An Obligation to Practice Medicine
Tuesday, October 18, 2011
Let’s face it. It takes a great deal of financial resources — both from personal and public realms — to produce a practicing physician, but should that translate into physicians who are duty bound to practice medicine full time once training is complete?
Physicians invest an average of 10 years and $156,000 to become doctors, according to industry estimates, but since the 1960s when Medicare was launched, Medicare funding has also contributed to offset residency program costs at teaching hospitals. In today’s dollars, this public funding known as graduate medical education (GME) supplies about $9.5 billion in taxpayer dollars, according to Association of American Medical Colleges — a number large enough to be targeted for cuts to help offset the nation’s trillion dollar deficit.
For most professions, the decision to work fewer hours is seen as a personal choice, but when it comes to the field of medicine and projected physician shortages, such decisions have the potential to affect public health at large. Still, the numbers are growing.
A survey from the American Medical Group Association reveals the number of part-time physicians has expanded by 62% since 2005. Especially prone to this shift are women, with almost 4 in 10 female physicians between the ages of 35 and 44 reporting they work part time. This is particularly problematic, because more female medical students than male students apply for residencies in such frequented specialties as family medicine, pediatrics, and obstetrics and gynecology, according to figures from the Association of American Medical Colleges (AAMC).
The case for physician obligation to full-time service may never be stronger than right now, as the AAMC predicts physician shortages over the next 14 years. According to projections from fall 2010, there will be a shortage of about 63,000 doctors by 2015, 91,500 by 2020 and 130,600 by 2025.
In the midst of shortages, physician career satisfaction in the United States has floundered for at least two decades for numerous reasons. A 2008 survey by the Physicians’ Foundation found that out of 12,000 respondents, 49% would consider leaving medicine if they could. A majority claimed they were overwhelmed by red tape generated from insurance companies and government agencies.
The 2009 Physician Retention Survey by the American Medical Group Association reported that male physicians who chose to work part-time cited administrative and leadership duties (64%) and preparing for retirement (17%) as the main reasons. For female physicians, the reasons cited were family responsibilities (54%) and administrative and leadership duties (32%).
In July 2011, physician recruiter The Medicus Firm released its eighth annual Physician Compensation and Relocation Report. In a survey of 2,339 physicians from 19 medical specialties across the country, 61% of respondents expressed some level of dissatisfaction with their 2010 income. Of those who were dissatisfied, 6% said they were considering leaving medicine.
While there appear to be no easy solutions, the situation merits attention. Physicians are faced with balancing careers and the business of medicine against patient needs and payer rules and regulations. Those kinds of pressures coupled with the expected influx of insured into the healthcare system in 2012 means this topic will gain more attention.
Tell us what you think: Are physicians who occupy a spot in government funded residency programs obligated to practice medicine full time upon completing their education? Weigh in on this issue in the comments section below— or link to our Peer Perspectives submission form to share your thoughts on any other pressing health care topic.
I can't think of any better way to REDUCE THE NUMBER of doctors than to impose yet another government-mandated obligation on them. What person in his or her right mind would agree to enter a profession which places specific and quantifiable demands on the rest of their lives?
Should all students who attend state-funded colleges and universities be obligated to practice their professions or crafts where and when the government demands?
This is completely and utterly ridiculous and unconscionable on top of it.
Well, there is the best reason thus far NOT to go to medical school.. Huge loans, huge time investment, huge taxes, huge frustration at bureaucracy and unending patient needs, and cap that with being handcuffed to the treadmill. The once noble and beloved profession becomes a life sentence.
The more appropriate question to ask is why are physicians so dissatisfied. If physicians were happy practicing medicine in the current climate far fewer would be working part time.
Agree Donna. Servitude would be a sure fire way to smother what little interest is left for smart kids to enter medicine.
First, I think the "average debt" you cite is low. The 4th year medical students who rotate through my office carry debt loads of $300,000 to $375,000. Oh, and by the way, I am not paid to teach them. (It's called "giving back.)
When I was a resident, some 25 years ago, we worked 80-95 hours a week, saving the hospital from hiring someone to provide care. We made well under minimum wage. (I think that's called paying back.)
Rather than contemplate indentured servitude, and thereby ensure that no one will want to enter medical school in the future, why not take a harder look at those "payor rules and regulations?"
Are you serious? You really think a doctor who finishes residency hasn't paid back any government investment many times over? Or that any young person contemplating a medical career would want to add indentured servitude to the list of negatives to look forward to? The list includes declining income, declining status, an increasing number of ways to become a status criminal by unintentional violation of any one of a myriad of new laws, and serving as a host for the parasites known as malpractice plaintiffs?
Sure, sign me up!
1. During my residency, I worked for 4 years at well below minimum wage. I'd say that any "debt" I owe the government or the people of the USA was paid even before I completed my residency.
2. So, should everyone who went to a public university be required to work in public service full time for a certain period of time? How about if you went to a public high school? Where does this ridiculous, asinine theory end?
"From each according to his ability, to each according to his need"
The logical next questions, if doctors are "obligated" to practice medicine full time upon completing their education, is for how long? Under what circumstances? Is this work to be paid, or unpaid? What is the definition of "full-time"- 40 hours, 60 hours, 80 hours? Where can this work be done, or is the mandated full-time work to be done where need is greatest? Who would determine who is eligible to be conscripted under this? Only new graduates, or would all living MD's be required to work full time? What about cosmetic services- would these physicians be required to serve doing other types of medicine? What would be the penalty for not being able to work full time? How would the conscripted physicians pay be determined?
This sounds like a really brilliant solution.
Americans have always held dear the ideals of self actualization, rebirth and reinvention of self. The spirit of this arguement doesn't appear to blend with our overall philosphopy and self identity. When people immigrating to the US didn't have enough money for transportation here they became iindentured servants and bought their freedom with 7 years of labor after which they were considered free men. Free to do as they choose. Free to continue to serve in the same way or free to start a new life. My belief, as an American doctor, is that if you have served and paid back that which you owe, your obligation to serve has ended. Those of us that continue to lover our work will continue to serve. Those of us that don't should be allowed to open the next chapter in our American identity.
I have practiced in an underserved area for over 15 years now so I would say that I've already paid back my "debt" to society. If you extend your ridiculous argument you, than need to require everyone who receives public assistance to somehow pay back that debt, including those receiving medicaid and food stamps. Since congresional salaries come from tax revenues, our representatives in Congress as well as our president would be at the top of that list.