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Demystifying Medicine One Month at a Time

“One Word, Benjamin: ‘Plastics!’ “

Is medicine still a noble profession? Would you advise your child to enter the field?the-graduate----plastics

You don’t have to look very hard to find evidence of medical professional burnout or job dissatisfaction. The ground is shifting underneath all of us as the industry undergoes massive political, economic, and social transformation.

A Chicago college advisor named Regnal Jones, who has been helping mentor students into medical school for almost thirty years is now advising against it. [Dentistry, meanwhile, is still advised.] Here are the key reasons he provides, quoted from a Chicago Tribune column:

“The cost is too great, and it’s a lousy job….The minute you say to me that you want to be a physician, it’s tantamount to saying you want to be an indentured servant.”

Jones said he feels so strongly in part because medical school tuition can cost hundreds of thousands of dollars, and the time investment, depending on whether the student wants, for example, to be an internist or surgeon or orthopedist, can consume years of his or her life.

The indentured servant reference is telling. Jones is the executive director of the Chicago Area Health and Medical Careers Program that recruits students from underrepresented racial and socioeconomic groups. Over almost three decades, he’s helped thousands of students enter health fields and other professions.

I find this very sad.

Apology

A couple of weeks ago I wrote a snarky post poking fun at the city of Portland, OR. By some accounts there are too many handicapped placards issued in Portland, and not enough parking spaces for all those possessing them.

Further, those with placards are able to park for free–indefinitely–in metered city spaces.

I mean no ill will to people with disabilities. The snarky tone was inappropriate. Blogging is a chance for me to hone my voice, and to sometimes be playful, but I woefully missed the mark here, as many readers let me know. I’m more appreciative that being disabled involves many indignities, inconveniences and extra costs–and allowing convenient free parking is only a fraction of what we can do to be more helpful as a society.

The main point of the post is that it’s somewhat ludicrous to have doctors be the arbiters of who can get hang tags. It leads to exactly the problem they’re having in Portland.

I’m sorry for the harm I’ve caused.

5 Comments

  1. Say what you will. There are few professions that get the universal respect a physician does.
    Would you agree that bad insurance is much worse than no insurance? I would much rather pay the insured charges than the uninsured charges.

  2. Hi Dr. Schumann,

    I apologize if this comment is not left in the correct space. I came to this blog after reading your article on nine points about the ACA.

    You write about the ACA causing the end of long-lasting, individual doctor-patient relationships, saying that trends will make such relationships a luxury. Can you expand on why this is, and what’s causing it? I’d appreciate it.

    • glasshospital

      October 3, 2013 at 12:41 am

      Thanks for reading. As to whether this is the “correct space,” I’d say: definitely.

      My prediction about the demise of the doctor-patient relationship comes from two major trends:

      1. The consolidation and ‘industrialization’ of medical practices.
      2. The dissatisfaction of many doctors with practicing in such environments, and the exodus from ‘the system’ into boutique/retainer/concierge type arrangements.

      The number of primary care doctors in solo practice is dwindling. It’s the canary in the coal mine. As for one example that typifies the trend, see here.
      The point is that the costs of remaining in solo or small practice are too great–there are economies of scale in large group practices or the safety in becoming an employee–which doctors have done in unprecedented numbers.
      Large practices lead to innovations like the medical home model–good in theory, but diffuses responsibility into team-based care. Nothing inherently wrong with that, but it’s a shift away from the doctor-patient relationship to the team-patient relationship.

      The trend toward doctors leaving the ‘hamster wheel’ (see this as an example, sorry for the self-reference, couldn’t help it) will accelerate in the coming years. Partly as a response to Obamacare, partly as a response to economic trends (are those synonymous? maybe so for the medical profession…). Again–not a judgment for or against–just a trend–one that will bring both innovation and dislocation to the age old model. Docs in this category will indeed have more typical feeling doctor-patient relationships–though they will be paid for and structured differently (much more tech, virtual, etc).

      My conclusion: if you want the personal attention of a physician, away from the large group models with other types of ‘providers,’ i.e. your value as a patient is in a long term relationship with a single doctor, you’ll have to pay for it.

      Will there be exceptions? You bet.

    • glasshospital

      October 3, 2013 at 11:21 am

      Thank you. I hadn’t seen that, as implausible as it sounds. Good to know sometimes I share a wavelength with some thoughtful folks, even if what I’m reporting on here is different than what they are saying.

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