specialties, like radiology, ophthalmology, anesthesiology and dermatology, doctors must continue with their training into their 30s. That means they can’t start chipping away at their debt–let alone make money–until a time by which their counterparts in law or business are usually prospering.
Meanwhile, getting sued by a patient is a major concern. Of course, doctors who make fatal mistakes and who are unqualified should be held responsible. But there’s evidence that the bulk of lawsuits brought are frivolous. Of all malpractice lawsuits brought to jury trial in 2004, the defendant won 91% of the time. Only 6% of all lawsuits go to trial; those that aren’t thrown out are settled. Only 27% of all claims made against doctors result in money awarded to the plaintiff, according to Smarr, president of the trade association for medical malpractice companies.
Regardless, doctors need to defend themselves against the possibility of damages–and that’s an extremely expensive proposition. It takes about four-and-a-half years from the start of a lawsuit to the end, and the average cost to the defense in legal fees was $94,284 in 2004, according to the American Medical Association.
Many states are trying to establish laws to protect doctors from baseless suits. Texas went from the state with the most lawsuits filed to the only state that wrote tort reform into its constitution after its citizens voted it into law. Since tort reform was enacted in 2004, the yearly premium doctors pay in Texas for malpractice insurance has dropped by 40%. Now, the most plaintiffs can recoup for emotional damages is $250,000 from doctors and $500,000 from hospitals. Most interestingly, the number of claims filed against doctors has dropped by about half.
“The lawyers know the huge damages they were [previously] able to get are [now] limited,” says Smarr.
Miami-Dade County, in South Florida, is now the most precarious place for doctors to practice when it comes to lawsuits. In 2007, OB/GYNs paid on average $275,466 annually for malpractice insurance. That number is a slight drop from 2006, when the average cost was $299,000, according to Mike Matray, editor of the newsletter Medical Liability Monitor.
Doctors have to practice defensive medicine, and their insurance rates are so high,” says Matray. “But rates are leveling off and coming down right now. However, if history repeats itself, they will go up in a few years. A lot of doctors right now are not encouraging their kids to be doctors.”
To support that assertion, a 2007 survey by Merritt, Hawkins indicated that 57% of 1,175 doctors questioned would not recommend the field to their children.
The solutions are widespread. Nine new medical schools are under development or discussion, according to the Liaison Committee on Medical Education, which accredits medical schools. The AAMC estimates that almost 800 first-year students will attend these new schools in the academic year 2012-2013, based on future enrollment figures.
Hospitals and medical practices are trying to entice doctors by addressing the work-life balance issue. Many hospitals now use “hospitalists,” physicians that do shift work in order to relieve the physician shortage in many hospitals and practices. They chose only to work in hospitals and don’t have outside practices. For instance, if a physician needs to admit a patient to the hospital, that patient might be seen by their primary doctor’s hospitalist so the physician can continue to see scheduled patients. Laborists serve the same function in the OB/GYN field.
“That allows physicians to free up some of their time and makes them more efficient in their clinics,” says Cindy Bagwell, vice president of professional staffing at Geisinger Medical Center in Dannville, Pa., a practice that uses hospitalists and laborists frequently.
On the flip side, many hospitalists and laborists enjoy knowing they have a set schedule and will never be woken up in the middle of the night by an emergency at the hospital. Many of these changes have to do with doctors wanting more free time and female physicians’ desire to work and raise a family.
“It’s hard to argue with people wanting to take great care of their children, so we try to make it work,” says Bagwell. “As long as we can keep patient care at the forefront, we’re willing to try things.”
Tara Weiss/5-5-2008 @5.30pm