The latest version of an annual survey from Medscape/Web M.D., shows dissatisfaction among U.S. doctors rising. In an online questionnaire of 24,000 doctors representing 25 specialties,only 54%, said they would choose medicine again as a career, down from 69% in 2011. Just 41% would choose the same specialty again. Only a quarter of doctors said they would choose the same practice setting, compared with 50% a year ago. Why such frustration and discontent among physicians? The Medscape survey cites declining incomes, excessive paperwork, and vast uncertainty about changes dictated by the Affordable Care Act. David Korn, a former dean of medicine at Stanford and former vice president at the Association of American Medical Colleges says that, although it’s a “third rail” for the Republican party and for many doctors, the lack of a single payer system is responsible for much of the frustration. Especially for patients over 65, doctors must fill out multiple layers of insurance forms. A single elderly patient can have Medicare, and then secondary and tertiary insurance coverage, all of which require separate forms. “It’s a crushing burden that no doctor enjoys,” says Korn. According to the survey, 33% of doctors spend more than 10 hours a week on paperwork and administration. The Medscape survey also describes how hospitals are buying up private practices both in primary care and other specialties. This makes some doctors feel less independent and discouraged, says Howard Forman, a professor at the Yale School of Management who researches diagnostic radiology, health policy and healthcare leadership. “The transformation of the field from independence and professionalism to being commoditized and feeling like you’re just another worker is disheartening to some,” he says. Korn and Forman both say that many doctors are concerned about the way doctors will be paid under the Affordable Care Act. The Act mandates that Affordable Care Organizations (ACOs) will receive payment from insurers, and the ACOs will divvy up the money among doctors and hospitals. Many doctors worry that their reimbursements will come down under this system, since they will no longer directly receive fees for services. Forman points out that the ACOs are also aimed at reducing inefficient services but, he points out, “somebody is providing those services and making money off them.” Many medical professionals are nervous that their jobs will be deemed unnecessary. The Medscape survey documents declining compensation in a number of specialties, like general surgery, which is down 12%, orthopedic surgery, down 10% and radiology, also down 10%. But Forman points out that doctors are still among the best-compensated professionals in the U.S. Forman posits that some doctors may feel remorse about their job choice because they see their peers in finance or other lines of business, making far more than they do. “Physicians have not gotten poorer over the last decade,” he says. “But more and more you’re witnessing physicians who feel they could have done better if they had done something different.” Forman also takes issue with the survey’s point about paperwork. “I don’t think that’s changed since 1982, when managed care became a dominant force and Medicare became more complicated,” he says. Nevertheless, he concedes that doctors do a great deal of paperwork. What does this all mean for the future of medicine and the number of young people aspiring to become doctors? Korn is concerned about the short term. “Having great numbers of physicians unhappy, disgruntled, who can’t wait to retire, is not a great promotion for the profession,” he notes. That said, he notes that the number of medical schools in the U.S. continues to rise, as do the number of med school applicants. One problem that has already manifested itself: Fewer medical students are going into lower-paying specialties like family and internal medicine. Forman believes that surveys like Medscape’s are a healthy contribution to the field. “People should have a better notion of what they’re getting into,” he says, “rather than a fantastic view of what they watched on a TV show.” If young people pursue the profession with full knowledge of what’s in store, “they’ll be more satisfied than if they believe they’re going to be thanked every 15 minutes,” says Forman. “It’s a tough job.” My colleague Jacquelyn Smith wrote a piece about the best and worst paying jobs for doctors, here, culled from a consulting firm, Merritt Hawkins. It’s interesting to note that the Merritt Hawkins data shows doctors earning more than does the Medscape survey. Here is Medscape’s data on the highest and lowest earning medical specialties: Highest paid: Radiology: $315,000 Orthopedics: $315,000 Cardiology: $314,000 Anesthesiology: $309,000 Urology: $309,000 Lowest paid: Pediatrics: $156,000 Family medicine: $158,000 Internal medicine: $165,000 Diabetes/endocrinology: $168,000 Psychiatry: $170,000 Source
