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"In my medical career, I have been through many struggles and right now, I’m feeling a lack of control. It’s a sense of being in an environment in which no one is listening."
All the articles coming out now about physician burnout seem to be too late and today, physicians like me are treading water.
Since 1974, as a woman student, intern, resident, and private practitioner, I have seen the evolution of medicine. In that time, there have been many positive changes, but the negatives seem to now outweigh the positives, resulting in physician burnout.
In my medical career, I have been through many struggles and right now, I’m feeling a lack of control. It’s a sense of being in an environment in which no one is listening.
As a woman, I was treated differently. When I got accepted into medical school, I was made to feel that I had taken away a spot from a male candidate, because of course I would give up my career once I got married and had children. As a student, all the patients thought I was a nurse even though I was wearing a white medical jacket. When I was a resident and pregnant, an attending said he didn’t want to scrub with me because I might faint and force him to finish the case by himself. My 2-week maternity leave was resented by male colleagues, but they had no problem when a male resident took the same amount of time off after a broken affair.
From what I see now, female residents are treated much better, one of the positive changes in medicine.
On the negative side, there has been a great erosion in physicians’ autonomy to practice over the last
20 years. When I was a resident, we were drilled to think, make a differential diagnosis, decide on the top diagnosis and treat. Now, if I want to admit my patient for observation for PIH, severe hyperemesis, and bleeding, I have to justify it to the MFM, residents, and financial powers of the hospital. To order an MRI for a woman who has a strong family history of breast cancer with questionable results on a mammogram, I have to justify it to a young non-medical person. If I feel a patient needs to be delivered, it has to be cleared with MFM. Putting a patient with a history of PTB on Makena requires justification to the insurance carrier. Treatment is summarily disallowed after I engage in peer-to-peer review with a complete stranger who doesn’t really know my patient or her previous pregnancy losses. And there are times when the residents do not respect my judgment or experience because they feel it isn’t evidence-based medicine. What they don’t realize that I have seen the cycle of medicine-always VBAC, never VBAC, OK with one C/S, OK with two, deliver all breeches, only multiparous, no none and now, maybe PTL treatment-alcohol, magnesium sulfate, terbutaline shots/pumps, home monitoring, Procardia, Makena. What I hope they can understand is that experience is worth something even if it hasn’t been printed in an obstetrical journal. With increased use of electronic charting, there appears to be a gap in direct hands-on practice.
Ultimately, the system of medicine has eroded the patient-doctor relationship. With changing insurance plans, sometimes patients have to change doctors. Their doctors can’t change with them, since the insurance rosters are full.
With the EMR, a doctor can spend more time with the computer than with the patient. Even if you hire a scribe, it really isn’t the same thing. EMRs themselves are tiresome, and not all the boxes are relevant to every encounter. But if they are not filled out correctly, that is more fodder for the litigation lawyers.
In regards to the business of medicine, the normal business model is not there. Most models are built on the premise that if expenses rise, they can be offset with a higher charge for the product. We are living in a time of higher expenses with diminishing reimbursements. There is the looming threat of malpractice rates. I live in New York, which will never institute litigation caps due to the resistance in Albany.
Many doctors are retiring or selling their practices to large medical networks or hospitals. Physicians have given up delivering, but to stay in practice in their office, they still have to pay full obstetric malpractice rates, leading them to take a pay cut.
The tragedy that I see and feel is that I have spent my whole life struggling, striving to become a caring ob/gyn and running a private practice while being a mother, wife, and grandmother. I have enjoyed the practice of medicine but with restrictions and constraints, it is getting harder to do.
Dr. S. RaisIn private group practice
Brooklyn, New York