Ladies,
You know, there are SOOO many posts in MOMMD that lament that we, those who are in primary care, are unhappy in our jobs, and yet so many of us are bound by medical school debt so we are forced to work. This experience is shared by many of my colleagues in real-life across spectrums as well.

This is one of the most brilliant scams out there.

Maintain an aura of prestige and competition. Let people fight over a spot in med school. Get people to sign over hundreds and thousands of dollars. Paint a rosy picture about primary care. Match people to it. Force people to provide medical care for hospitals and clinics for little wage for 3 years. After 7 years then indenture people for years to work bound by their growing debt.

I am wondering what you thinking about bringing a class action lawsuit against US medical schools for "falsifying" information to medical students and premedical students about the state of primary care.

When we were students weren't we told that primary care physicians need to possess the skills of listening, organizing, and educating patients. As I recalled, we were told that we'd be the corp of "special" physicians who understand patients in the whole biosocialpsychological context. This is why, students should aspire to match in primary care. There is a disconnect between what academia teaches its students and what real working environment is.

In reality, we are seeing patients 15 minutes a piece. Time to educate, reinforce, listen, organize, document, analyze, etc ARE NOT REIMBURSED. We are seeing 20+ patients a day being responsible for every aspect of patient's medical care, with time to review labs that come out of our staying later, during lunch break, cutting corners as much as we can get away with. In the meantime, patients expect their primary care doctors to practice "perfect" medicine like Norman Rockville's doctors. Or else, they will sue. We all buy million dollar medical liability insurances.

Because of our educational debt, we can't quit. Meanwhile, medical schools accept more med students and churn out more medical residents who are going into primary care thereby reducing our negotiating leverage. Do you see how in the bigger economic scheme of things, we have very little power?

How about it.
Do we have a case?

If there was such a lawsuit, initiated by someone else, how much money are you personally willing to contribute to it to pay for high-profile attorney's fee? I for one know that if someone initiated this lawsuits, I would contribute in the ballpark of $200-500 but I'm not sure if other people feel this way.

Does anyone know how much of such lawsuit would cost?

Even if the case was lost, it would provide media exposure and open a topic of discussion. It might detract premeds and med students going into primary care, which ultimately will lead to some radical changes.

Alternatively, should people form an organization of physicians who go out to tell pre-meds and med students NOT TO MATCH in primary care? Given the 50% of med students are women, would they listen with more if this message came strong and clear from women physicians who are practicing and living the real life?

Like many other groups of disgruntled workers...we should unionize. That way we can make the rules...and if hospitals, insurance companies, clinics, etc. want to play this "medicine game," they'll have to deal with the doctors union. We protect our rights, and our voices are not only heard, but respected.

If we could change medicine just a tiny bit, in significant ways, we would be happier practicing. If we were happier practicing, the debt, time invested, and all the things mentioned, would be worth it.

I think it's more likely that a union would work than a class action law suit. And if the class action law suit is an option...doctors need to organize anyway (even for that to be successful).

Bottom line...doctor's need to unite and fight. There is no medicine without us...we need to flex our muscles a bit, and remind the country that *we are medicine.*

This is a little off topic, but I'd like to sue the lawyers for all the frivolous and truly non-malpractice cases they create!! This is creating terrible work conditions for physicians now. I hardly know a doc who's not being sued anymore. I got dragged into a case right now where all I did was order an xray--radiology misread it and a diagnosis totally unrelated to her visit to me was delayed by a few months, but the patient received appropriate care for it. But she died of something else entirely 3 years later!! Tell me how that is my fault!! My attorney says I'll get dropped eventually, but I am stuck in this case for years now until then.

I find it morally reprehensible in our country the way it is so easy to sue doctors when the patient or family simply isn't happy with the outcome. Greedy, greedy, greedy and no sense of self-responsibility.

I do feel let down by the practice of medicine in our country, but feel it is more due to our government and law system. Maybe if the doctors back in the 60's and 70's had paid better attention to things and maybe unionized back then, we'd be in better shape today.

doctorhope....

I couldn't agree more with your analysis of the scam we all were suckered into. My finance used to talk about that exactly as you wrote. I always thought he was a bit of a conspiracy nut. Now I can see that scam and multitudes of similar others throughout our society and wished I had woken up sooner. It deeply troubles and saddens me. It is quite comforting to read that others are aware of it too and interested in taking action.

In med school, I started stressing over the debt that was accruing. The financial advisors at school always smiled and reassured me that I would be able to pay it off really quickly with my future doctor salary. My tuition was huge and then they gave me only a tiny amount to live off of (so I had to take out private loans). They also seemed surprised and annoyed that I couldn't just call my parents for money to pay rent and groceries etc...

I can't imagine paying this off anytime soon. My loans payments are more than most peoples house payments. Even if I lived out of my car for 5 years, I doubt I would be able to pay this down much. I don't even have kids yet, so I can't imagine how others deal with it. My income is not increasing, but my malpractice and business expences keep going up. I feel terribly trapped.

I would be interested in taking action, but I'm not sure we could win the lay suit your discussing. People do not have much empathy for doctors or understanding of our problems. Even many of the premeds on this website (who interact with us here daily) do not seem very understanding towards our problems and are lining up to go right down the same path we did. Although it does seem they are getting the message to avoid family practice.

naw, don't need to sue the medical schools -
It is really more of a government funded indentured servitude - most especially with primary care. It is the government that loans us the large amounts of money (Stafford, etc.) to attend school and it is also the government that later on has a huge influence in how much we are paid for our services - Medicare and medicaid - and of course, the private insurers continually low-ball down reimbursements toward the government rates. Oh yeah, our residency training wages are also government funded -

CaliMed

Your analysis is brilliant. It IS the government. Wow. I never thought of it that way.

And here I am thinking that the government is the innocent party. I think that way because I get less hassle from Medicare then private insurance companies.

You rightly pointed out the following.

It is the government who subsidize additional funding to medical schools such as mine that labeled itself as a primary care focused school. Stupid me. I should have wondered why there's a shortage of primary care physicians. Duh.

It is the government that helped to defeat the lawsuit of residents against ACGME for the Match. If residents were to earn more, the health care system would go bankrupt.

It is the government that guranteed the loans.

It is the government that sets Medicare fee schedule.

But the government didn't act alone. It is the final result of the big corporations (biotech companies that make invasive procedure related devices), insurance companies, pharmaceutical companies, special interest group (including our specialists colleagues in the AMA) that lobby hard to make goverment make its decisions.

I think the public is totally in the dark and clueless about what is going on. This brings back the story of how the government allowed GM to make SUVs which are nothing but a bigger car built on a truck frame that is not only dangerous but energy inefficient and harmful to the environment. The government caved into the lobby effort of GM, and then GM sells this terrible product to consumers with glorified image of a very dangerous vehicle by multimillion dollar advertisement. Read High and Mighty, a story of how SUV came to being, well written by a New York Times author.

We will never win in this lawsuit. But it might bring an unprecedented awareness to the public and mobilize public advocacy. Do you think most patients know why their internists/FP spend only 15 minutes on the average for a visit?

"Doctors don't listen. They don't spend time to tell me ANYTHING!"

I guess the only other approach is to form an organized effort to tell premeds and medical students NOT to do primary care. Less supply=greater demand=less leverage power. We at MOMMD can do it.

I don't agree with those doctors who say, wow, the shortage of primary care doctors is so bad for the patient. No. That there are unhappy primary care doctors working as such is bad for the patients and the doctors.

We say that we have to take power back. But how?

I personally would be happy with the same salary but seeing fewer patients a day (10 patients in the clinic, or 7 patients as a hospitalists). This is ridiculously low for our census currently, but it would mean that I could provide outstanding care and not burn out even after 20 years of practicing. I can have a life outside of medicine like normal people because with the extra time, I can eat lunch for 20 minutes without interruption, I can keep up with medical journals, and investigate the really tough cases without a diagnosis. I can return lab work and discuss them in detail the way patients like it...It would be an honest 8 hour day.

There is a survey out saying that primary care is picking up as there is more demand. Could it be that it's already happening? Fewer people choose primary care because it sucks? Or more people get old and need primary care? Or has the government once again created a perceived hysteria that we don't have enough primary care physicians, so they can churn them out more as a way to lower our fee?

Calimed is right. The government is the ultimate supplier of primary care doctors. In fact, the system creates a safety valve. All those internal medicine subspecialists in a time of crunch or highly desirable enviornment, can switch to perform primary care--even though they may be very bad at it because primary care is not without clinical challenges.

Suppose primary care picks up and all the physicians are happy, then there would be more people going into the primary care, and the whole cycle of bad practicing environment would start again. The whole issue is with supply and demand. We need to have a check in the system that monitors primary care very closely, and advice premed/med students whether they should or should not go into primary care.

We are not totally powerless. I personally tell people not to go into primary care. We can do that. Or we can ask patients to lobby for us. Too naive?

Doctor Hope,
You are brilliant! I love it. We'll sue for false advertising. I'm laughing all the way to Wal-Mart to spend my latest paycheck. :rotfl: :rotfl:

I love this topic! I agree that it is a government conspiracy, and we were all too overwhelmed trying to figure out which cranial nerve came out of which fossa to consider the future. Now here we are in the future, scratching our heads. How did this happen?? I would contribute $500 to the cause. Sign me up.

On a practical note, I needed sanity in my life. I now charge $25 for non-urgent afterhours calls(refills/just to talk advice/UTI/URI etc). If I send you to the ER I won't charge you. And they pay.
I charge $25 no-show fee.(cancel in 24hrs)
I charge $30 to pierce ears (fun and easy)
I charge $25 phone consult fee (get credit card up front, I use this to manage HTN/ADD/LIPDS etc) for my patients who won't come in and need refills. I just put them in the schedule first thing after lunch and I call them.
I charge $25 e-consult. Can send pictures this way. kinda fun and can do this at home (medfusion)
I charge $5 a page to fill out forms.

The patients grumbled a little, but realized we would all quit if we didn't have some sanity. They are now trained and call is much much better. No more refills to call in while I'm shopping with my kids at Target.
Back to the subject at hand, I think Loan Consolidations should be at much lower interest rates (again, a govenment set fee). And yes my financial guy told me to pay as I go, and don't double pay unless I had a ton of extra money laying around. He said you can borrow for kids schools, but can't borrow for retirement. hmmm. Student loans are such an emotional decision, does getting rid of them make me that much happier? yes! but does it make the most financial sense?
txfp

Hey, txfp, wow! This is the first time I've read of an FP having an established fee schedule for all those generally UNREIMBURSED and time consuming activities that FP's perform! You must not have any significant medicaid, medicare or especially HMO patient population, right?