we are so not in charge. there are huge industries that are built on the back of physicians. they will pay some of us just enough to keep us quiet. And the rest they will tell if you were only good enough, you would be able to do this. we are glorified hourly workers in the the plant called the hospital. the hospital and the insurance company are all fighting about who makes the most profit off the work of the physician. any physician who has been displaced by a medical management company know of what I speak.

amen, khk, I painfully know about which you speak. Ya know, so many times when I read the words of premeds desiring to be a physician because they want to have "autonomy", authority and be the so-called "team leader" or "boss" - I more than CRINGE. Premeds need to immediately drop their preconceptions about what it is truly like to be a physician these days. Autonomy my foot!

I find it incredibly ironic. That the tone of the practicing physicians and those aspiring to be a doctor are completely opposite. I really wonder if the premeds or doctors to be read the items in this particular forum or find it too depressing to consider. I can amen everyone one various points.

I am truly sorry to hear about your plight. My heart aches for you hearing that your ungrateful patients have sued. It makes me SOOOOO MAD.
I hope you will remember that some people are crazy and plain greedy. You did your best. You are a human being. Your enviornment does not allow you to practice perfect medicine. Bad outcomes happen even despite of best human endavors. Even if it had been, there is no such a thing as 100% perfection in ANY human endeavor. You've dedicated so much of your life to help others. That is an eternally noble calling. I hope you will really know it deep inside that it is not your fault. I will stand by you. I will stand by you. Let me say again. I. Will. Stand. By. You. I want to give you a strong hug, a strong handshake, and let you know.

Yesterday a 90 yo lady with her 50 yo niece came in. At some point, I helped the 90 yo to the exam table, and seeing that she was wobbly, I said, "are you sure you are OK sitting up here?The last thing we want is to cause more harm to you--if you fell, we'd feel very bad."

I am 5'2'', 105 lb, not much bigger than the little 90 year old, but I helped the little lady up on the table. The niece sat there like she was expecting to be served. Didn't move an inch to help.

Then the 90 yo lady said, "why would you feel bad if I fell?" Her 50 yo niece then promptly interjected, "oh, it's because you fell, you can sue her."

Oh man. I wanted to punch her.

I almost lost it. If it had been my own practice, I would have immediately become stern and scary looking, and said, that if a patient even as remotely joked about lawsuits, I'd want him/her out of the practice immediately. But because it isn't my practice, I pretended like it didn't bother me.

Moving on. To the "raping" of doctors by their student loans.

I told my SO that even if we died, and didn't pay our stafford back, the government will have made enough money off our backs. Imagine, getting a PA to do all the work we did in 2 years of medical school, 3 years of residency, how many hours did we work? A regular PA gets paid $75000 a year--times that by three, it is $220,000--what they have gotten out of us during labor in residency--not including overnight, overtime, holidays, and weekends. Minus residency wage of $120000 for three years. The government still made at least $100000 off our backs. No wonder they guranteed the Staffords which bind us further into labor.

Ladies, I hear you. My colleague's group, an excellent group of great docs are being replaced by another group of lesser doctors. Hospitals, Physician Executives, Management companies control the board game. We are the little soldier pieces.

I think we have complained. Everyone says amen to the complaints. Let's shift gear to think what we can do, individually and collectively to change the situation.

The AMA is not our friend. The AMA has many subspecialty interests who are making a lot of money in doing procedural oriented specialties. The woes that I am hearing here belong to primary care (FP, psych, Peds, IM). We need a subgroup and organize. The ACP and the AAFP have led the current situation to develop so they are dubiously reliable.

What can WE DO?

Please contribute here what you think you can do.

I really think we should organize as primary care providers and block supply of future docs. Do you think going to medical schools and premeds forum and discourage people going into primary care is a good idea? I think that is the least costly and most effective way to change our professional leverage. Decrease the supply. The demand will go up. Then when we organize, we have so much more leverage.

Even if we don't succeed, we can drum up some media attention. The way it is now is NO good for patients or doctors. Patients are pushed through a factory, with many opportunities for "mistakes"/redundancy/frustration/inequality/misconception etc.

What happened in Nevada? What was the walk out like? Who organized it?

It't hard to believe that months have passed by. Today, I read a thread by a pre-med wondering about this thread. I wrote my response there because I thought pre-meds, med students, and residents need to be informed before they can join primary care. Please take a moment to read the thread in general discussion and add your thoughts about primary care.

I have been in touch with folks who are actually happy doing primary care. More to come.

This is a really old thread, but I hadn't seen it before.

It's so great to see it because I have thought the same thing. Everyone can sue us; we should be able to sue someone for false advertising/failure to warn, something!

And, I'm a gyn, so it's not just primary care.

I returned to school a year ago to get an MPH and that made me feel somewhat hopeful that I could get out of this, but now I'm having second thoughts about it. Not because there's anything wrong with it but because I'm not doing it out of some burning desire to do public health but as a way to salvage something from my medical training and practice. I'm doing environmental and occupation health which includes built environment issues, so I thought it would be close enough to what I really live - interior design. But I still can't shake the nagging tap on my shoulder about what I'd really like to do. The only thing I really love is interior design, but I didn't pursue that because my dentist father and my mother who was his office manager didn't value that and I was too young when the decision was made to think for myself. Whenever I said anything about doing something creative when I grew up, they didn't say much, but when I said medicine they bought me a car - how's that for positive (or negative) reinforcement? I went into medicine because I thought there'd be stability and a good income and that I'd be intellectually challenged, but that has definitely not been the case. Now, I'm seriously thinking about being brave for once in my life and taking the leap and applying for a graduate interior design degree. I'm scared I'll starve to death before I get anywhere, but heck, there have been plenty of months as a private-practice physician where I don't know how I paid my mortgage, so what's the difference? At least I'll never be on call.

Go for it, DrEthiope. Medicine is only going to get worse if health care reform is passed in its current form.

Did not realize this thread was so old when I started reading it - but yes, this is exactly right! It is soooo refreshing to hear these truths, spoken "out loud"! Yes, the AMA is not our friend. Yes, my patients and family have NO IDEA what is behind the way medicine is practiced today. Thank you, Doctor hope, for talking about it!

I myself have been outspoken about this. During my residency, I was starting to realize I had been subject to this institutionalized "scam". When I was invited to my undergraduate Alma Mater to speak about becoming a physician to a group of premed students, I told it like it was. The crippling loans. The dangerously long hours at work (I actually fell asleep at the wheel driving home from a 36 hour long work "day" in the PICU and luckily veered into the breakdown lane - woke up with traffic coming head on toward me...). I was not invited to return to speak the following year. The administration clearly did not want the students to hear the truth, just their idealized version...

Well I am not sure I can change the way it is. I guess I kind of feel like the old saying about knowing the difference about what you can and can not change. Or perhaps I just lack the energy to try. Anyway, I will continue to tell the TRUTH about the practice of medicine to anyone who asks. And, BTW, I think specialists are unhappy too...

I have two sons. I will discourage them both from going into medicine.

Thanks for the encouragement AnnaM. As I write this I'm preparing to go to my first interior design course tomorrow evening. I've just taken a leave from the MPH cause I don't want to burn any bridges until I'm sure. For some reason I'm absolutely scared to death! I think it's because, for the first time, this is something I really want so I'm scared I won't be good enough, etc. Believe it or not, I didn't feel this with medicine. If they had told me I didn't get in med school, I probably would have felt somewhat of a sense of personal failure, but I don't think it would have been devastating. But, this. It's taking everything in my power not to chicken out, but like I said before, gotta stop being a chicken sometime. Wish me luck!

Good luck to you DrEthiope! Let us know how things go. My daughter is a creative type and I love to see how much she loves what she is doing. She started out wanting to do interior design but ended up switching to fashion design and then an interdisciplinary major between fine arts and theater with the intent to do costume design. I worry occasionally that she won't be able to support herself (wishing she had stayed in interior design), but mostly I just think that she loves it so much she will find a way to make it work.