More inflammation will not solve the doctor shortage

There is a lot about young people that I don’t understand. Tattoos, body piercing, rap music and a complete lack of desire to detach from smart-phones are a few likes that make little sense to me.

But one of the new generation’s basic tenets that I find highly enviable is their desire for balance between work and life. That’s really smart, as balance makes for better everything: better marriages, better doctoring, better cycling, (and even better blogging).

In private practice, we see this phenomenon when young doctors interview for a new position. Both men and women alike ask most about the amount of night call and weekends, time off and daytime work load. Rare are the throwbacks who want to work more.

The problem with doctors working less, of course, is that our country already has a shortage of doctors, especially in primary care. This shortage further exacerbates the cost of care because it drives patients to emergency rooms, profit-driven walk-in clinics or not to the doctor at all (which means less prevention.) Almost everyone who isn’t a doctor has faced the problem of getting a timely appointment with a well-thought-of doctor. And it’s not just primary care doctors that are hard to find, specialists are in high-demand as well.

We can all agree that a solution to the doctor shortage is needed.

Weekend readers of the NY Times were treated to an interesting idea on a possible remedy for such a vexing problem. It came in the form of a distinctly un-grandmotherly Dr Karen Sibert, an anesthesiologist, who offered young people (mostly women) this gem:

“They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve.”

With a stunningly paternalistic tone, she advocates stemming the shortage of doctors by rekindling the old ways where doctors worked all day, many nights, had few other interests and barely saw their families.

That’s a solution? Really?

In the current medical climate of hyper-regulation, burdensome bureaucracy and declining reimbursement this modus is a recipe for burnout, early retirement and even medical mistakes. A colleague of mine whose Dad was a cardiologist, liked to remind his son of this wise tale: you can angioplasty in the day, or in the night, but not day and night.

Kevin Pho, a leading voice for doctors, wrote that our “health system needs to change, and adapt to physicians who choose to place both medicine and their family on an equal pedestal.”

He’s right, and so are the younger people who refuse to inflame themselves.

In medicine, what was, rarely remains what is. And in this case, what was, clearly isn’t best.

JMM

8 comments

  1. What is being done about the doctor shortage? Anything? As a patient it’s incredibly frustrating when a specialist cuts back his hours to 3 days a week because said specialist is mountain biking 4 days a week. Do I abandon a practice after 10 years, or put up with 6 week wait times.
    Medicine today with its hoops and administrators in cubes is not just aggravating for the doctor. My new insurance company denies treatment that allows me freedom of movement, their suggested alternative; up the dose of NSAIDS.
    Doctors are people with prestige and a voice, is there any organized resistance to this craziness or are we all just going down together?

    1. Allison,

      I suspect the doctor shortage will have to get worse before it becomes actionable in the policy makers eyes. I also suspect that many of the future MD deficiencies will be filled by non-MD extenders, which of course is another debate entirely.

      The physician “voice” has always been a problem.

  2. I am not sure the young people “get” balance. They do get that they do not want life to be all about work but I am not sure they know what they do want it to be about; what the other side of work is. Also money changes people. When you realize you can make much more, you get into a cycle and like John Lennon saw, you just keep the merry-go-round going just to make life happen on the economic scale you now need. Hard to jump off once on unless you let it all go for awhile.
    I read the Times opinion page and had mixed feelings. I wondered why the Dad did not do more. If you can’t read your children bedtime stories, they do not have to miss them totally each night. Dad can do-there was no mention of that.
    And for physicians that really want a higher quality of life-hire a PA or NP and really integrate them as a junior partner. It pays off on balance and economically.
    Dave

  3. Very interesting stuff here. I’m guessing that Dr. Karen Sibert, based on when she graduated from med school, is part of the Baby Boomer demographic. As such, researchers like Dr. Linda Duxbury of Ottawa would likely say of her: “Well, no wonder . . .”

    Duxbury is the co-author of a landmark Canadian sociological study on work-life balance, a massive project spanning 10 years and over 31,000 participants. I heard her speak at a conference years ago, and one of the key points I vividly recall was that older workers (not just in medicine, but in ALL sectors) generally cling to some kind of wacko-crazy work ethic (my words, not hers!) that younger Gen X or Y workers tend to lack, but that Dr. Sibert apparently embraces.

    Younger employees, says Duxbury, have grown up watching their Boomer parents sacrifice themselves, their health, their family/social life, all for The Job. Many have then also watched their parents’ generation downsized during economic slumps without so much as a “thank you”. They, in short, think their parents are nuts for having willingly traded their personal lives for a thankless workplace. Their parents work when they’re sick, they work when they’re injured, they work because it’s expected, they work because others are counting on them, according to Duxbury’s study. Work clearly comes first to many of our generation. I’ve been stunned and shocked, for example, to see how many other heart attack survivors like me have their (older) cardiologists’ home and cell phone numbers! Are these docs expected to be eternally available, on call at all times, to put their own families and children in second place 24/7?

    However, for our children’s demographic – unlike Dave’s observations above – Duxbury says Gen X & Y workers merely shrug and say: “No way. I’ve already made other plans for tomorrow. I’m going snowboarding! See ya . . . .”

    It must be challenging for physicians like Dr. Sibert to have these younger folks as colleagues – but they’ve got it right. I congratulate young docs who have their heads screwed on correctly and are determined to set appropriate personal boundaries early on in their careers before these careers eat them up.

    FYI, more on Dr. Linda Duxbury’s work-life balance report at http://www.hc-sc.gc.ca/ewh-semt/pubs/occup-travail/balancing_six-equilibre_six/sum-res-eng.php

    Cheers,
    C.

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