how do the docs feel?

Not about to crucify you here, but I work in a big teaching hospital, and the docs feel stressed. Recently we had an MD quit his residency half way through due to the stress it was causing his new family. We have one resident who routinely asks me to shoot him in the head. He is incidently a very talented surgeon whom the families adore, not dysfunctional, but tired. The attendings are harried with all sorts of regulations regarding billing and medicaid and medicare. These guys and gals do not see their families much and are called to the hospital at all hours of the night - and yes they are complaining quite a bit about HMO's and how that has restricted their practice. There is a lot of turmoil in healthcare these days. I don't think becomeing a physician will actually change the frustrations, they will just be different frustrations.

Being an NP, I work with a group of physicians who have their own share of problems. There is a demand to see as many patients as you can [the more you see, the more the establishment can bill insurance companies!], your time has to be productive as a result. Time slots are 15 minutes, sometimes they are double, or even triple booked-- I know I don't see half of them take a break, they just go from patient to patient to patient.

HMO's and other insurance companies limit and prescribe what a doctor can do. If an MD feels that the pt. would benefit from a CT scan, the insurance company won't pay for it unless a less invasive form of test [x-ray] was first done. If the doctor wants to prescribe outside of a HMO's formulary, he/she better have a good reason for doing so. Otherwise, sure the patient could still obtain the medication, but they better have the money to pay for it themselves.

ASIDE: I could never figure that out... by the time you pay for an x-ray, the radiologists fee to read it, a CT scan (with/without contrast) the technician to administer it, the radiologist to read it, etc., we could just send people for MRI's right off that bat, which, by the way is far superior to the prior two mentioned techniques!!!

At any rate, I don't think it's a bowl of cherries to be a physician. They make more money [at least double my salary, more like triple], but they have exponentially more headaches. If someone is going to file a lawsuit, and we have a choice between MD and nurse.... guess who is going to get it??? The physician always has liability insurance [versus a nurse who may or may not have it]. Yes, nurses have been sued, but my malpractice insurance is only about $370/year. Physicians in general practice pay about $2,500-$3,000/year. Want to take a guess why???? One group has been sued more!

Consider it carefully. Don't jump from the proverbial frying pan into the fire.

Being a doctor certainly isn't a lifestyle I envy, that's for sure. I'm a nurse for an internist and he has been in practice for 25+ years. He works about 12-14 hrs a day on average, and is required to be on-call for one weekend a month, and constantly gets called in the middle of the night for things like xanax or ativan. He makes rounds at the hospital and nursing homes while the rest of the office takes 2 hrs for lunch.

Besides the time away from their families, very few docs anymore are getting real rich. Sure they make nice money, but they earn every red cent of it in my opinion.

HMO's dictating what tests can be performed and what meds can be prescribed are a whole other ball of wax. The amount of prior auth's we have to fill out for something as simple as prilosec is absurd. Very frustrating.

Maybe you'd love med school and the profession that follows, Only you can decide, but definitely look into what a new MD goes through and even what a doctor's typical day in the life is like after s/he is established!

Julie

Originally posted by TRN:

With all the changes in healthcare that have affected nurses, I wonder if doctors are affected in similar ways? The reason I ask is b/c I am considering going to med school, but I do not want to change one dysfunctional field for another. Have any of you heard the MD's talk about their field in such negative ways as nurses do? I do know that medicine does not pay what it used to, but it's still better than nursing. I was going to go for my Master's in nursing but then decided for another 1-2 years I can be an MD. Especially since a Master's in Nursing still doesn't help pay the bills any better. Now, nurses, don't crucify me for this question and the fact that I am considering med school.

Satisfaction and happiness starts inside the person. Each of us makes our own path toward satisfaction. We tend to blame anything external for our unhappiness because it is easier to blame something or someone rather than take responsibility for acting on our own behalf. If you are chasing money rather than looking at what type of meaningful work will truly make you happy, you will have great difficulty finding happiness in a career. Look inside and find what you actually LOVE doing, then figure out a way to make it your life's work. MDs are human, just like nurses and deal with their own set of healthcare baggage. People from all walks of life are unhappy in career choices, not just healthcare givers. As a personal aside, you can do anything you want in nursing if you take the time to examine what you want out of life and career, then put action to those needs and wants. There are huge career/work rewards for the master's prepared nurse. If you find what you LOVE, the money will come.

best of luck

chas

Hi TRN

What the other posters have written here about exchanging headaches is all true. My husband is a doc on a small FP residency faculty and they've had a number of former nurses, PA's, med tech's who were retraining to be docs, so people actually do it. One of their NP's is in the process herself. These folks actually fascinate me a bit because it's such a long path to medicine but I think some of them truly wanted to be in the drivers seat and for them the journey is worth it. Some of them just wanted more status I think. (Go ahead, say I'm catty--you might be right.) I am thinking of one individual who retrained and they are not a good decision maker and you would have thought that their time as a mid-level might have taught them that. Another observation I have is that a lazy nurse, med tech, pa makes a lazy doc and we've seen that too. They are hard on their partners.

In short, my husband would easily leave medicine if he could find something else to do that paid comparably. (And believe, me, as a doc working a residency NO ONE can say he just does medicine for the money.) Regulations, expectations of perfection and malpractice pressure, insurances that want a lot but don't want to pay, the flavor of money that pervades everything have removed a lot of joy from medicine for my husband.

Finally, Tim--if my husband's malpractce insurance were ONLY $3,000 he'd be dancin' a jig. Our state has extremely high rates of medical malpractice insurance. Several years ago when he was doing ED medicine, we were paying $12,000 to 13,000 a year and I know because we paid it. Now, the residency pays it and likely it is higher because he's doing OB.

Good luck, TRN. The funniest thing I notice is that former RN MD's are really hard on nurses. Would seem their could be a thesis in that ;-)

From my observations, the HMO's have done a number on the docs. I have seen some ousted because their patient numbers weren't high enough. Others are frustrated because they are unable to order the appropriate tests until the protocols are satisfied, as Tim mentioned. I have seen independent MDs in the smaller towns ruined because they refused to join the corporations. These may be isolated incidents, but I doubt that. I would opt to be a nurse practitioner. The ones I know have more autonomy, work shorter hours, and spend more time with their patients. The pay isn't as much but it is more than adequate.

TRN -

Welp, I'm one of those nurses jumping ship. I've been accepted to a handfull of DO (DO -osteopathic vs. MD - allopathic) medical schools (my choice) first try and will be a MS-1 this Fall.

Do I believe the grass will be greener? Heck no. I believe the grass will only be *different* - an exchange of "headaches," if you will. Is this the right decision for me? Yes. I can look in the mirror and be confident in myself and my decision to make my life a living he%# for the next 7 years or so....

Only you can answer the question of whether going the MD/DO route is for you. It requires a lot of sit-down honest soul searching on "why am I leaving/going into medicine" and "where do I see myself" and "what responsibilities to I want to take on", etc, etc....not the easist questions, I know. I spent *time* thinking, thinking, and then....I thought some more.....

Good luck to you...feel free to e-mail me.

Kat

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The grass isn't greener on the other side -- it's just different grass

[This message has been edited by NurseyK (edited February 16, 2001).]