We're 'doing charity work but get no benefit': 1 physician on what needs to change in healthcare

John Nelson, MD, a diplomate of the American Board of Pathology boards of anatomic and clinical pathology and cytopathology, connected with Becker's to discuss why physicians are leaving medicine behind and what to do about it.

Question: Only 57.5 percent of physicians said they would choose to become a physician again in a recent survey. What reform would you make to change their minds?

Dr. John Nelson: I would say a few main things:

1. Cultural reform to add physician respect and improved life work balance. I personally feel like most physicians are not held in higher esteem by admin/insurance, that they are just factory workers. We see this in new physicians not having initiative to work longer hours as they focus on their life and treat the profession as a 9 to 5 job. The resident work duty hours have ruined any initiative for new physicians to be high producers.

2. Improved insurance reimbursement to include universal healthcare coverage for all Americans. I know some may not agree, but we need universal health coverage and not this current system where it is like Dr. Seuss' Sneeches on the beaches with those with stars and those without on their bellies. I work in one of the poorest states in the union [Mississippi] and my "self-pay" rate is around 48 percent. Physicians are doing all this charity work but we get no benefit like deductions, etc., on this. This is a hard issue to address.

3.  The field is diluted with physicians who probably should never have been trained. I would hate to sound like an old codger, but if you cannot get into an American medical school, you should probably not be allowed to practice. The Caribbean grads are typically subpar and it is hard to elevate them to the operational level. They need to make the processes exclusive and medical education has become a venture capitalist endeavor. I see the DO students I teach come out owing $400 to $500K in loans for barely subpar training. I think this debt burden in a world where physicians have "salaries" is one cause of the poor results of physicians not "wanting to do this again." I myself trained at a state school in Louisiana and the emphasis was on education of physicians and not pure profit as many, many of these new medical schools are focusing on. 

4. On the education note, I would also suggest a consideration of switching to the European method of training whereas physicians do not have to attend undergrad and matriculate straight into medical school. I started this road from college to medical school to residency and fellowship at 18 and did not finish and start my first "job" until 33. My colleagues who are non-MDs have been in the workforce for 10 plus years while I was still living like a gypsy.

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