Why are so many physicians unhappy with their careers?

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fredflinstone
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Why are so many physicians unhappy with their careers?

Post by fredflinstone » Sun Oct 13, 2013 7:31 am

Many physicians, including some on this Forum, express profound dissatisfaction with their careers. Why?

Salaries are excellent, albeit not as good as they once were. The profession is highly respected. Most health care jobs cannot be outsourced. There is an opportunity to help people in a very direct way.

Yes, I understand that insurers limit physicians' autonomy. I understand the paperwork and long hours. I understand that many people coming out of medical school are saddled with debt.

Even so ... in an economy that is providing fewer and fewer decent career options to smart, well-educated young people, it still seems like one of the best options out there.

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Re: Why are so many physicians unhappy with their careers?

Post by gerrym51 » Sun Oct 13, 2013 7:37 am

fredflinstone wrote:Many physicians, including some on this Forum, express profound dissatisfaction with their careers. Why?

Salaries are excellent, albeit not as good as they once were. The profession is highly respected. Most health care jobs cannot be outsourced. There is an opportunity to help people in a very direct way.

Yes, I understand that insurers limit physicians' autonomy. I understand the paperwork and long hours. I understand that many people coming out of medical school are saddled with debt.

Even so ... in an economy that is providing fewer and fewer decent career options to smart, well-educated young people, it still seems like one of the best options out there.
are you a physician Fred?. The grass is always greener''''''''''

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Re: Why are so many physicians unhappy with their careers?

Post by livesoft » Sun Oct 13, 2013 7:39 am

Because there are better careers that pay more and get more respect?

It's a behavioral economics thing that they are teaching kids nowadays. See this thread: http://www.bogleheads.org/forum/viewtop ... st=1826054 and Number 12 Competitor Orientation. After all, slackers do not become MDs (oops, Number 13 Overweighting of Small Probabilities).

Full disclosure: I am not a physician, but I worked in a hospital once.
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Re: Why are so many physicians unhappy with their careers?

Post by fredflinstone » Sun Oct 13, 2013 7:44 am

livesoft wrote:Because there are better careers that pay more and get more respect?
What are those other careers?

Engineering? I have a friend whose (very bright) son recently graduated with an undergraduate degree in engineering from a highly regarded program. He received only one job offer.

Law? I'm hearing numerous reports that recent graduates from law school cannot find steady employment. http://www.bogleheads.org/forum/viewtop ... 3#p1826093

Finance? Sure. If you can get into one of the top business schools in the country.

Music? Ha ha ha! http://www.bogleheads.org/forum/viewtop ... st=1815097

So, serious question: What are those careers that pay more than medicine and get more respect?

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Re: Why are so many physicians unhappy with their careers?

Post by WendyW » Sun Oct 13, 2013 7:47 am

gerrym51 wrote:The grass is always greener
I believe that this is the answer.

When you work in career X, you learn all of the downsides of career X.
Suddenly careers Y and Z look good in comparison.

I think physicians don't realize how good they have it. Though, I'm not a physician.

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Re: Why are so many physicians unhappy with their careers?

Post by livesoft » Sun Oct 13, 2013 7:47 am

fredflinstone wrote:So, serious question: What are those careers that pay more than medicine and get more respect?
Nobel prize winner

Dean of a university

CEO of biotech start up

Nobel prize winner who is dean of a university and CEO of a biotech

Football coach
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Re: Why are so many physicians unhappy with their careers?

Post by fredflinstone » Sun Oct 13, 2013 7:52 am

livesoft wrote:
fredflinstone wrote:So, serious question: What are those careers that pay more than medicine and get more respect?
Nobel prize winner

Dean of a university

CEO of biotech start up

Nobel prize winner who is dean of a university and CEO of a biotech

Football coach
So physicians are unhappy because they aren't earning as much as Nobel prize winners and biotech CEOs? Oookay. I suppose you can add NFL player, rock star, movie star, lottery winner, and super-model to the list. Unfortunately, these are not realistic career paths for 99.999 percent of people.

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Re: Why are so many physicians unhappy with their careers?

Post by VictoriaF » Sun Oct 13, 2013 7:57 am

livesoft wrote:
fredflinstone wrote:So, serious question: What are those careers that pay more than medicine and get more respect?
Nobel prize winner

Dean of a university

CEO of biotech start up

Nobel prize winner who is dean of a university and CEO of a biotech

Football coach
There is a Nobel Prize in medicine but not in football.

Victoria
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Re: Why are so many physicians unhappy with their careers?

Post by ThSGM » Sun Oct 13, 2013 8:01 am

fredflinstone wrote:
livesoft wrote:Because there are better careers that pay more and get more respect?
What are those other careers?

Engineering? I have a friend whose (very bright) son recently graduated with an undergraduate degree in engineering from a highly regarded program. He received only one job offer.

Law? I'm hearing numerous reports that recent graduates from law school cannot find steady employment. http://www.bogleheads.org/forum/viewtop ... 3#p1826093

Finance? Sure. If you can get into one of the top business schools in the country.

Music? Ha ha ha! http://www.bogleheads.org/forum/viewtop ... st=1815097

So, serious question: What are those careers that pay more than medicine and get more respect?
WendyW wrote:
gerrym51 wrote:The grass is always greener
I believe that this is the answer.

When you work in career X, you learn all of the downsides of career X.
Suddenly careers Y and Z look good in comparison.

I think physicians don't realize how good they have it. Though, I'm not a physician.
I'm not a physician myself, but I do work as an academic professor, and have quite a few family relatives who are medical doctors. One of the advantages to working as an academic and teaching a fair number of undergraduates is that I do get a sense of what the wider employment market is like for a variety of fields. Yes, it's true, there is a whole "grass is greener" type argument. I've learned not to get into arguments about who works more in field X, or what opportunities are better in field Y. Academia, for example, can be a wasteland for job opportunities.

On the other side of the argument, I don't think we should be so rash to just say that everything is relative. There are some disciplines which make you very employable (one of those is engineering), just as there are some disciplines that make you not-very employable, unless you are directly involved with obtaining a second skill.

There is one universal rule of education that I stress: you can't predict the job market in 10 years. What this means is that the best way to ensure you get a good job is to be very flexible in your education. This is why I believe engineers often do very well: they aren't pidgeonholed into working in exactly academia, industry, or government-related work. It is basically the jack-of-all-trades discipline in the hard sciences.

In terms of the medical sciences, then again, the key here is specialization. My family and friends in the business tell me that if you are too specialized (e.g. surgeon), then you can have a tough time because there is a lot of supply and not so much demand. However, if you are open to a variety of specializations, then this is a good thing. There will always be a need for people with medical licensing and medical degrees; the debate here is whether you're set on working say, in the ER at a big hospital versus opening up a general practice.

The same goes for the examples you raised. Take finance for instance. There is a very big difference in working on Wall St. as a quant and working as an actuary or an accountant. From my experience with students, quant positions are very high paying, but explosive in terms of instability. Actuarial positions are rather stable (same goes for accounting). The question here is whether you were dead set on working for say, Goldman Sachs as a quant? Or would you be happy working in any area of finance? How geographically restricted are you? And so forth and so on. Here, the details matter a great deal.

Depending on what you will need to pay, medicine, like engineering, will be a good bet for a stable career. The postgraduate requirement is only 3 years (plus residency, etc.) in the US. Compare this with a 5-7 year PhD in say, Linguistics, Psychology, etc. etc. which is much longer, and for which the career and salary prospects are much lower.

It amuses me to relate trying to predict the job market with trying to predict the stock market.

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Re: Why are so many physicians unhappy with their careers?

Post by VictoriaF » Sun Oct 13, 2013 8:14 am

ThSGM wrote:There is one universal rule of education that I stress: you can't predict the job market in 10 years. What this means is that the best way to ensure you get a good job is to be very flexible in your education. This is why I believe engineers often do very well: they aren't pidgeonholed into working in exactly exactly academia, industry, or government-related work. It is basically the jack-of-all-trades discipline in the hard sciences.

...

Depending on what you will need to pay, medicine, like engineering, will be a good bet for a stable career.
The problem with engineering is that it's easy to outsource. Unlike a physician, an engineer does not have to be physically present at the workplace; unlike a lawyer or an MBA type, an engineer does not need to have a flawless command of English. And so many engineering jobs have moved and are moving to Asia and Eastern Europe.

At we speak, Alcatel-Lucent is laying off 10,000 engineers and scientists, and in Connecticut United HealthCare is dropping thousands of physicians from the Medicare Advantage. Which ones do you think are more likely to find jobs?

Victoria
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Re: Why are so many physicians unhappy with their careers?

Post by WendyW » Sun Oct 13, 2013 8:21 am

I have an undergraduate degree in engineering and a graduate degree in finance, both from well-regarded schools.

I wish I had gone to medical school instead.

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Re: Why are so many physicians unhappy with their careers?

Post by gerrym51 » Sun Oct 13, 2013 8:30 am

VictoriaF wrote:
ThSGM wrote:There is one universal rule of education that I stress: you can't predict the job market in 10 years. What this means is that the best way to ensure you get a good job is to be very flexible in your education. This is why I believe engineers often do very well: they aren't pidgeonholed into working in exactly exactly academia, industry, or government-related work. It is basically the jack-of-all-trades discipline in the hard sciences.

...

Depending on what you will need to pay, medicine, like engineering, will be a good bet for a stable career.
The problem with engineering is that it's easy to outsource. Unlike a physician, an engineer does not have to be physically present at the workplace; unlike a lawyer or an MBA type, an engineer does not need to have a flawless command of English. And so many engineering jobs have moved and are moving to Asia and Eastern Europe.

At we speak, Alcatel-Lucent is laying off 10,000 engineers and scientists, and in Connecticut United HealthCare is dropping thousands of physicians from the Medicare Advantage. Which ones do you think are more likely to find jobs?

Victoria
being dropped as a provider on an insurance plan is not the same as being laid off.

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Re: Why are so many physicians unhappy with their careers?

Post by Manks » Sun Oct 13, 2013 8:38 am

I am not a physician. However, I am a clinical pharmacist at one of the top 3 hospitals in the country. I think a large part of the dissatisfaction comes realizing that one has invested so much of their lives to learn how best to help people, yet, continually seeing people neglecting to take any responsibility for their our health. At least that is the reason that I left adult medicine and now take care of pediatric patients.

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Re: Why are so many physicians unhappy with their careers?

Post by Dopey » Sun Oct 13, 2013 8:43 am

Lots of speculation thus far with no input from any physicians.... GO INTERNET!! :D

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Re: Why are so many physicians unhappy with their careers?

Post by VictoriaF » Sun Oct 13, 2013 8:49 am

WendyW wrote:I have an undergraduate degree in engineering and a graduate degree in finance, both from well-regarded schools.

I wish I had gone to medical school instead.
gerrym51 wrote:being dropped as a provider on an insurance plan is not the same as being laid off.
I think both of you are supporting my point. I have a B.S. and an M.S. in Engineering, and in two months I will finish the second M.S. in a related field. Engineering was very good for me, but I also know its many pitfalls.

Victoria
Last edited by VictoriaF on Sun Oct 13, 2013 8:51 am, edited 2 times in total.
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Re: Why are so many physicians unhappy with their careers?

Post by zzcooper123 » Sun Oct 13, 2013 8:50 am

Physicians are taught early in their training that they are part of an elite corps. Most put up with painful, extended training to enter this elite group. Unemployment is essentially zero among physicians and they expect that from the beginning. They are trained to be "Captains of the Ship" and dislike insurance or governmental meddling in their medical decisions.
They expect to be well paid from this endeavor and for their "lost years". They tend to be disappointed when this dedication is not rewarded.

Is it entirely justified? .....no.

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Re: Why are so many physicians unhappy with their careers?

Post by Toons » Sun Oct 13, 2013 8:54 am

fredflinstone wrote:
livesoft wrote:
fredflinstone wrote:So, serious question: What are those careers that pay more than medicine and get more respect?
Nobel prize winner

Dean of a university

CEO of biotech start up

Nobel prize winner who is dean of a university and CEO of a biotech

Football coach
So physicians are unhappy because they aren't earning as much as Nobel prize winners and biotech CEOs? Oookay. I suppose you can add NFL player, rock star, movie star, lottery winner, and super-model to the list. Unfortunately, these are not realistic career paths for 99.999 percent of people.

+1 :happy
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Re: Why are so many physicians unhappy with their careers?

Post by climber2020 » Sun Oct 13, 2013 8:55 am

fredflinstone wrote:Many physicians, including some on this Forum, express profound dissatisfaction with their careers. Why?

Salaries are excellent, albeit not as good as they once were. The profession is highly respected. Most health care jobs cannot be outsourced. There is an opportunity to help people in a very direct way.

Yes, I understand that insurers limit physicians' autonomy. I understand the paperwork and long hours. I understand that many people coming out of medical school are saddled with debt.

Even so ... in an economy that is providing fewer and fewer decent career options to smart, well-educated young people, it still seems like one of the best options out there.
Physician here.

I think one of the main sources of discontent among physicians is rampant overconfidence. My peers who are unhappy with their careers often make comments like "I should have gone to business school", "I should have been a CEO", "I should have been an investment banker", "I should have gone into real estate", mistakenly thinking that being intelligent enough to make it through medical school and a residency automatically makes one qualified to succeed in one of these other career options. Never mind that some of these individuals are some of the most socially awkward people imaginable, which, while fine for a liver surgeon, would likely lead to abrupt failure in any career requiring strong people skills.

With regard to my own career choice, I have been very satisfied with my decision to be a doctor for all the reasons you stated. The pay is nice, I get respect from my patients (for the most part), and it is very difficult to outsource a surgeon.

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Re: Why are so many physicians unhappy with their careers?

Post by whaleknives » Sun Oct 13, 2013 9:02 am

Postby livesoft » Sun Oct 13, 2013 8:47 am
fredflinstone wrote:So, serious question: What are those careers that pay more than medicine and get more respect?
. . .

Football coach
Make that "Winning football coach".
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Re: Why are so many physicians unhappy with their careers?

Post by Munir » Sun Oct 13, 2013 9:23 am

zzcooper123 wrote:Physicians are taught early in their training that they are part of an elite corps. Most put up with painful, extended training to enter this elite group. Unemployment is essentially zero among physicians and they expect that from the beginning. They are trained to be "Captains of the Ship" and dislike insurance or governmental meddling in their medical decisions.
They expect to be well paid from this endeavor and for their "lost years". They tend to be disappointed when this dedication is not rewarded.

Is it entirely justified? .....no.
Agree with above analysis. If one is in medicine merely to make money and be the "captain fo the ship", then disappointment down the line is frequent. You need to have the dedication to your profession and to love serving others as your primary motivators in order to be in it for the long haul. The prestige, independence (far diminished these days), and money are enjoyable as extras but do not have sustaining powers by themselves to make you happy and fulfilled.
PS: I'm a retired urologist.

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Re: Why are so many physicians unhappy with their careers?

Post by Jfet » Sun Oct 13, 2013 9:26 am

Out here on the west coast, a senior software engineer can probably find a job faster than a physician, although maybe not for as much pay (I am not sure how much physicians make). 4 years of education vs 10+ years? I guess it is easy to see why physicians may feel a bit cheated.

Good software engineers are not outsourced. Only the grunt coders when a company is cheap and doesn't really care how many times a 12 hour long build breaks for their critical release product. My wife has had many times where she had to do a complete rewrite of crap software outsourced to Asia when the bean counters thought they were being smart.

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Re: Why are so many physicians unhappy with their careers?

Post by The Wizard » Sun Oct 13, 2013 9:41 am

Similarly, there's a wide variety of U.S. government engineering work which can never be outsourced to foreign countries for reasons I can't be specific about...
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Re: Why are so many physicians unhappy with their careers?

Post by gerrym51 » Sun Oct 13, 2013 9:48 am

People complain about their jobs and then complain when they lose them. :mrgreen:

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Re: Why are so many physicians unhappy with their careers?

Post by travellight » Sun Oct 13, 2013 9:52 am

I think difficult and demanding patients have increased in number over the past few decades. Patients with difficult problems are not the issue, in fact, it is a delight to cure/solve a more challenging problem and provide greater help. The unreasonably demanding (as opposed to reasonably demanding although this should not exist because if it was reasonable, they would not have to demand) patient who bullies and threatens litigation to get their way is a significant detractor to career satisfaction.

For me, it isn't about money or respect. It was about really helping people and being appreciated for it. I once said early in my career after helping a lovely gentleman with a difficult problem, "I would take a 20% pay cut if I could be assured all my patients were like Mr. X."

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Re: Why are so many physicians unhappy with their careers?

Post by travellight » Sun Oct 13, 2013 9:55 am

That being said, I am not unhappy with my career. I am delighted with it. I am just citing the challenges that could produce unhappiness.

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Re: Why are so many physicians unhappy with their careers?

Post by The Wizard » Sun Oct 13, 2013 9:56 am

gerrym51 wrote:People complain about their jobs and then complain when they lose them. :mrgreen:
I think that ALL jobs have slow periods or periods of dissatisfaction for various reasons.
You don't necessarily know what these are going in as a new grad.
Which is why it's good to save lots of $$$ so that you have various options when you get to your 50's.
I can't speak specifically to what the issues are with physicians since I'm not one...
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Re: Why are so many physicians unhappy with their careers?

Post by gerrym51 » Sun Oct 13, 2013 9:59 am

I have just retired from being full time pharmacist. i advise young people not to go into the profession because of

this.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687123/


but they don't listen



the same thing is happening to physicians although not in the same way. government is pushing more classes of providers to do traditional doctor stuff(could not think of better word). whether physician assistants-nurse practioners etc the income for physicians is dropping and aggravation increasing.
Last edited by gerrym51 on Sun Oct 13, 2013 10:15 am, edited 1 time in total.

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Re: Why are so many physicians unhappy with their careers?

Post by 7milehi » Sun Oct 13, 2013 10:03 am

One career that will have a major shortage in the next 2-15 years is for aircraft pilots especially airline pilots . The average age of a major airline pilot is 51.5 years old and a federal mandated retirement age of 65 . I've been an airline pilot for 33 years and can actually say I still love my job . There is still a rush when I push the thrust levers up on take off and coming in for landing . I also have the best office window of any job in the world ! The airline I work for has several pilots that have their MD , JD or MBA .

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Re: Why are so many physicians unhappy with their careers?

Post by smiley » Sun Oct 13, 2013 10:07 am

another physician here.

medicine is changing, i suspect more than it has in quite some time. i would imagine that there will always be people unhappy with change.
i've been in practice for roughly a decade. i realize that nothing else that i could do would give me as much satisfaction or pay me as well. i love my patients. i will not change careers, but i may choose to retire as early as possible.

the changes i've seen in medicine over this period of time are highly annoying and require an awful lot of administrative time and expense on my part.
i get angered on an almost daily basis with the need to talk to a medical director of an insurance company (usually a retired MD of an unrelated field) over the medical necessity of a particular test or therapy.
i hate the need to hire 3-4 full time employees to obtain prior authorizations for everything (tests and treatments) we order.
i can't stand the fact that we were forced to invest millions of dollars into an electronic medical record system, that 5 yrs later still crashes a couple of times a week and is incapable of talking to the systems of other physician offices. it takes me roughly 10-15 minutes longer with each patient, and i hate having to look at a computer screen while i interview patients.
i hate the 10 page office notes that these electronic systems generate that basically don't tell you anything.

if i sat and thought about it a little longer, i'm sure i could add to the list and get my blood pressure up a little more. i'll go do some yoga instead.

:happy

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Re: Why are so many physicians unhappy with their careers?

Post by smpatel » Sun Oct 13, 2013 10:19 am

I have not come across a physician who is unhappy and I know 15 of them including surgeons.

Regarding work schedule, they have the most flexible work schedule that I could see. Attending all the child activities during weekend, travelling with kids for their athletic activities during the weekend/during the week. The range of their specialty include-
OBGYN
Orthopedic surgeon
Internal medicine
Heart Surgeon
Family Physician

All of above seem to have ample time to do many things they enjoy and the pay is very good, they live in large homes, drive luxury new cars.

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Re: Why are so many physicians unhappy with their careers?

Post by Texas hold em71 » Sun Oct 13, 2013 10:19 am

The Wizard wrote:
gerrym51 wrote:People complain about their jobs and then complain when they lose them. :mrgreen:
I think that ALL jobs have slow periods or periods of dissatisfaction for various reasons.
You don't necessarily know what these are going in as a new grad.
Which is why it's good to save lots of $$$ so that you have various options when you get to your 50's..
+1

While people say "Do what you love and you will never work" over a 40 year period that is a tough bill to fill. Once you have invested in training and education and achieved a certain level of income, switching to something new is "expensive." It is easier to stick it out in a job you don't like too much but once loved than to risk current lifestyle to find something you love.

Most people I know are unhappy in their career by their 40s.

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Re: Why are so many physicians unhappy with their careers?

Post by cowboy » Sun Oct 13, 2013 10:21 am

I'll chime in as a primary care physician. In general, I love the work I do, but it has certainly come at a price and is not without its problems. Some of my thoughts:

1) Work-life balance is a struggle. This is the biggest source of discontentment for me, and a primary source for many of my friends. While highly-dependent on the choice of specialty, the reality of my work-life balance is very different than my perception before I entered medicine. While the four years of medical school was more demanding than my undergraduate degree in engineering, residency (usually 3 to 7 years, followed by 1-3 year fellowships should we decide to subspecialize) is an entirely different beast. 30-36 hours of continuous work with no sleep, working typically over 100 hours/week... while in itself exhausting, I was always more concerned with the lack of time I was able to spend with my family. There were entire months in which I did not see my children due to my work schedule. There were also entire months I did not see my wife due to the marital discord that frequently accompanies being an absentee parent and spouse. In fairness, my schedule post-residency has been less demanding, but 60-80 hours of in-the-office work (I still spend significant time working at home in addition to this--presentations, paperwork, attempting to stay current with an exponentially increasing field of knowledge) is still twice as much as the typical American worker.

2) We don't always get to practice medicine the way we'd like. My favorite parts of being a physician are getting to actually interact with my patients and making clinical decisions regarding their healthcare. The parts nobody sees are all the things that are driven by insurance companies and bureaucracy: I spend most of my working time either a) writing notes that are full of administrative fluff and cover-your-butt medicolegal material or b) coding my encounters and dealing with insurance nonsense. Increasingly so, I can't run the tests or use the treatments that will actually help my patients. Similarly, non-clinical administrators and insurance companies may demand that tests/meds be used which were never indicated and will not help my patients. Much of medicine is shifting toward being practiced via algorithms. I didn't complete 25 years of education and training to follow a cost-ineffective algorithm. This worries me a bit, as that's the direction much of medicine is headed. Many of my senior colleagues are leaving medicine for these very reasons.

3) I often question my decision to enter medicine. While I concur with climber2020's thoughts on rampant overconfidence amongst physicians, I was quite marketable as an electrical engineer out of college. The compensation would have actually been quite comparable, and without the need for another 8 years of training. When I imagine this in terms of "income per unit of happiness", I think engineering probably would have been the winner. However, I am probably not aware of the all of the pitfalls as VictoriaF mentioned.

It's been a rocky road, but I'm at the point now where I'm glad I entered medicine, and I am grateful to have a well-compensated job which permits me to serve others in a way that is emotionally rewarding. There is administrative-foo in all fields, and, in the grand scheme of things, it's a small price to pay to have such a profound impact on the lives of others.
Last edited by cowboy on Sun Oct 13, 2013 10:39 am, edited 1 time in total.

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Re: Why are so many physicians unhappy with their careers?

Post by Texas hold em71 » Sun Oct 13, 2013 10:22 am

smiley wrote:another physician here.

medicine is changing, i suspect more than it has in quite some time. i would imagine that there will always be people unhappy with change.
i've been in practice for roughly a decade. i realize that nothing else that i could do would give me as much satisfaction or pay me as well. i love my patients. i will not change careers, but i may choose to retire as early as possible.

the changes i've seen in medicine over this period of time are highly annoying and require an awful lot of administrative time and expense on my part.
i get angered on an almost daily basis with the need to talk to a medical director of an insurance company (usually a retired MD of an unrelated field) over the medical necessity of a particular test or therapy.
i hate the need to hire 3-4 full time employees to obtain prior authorizations for everything (tests and treatments) we order.
i can't stand the fact that we were forced to invest millions of dollars into an electronic medical record system, that 5 yrs later still crashes a couple of times a week and is incapable of talking to the systems of other physician offices. it takes me roughly 10-15 minutes longer with each patient, and i hate having to look at a computer screen while i interview patients.
i hate the 10 page office notes that these electronic systems generate that basically don't tell you anything.

if i sat and thought about it a little longer, i'm sure i could add to the list and get my blood pressure up a little more. i'll go do some yoga instead.

:happy

This reflects the opinion of most physicians I know. I work in the field so I know hundreds. But when looking for an alternative career, most reflect your second paragraph and stick with it.

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Re: Why are so many physicians unhappy with their careers?

Post by kenyan » Sun Oct 13, 2013 10:35 am

VictoriaF wrote:
WendyW wrote:I have an undergraduate degree in engineering and a graduate degree in finance, both from well-regarded schools.

I wish I had gone to medical school instead.
gerrym51 wrote:being dropped as a provider on an insurance plan is not the same as being laid off.
I think both of you are supporting my point. I have a B.S. and an M.S. in Engineering, and in two months I will finish the second M.S. in a related field. Engineering was very good for me, but I also know its many pitfalls.

Victoria
Another engineer here with a Ph.D. from a top school. I would probably choose medicine as well if I could do it again. The pay is light-years apart. It's not all bad by any means, but my brother, who is a physician with slightly inferior credentials, is far, far better off in his career choice. I agree, though, that I am better off in work-life balance (in general, though there are certainly times where I have to work harder than he does, and I have to travel far more, and he at least gets paid for his overtime).
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Re: Why are so many physicians unhappy with their careers?

Post by momar » Sun Oct 13, 2013 10:36 am

I'm seeing a lot of complaints from physicians that are not unique to the profession. Dealing with bureaucracy/administration, unreasonable customers/management, work/life balance, IT systems that don't function properly, not having complete freedom to do the job the way they feel is best, thinking they should have gone to Wall Street or elsewhere, that things aren't the same as they used to be etc etc etc.

You guys should come down to my workplace and ask some of the scientists and engineers what they think. They will have ALL of the same comments and will have gone through just as much schooling/training (BS/MS/PhD/Postdoc, anywhere from 11-15 years before being staff) but of course will not be compensated as well.

edit: my point isn't that being a scientist/engineer sucks. It can be pretty great. But that lots of things about any job suck, and they are usually more or less the same things regardless of field at a given education/skill level.
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Re: Why are so many physicians unhappy with their careers?

Post by DireWolf » Sun Oct 13, 2013 10:49 am

Physician here. There are too many reasons to discuss them all... I can mention a few.

1. Lack of respect. It's funny to see some people on here mention that physicians are well-respected... maybe 30 years ago... that ship has long sailed. Patients are often rude and threatening. Administrators talk to you like you're a 2-year-old. Nurses often ignore and question orders. And the general public lol... that leads into #2.

2. The general public has shifted to become extremely anti-physician. I have stopped reading health care articles, particularly those relating to physicians. 90% of the comments label physicians as greedy, uncaring, lazy, overpaid, etc. When I read the last article about physician burnout in the NY Times, the comment section made me sick to my stomach.

3. Lack of autonomy. This has been going on for over a decade. Insurance companies, the government (Medicare/Medicaid), and hospital administrators making patient-care decisions against our advice.... almost always resulting in poorer care for the patient.

4. Midlevels masquerading as doctors. PAs, NPs, CRNAs, etc. They get half the training and act like they are doctors. Their ignorance is scary and dangerous. The ones who practice within their scope of training and have the insight to know their limitations are invaluable and provide great care. The ones who think they know it all are the ones who provide bad care and harm their patients. Some of them even want to be called "Dr" by patients. How disingenuous is that? Most patients don't know any better and think they are actually speaking with a physician... scary.

5. Income. Of course everyone thinks physicians are overpaid. I disagree. Some are overpaid, some are paid fairly, and some are underpaid. With some of the other professions making 7-figure incomes and providing no useful value to society (in some cases harming society), I would argue many physicians are underpaid.

6. Hours. There aren't many professions out there where a 70-hour work week is considered normal. Many people struggle to work 40-hours a week and complain how they are overworked. Not to mention all the holidays, weekends, and nights... again this is "normal" not above and beyond.

7. Debt/Sacrifice. Average medical school debt is $180k and rising. This doesn't include undergraduate education debt. And I pretty much only saw my family twice-a-year during medical school and residency. I sacrificed the prime years of my life (ages 23-31) to undergo rigorous training. While most people were out dating, traveling, starting families, and enjoying all life has to offer, I spent 14 hours a day in a hospital.

8. Malpractice. The difference between maloutcome and malpractice has been eroded. Trial lawyers have successfully lobbied to allow even the most frivolous suits to be initiated. Society's lottery mentality is alive and well. One bad outcome and everything I've sacrificed for can be taken away. While the majority of suits get dropped or settled, the stress can eat you away. I know several colleagues that have suffered major medical events and committed suicide from the stress of a lawsuit. Which leads into #9.

9. Stress. That's why the drug/alcohol abuse, suicide, and divorce rates are so high for physicians. Some specialties are more stressful than others. Anesthesiologists and surgeons for example, can permanently maim or kill a patient if any detail is overlooked or mistake is made. And this can still happen in spite of doing everything right.


For what it's worth... 99% of physicians I know are caring, dedicated, smart individuals who do their best despite a broken system that promotes failure.

And to address the cliche "all these rich, greedy doctors care about is making more money, not about the patient." First of all, if anyone deserves to make 7-figures, it would be a physician. With the average physician salary around $200k, we are not overpaid... not even close. And I don't know a single physician who doesn't want to see his/her patients get better.

One final thought: I hear this one a lot - "Doctors only go into medicine for the money". First of all that's not true. Most physicians don't make enough money to make up for all the things I listed above. If it was all about the money, business/banking would make more sense. Second of all, even if a physician did go into medicine only for the money, so what? Does that make him/her a bad doctor? If Lebron James only plays basketball for the money, don't you still want him on your team? He's the best at what he does and he helps your team win, so who cares what his motivation is?

A quick anecdote to illustrate my point- the best surgeon I know is primarily motivated by money. Notice I said he is the BEST surgeon I know. His outcomes are better than anyone else in the area. In order for him to do more surgery and make more money, he has to be a great surgeon or he won't get any referrals. You might not like his personality or his motivation for being great, but bottom line he is great, and he is the one you want cutting on you. Great surgeons make the most money because they get all the referrals. Seems fair to me.
Last edited by DireWolf on Sun Oct 13, 2013 6:05 pm, edited 4 times in total.

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Re: Why are so many physicians unhappy with their careers?

Post by swimirvine » Sun Oct 13, 2013 10:50 am

I'm a physician and I absolutely love my job! I literally find myself sitting at my desk somedays thinking "how did I get so lucky?!?!"

I think it sometimes might have to do with the hours worked. A lot of doctors have to work evenings, nights and/or weekends. This can seem exciting when you're in your 20's but after 20 years this can get old.

Also, there's more and more paperwork, less autonomy and the keep cutting reimbursement.

But I still consider myself lucky and I look forward to going to work everyday
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Re: Why are so many physicians unhappy with their careers?

Post by VictoriaF » Sun Oct 13, 2013 10:53 am

The medicine vs. engineering decisions are based on the recent history and have a long momentum. Curiously, I have a reverse story from another place and time.

About ninety years ago, my grandmother was a physician and my grandfather was an engineer. From what I have heard, my grandmother was a very good physician, and for several years she was the only doctor in a provincial Ukrainian town where her responsibilities ranged from pulling new-born babies to pulling teeth, and everything in between. However, my grandfather had a much better job that commanded much higher respect, pay and perquisites. In the 1950s, Jewish doctors were the most hated group in the Soviet Union (after they were accused in trying to poison comrade Stalin), and my grandmother has lost her job.

And so my parents, their siblings, me, and many other members of the family became engineers. It was a prudent decision at one time, but the family memory outlasted the prudence.

Victoria
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Re: Why are so many physicians unhappy with their careers?

Post by DireWolf » Sun Oct 13, 2013 10:58 am

smpatel wrote:Regarding work schedule, they have the most flexible work schedule that I could see. Attending all the child activities during weekend, travelling with kids for their athletic activities during the weekend/during the week. The range of their specialty include-
OBGYN
Orthopedic surgeon
Internal medicine
Heart Surgeon
Family Physician

All of above seem to have ample time to do many things they enjoy and the pay is very good, they live in large homes, drive luxury new cars.
What an ignorant post. Nothing could be further from the truth. One of the top complaints of physicians... "I never get to spend enough time with my family". Missing weddings, funerals, kids' games and activities, and daily routine stuff like dinner is the norm.

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Re: Why are so many physicians unhappy with their careers?

Post by Artsdoctor » Sun Oct 13, 2013 11:06 am

I think that you'll get a variety of answers to that question depending on age, specialty, financial obligations, etc.

I am part of a two-physician household, we are both in our 50s, and--mostly thanks to the Bogleheads--don't have any significant financial obligations and have exceeded our financial expectations because of careful investments. We work because we like it, and not because we have to.

The environment nationally is changing quickly. This creates uncertainty and uncertainty breeds anxiety. The anxiety is at a level that I have never seen and it reaches from the hospital administration, to physicians, to nurses, to really everyone--including patients. No one can anticipate what the next 2-3 years will bring which really creates an impossible planning environment.

I love the time I spend with my patients and I can honestly say that every day that I look at my schedule, I'm pretty happy. But the moment I set foot in the hospital (and this is a multi-billion dollar hospital which is managed well), my stress level goes through the roof.

There are many other apprehensions that we all feel, often driven by Medicare. Every year, the government threatens to reduce Medicare reimbursement by 20% or so. Every year, the government gives you a reprieve but increases the chance of an audit. Every year, more regulations come up and, humorously, Medicare will often have absolutely NO appeals process (electronic prescribing, etc.). And don't me started on the misrepresentation of Medicare regarding reimbursement associated with electronic medical records.

I think any physician could go on and on. Although there are always bad apples out there, most of us really do want to provide good medical care and enjoy working with patients. This environment is a very tough one. And if someone like me, who really doesn't care anymore about a paycheck, feels the intense anxiety in the environment, you can imagine how most people who have a lot of debt with large financial obligations must feel.

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Re: Why are so many physicians unhappy with their careers?

Post by katnok » Sun Oct 13, 2013 11:10 am

DireWolf wrote:Physician here. There are too many reasons to discuss them all... I can mention a few.

1. Lack of respect. It's funny to see some people on here mention that physicians are well-respected... maybe 30 years ago... that ship has long sailed. Patients are often rude and threatening. Administrators talk to you like you're a 2-year-old. Nurses often ignore and question orders. And the general public lol... that leads into #2.

2. The general public has shifted to become extremely anti-physician. I have stopped reading health care articles, particularly those relating to physicians. 90% of the comments label physicians as greedy, uncaring, lazy, overpaid, etc. When I read the last article about physician burnout in the NY Times, the comment section made me sick to my stomach.

3. Lack of autonomy. This has been going on for over a decade. Insurance companies, the government (Medicare/Medicaid), and hospital administrators making patient-care decisions against our advice.... almost always resulting in poorer care for the patient.

4. Midlevels masquerading as doctors. PAs, NPs, CRNAs, etc. They get half the training and act like they are doctors. Their ignorance is scary and dangerous. The ones who practice within in their scope of training and have the insight to know their limitations are very useful and provide good care. The ones who think they know it all are the ones who provide bad care and harm their patients. Some of them even want to be called "Dr" by patients. How disingenuous is that? Most patients don't know any better and think they are actually speaking with a physician... scary.

5. Income. Of course everyone thinks physicians are overpaid. I disagree. Some are overpaid, some are paid fairly, and some are underpaid. With some of the other professions making 7-figure incomes and providing no useful value to society (in some cases harming society), I would argue many physicians are underpaid.

6. Hours. There aren't many professions out there where a 70-hour work week is considered normal. Many people struggle to work 40-hours a week and complain how they are overworked. Not to mention all the holidays, weekends, and nights... again this is "normal" not above and beyond.

7. Debt/Sacrifice. Average medical school debt is $180k and rising. This doesn't include undergraduate education debt. And I pretty much only saw my family twice-a-year during medical school and residency. I sacrificed the prime years of my life (ages 23-31) to undergo rigorous training. While most people were out dating, traveling, starting families, and enjoying all life has to offer, I spent 14 hours a day in a hospital.

8. Malpractice. The difference between maloutcome and malpractice has been eroded. Trial lawyers have successfully lobbied to allow even the most frivolous suits to be initiated. Society's lottery mentality is alive and well. One bad outcome and everything I've sacrificed for can be taken away. While the majority of suits get dropped or settled, the stress can eat you away. I know several colleagues that have suffered major medical events and committed suicide from the stress of a lawsuit. Which leads into #9.

9. Stress. That's why the drug/alcohol abuse, suicide, and divorce rates are so high for physicians. Some specialties are more stressful than others. Anesthesiologists and surgeons for example, can permanently maim or kill a patient if any detail is overlooked or mistake is made. And this can still happen in spite of doing everything right.


For what it's worth... 99% of physicians I know are caring, dedicated, smart individuals who do their best despite a broken system that promotes failure.

And to address the cliche "all these rich, greedy doctors care about is making more money, not about the patient." First of all, if anyone deserves to make 7-figures, it would be a physician. With the average physician salary around $200k, we are not overpaid... not even close. And I don't know a single physician who doesn't want to see his/her patients get better.

One final thought: I hear this one a lot - "Doctors only go into medicine for the money". First of all that's not true. Most physicians don't make enough money to make up for all the things I listed above. It if was all about the money, business/banking would make more sense. Second of all, even if a physician did go into medicine only for the money, so what? Does that make him/her a bad doctor? If Lebron James only plays basketball for the money, don't you still want him on your team? He's the best at what he does and he helps your team win, so who cares what his motivation is?

A quick anecdote to illustrate my point- the best surgeon I know is primarily motivated by money. Notice I said he is the BEST surgeon I know. His outcomes are better than anyone else in the area. In order for him to do more surgery and make more money, he has to be a great surgeon or he won't get any referrals. You might not like his personality or his motivation for being great, but bottom line he is great, and he is the one you want cutting on you. Great surgeons make the most money because they get all the referrals. Seems fair to me.
+1
Agree with most of your points.
Although I make less as a PCP than the average salary than you quoted, my biggest complaints are not related to the pay. Its the lack of appreciation for the amount of time and effort that I put in. For example, on several occasions, I spent my days off trying to figure out a challenging case, speaking with specialists, and then getting back to patients. All for no extra pay.
Last edited by katnok on Sun Oct 13, 2013 11:22 am, edited 2 times in total.

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Re: Why are so many physicians unhappy with their careers?

Post by ThatGuy » Sun Oct 13, 2013 11:18 am

DireWolf wrote:Physician here. There are too many reasons to discuss them all... I can mention a few.

1. Lack of respect. It's funny to see some people on here mention that physicians are well-respected... maybe 30 years ago... that ship has long sailed.
In your eyes, what other job attainable by vast swathes of humanity commands greater respect? I know engineers that complain of a lack of respect for all the hard work they do. I think it's just a fact of the internet, by which I mean dispersion of information, leading to a more knowledgeable populace and a realization that there just isn't anything magical about most jobs.
DireWolf wrote:Administrators talk to you like you're a 2-year-old. Nurses often ignore and question orders.
This also happens in every profession. Business majors that don't know diddly about physics drive macro decisions about your widget and think you're incompetent when you try to explain why it won't work. Manufacturing personnel question your drawings, etc.
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Re: Why are so many physicians unhappy with their careers?

Post by DireWolf » Sun Oct 13, 2013 11:26 am

ThatGuy wrote:In your eyes, what other job attainable by vast swathes of humanity commands greater respect? I know engineers that complain of a lack of respect for all the hard work they do. I think it's just a fact of the internet, by which I mean dispersion of information, leading to a more knowledgeable populace and a realization that there just isn't anything magical about most jobs.

This also happens in every profession. Business majors that don't know diddly about physics drive macro decisions about your widget and think you're incompetent when you try to explain why it won't work. Manufacturing personnel question your drawings, etc.
I never said my reasons are unique to physicians. The author of the original post wanted to know why there is a high level of dissatisfaction among physicians, and I gave some reasons. I'm sure you could apply some of those reasons to other jobs. And by the way, I consider being a physician a vocation, not just a job.

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Re: Why are so many physicians unhappy with their careers?

Post by White Coat Investor » Sun Oct 13, 2013 11:33 am

First, a lot of it is just whining. Let's be truthful about that. We all whine sometimes, and doctors are at least as good at it as everyone else. First world problems and all that.

Second, medicine has changed a great deal over the last couple of decades. You might not believe the ridiculous hassles that have been placed onto physicians. It's gotten to the point where I can no longer keep track of the acronyms. It's almost as bad as the military. HIPPA, EMTALA, PQRS, MOC etc.

Third, liability is an overarching concern. I doubt that every time an accountant or engineer meets with a client he is thinking about what he is going to do when this person sues him. But literally, for many physicians, this is something they think about, if not with every patient, at least several times a day. Guess what? It gets old. There's a prominent emergency doc in the country who recently had a $6 Million malpractice judgment against him. Like most docs, he carries a $1 Million policy. Now what? That's what docs think about. It's not logical or rational (that type of judgement is extremely rare), but it wears on you.

Fourth, there is the constant threat, if not reality, of a declining paycheck. Many private docs have literally been forced into hospital employment due to not being able to handle the regulatory hassles and still maintain competitive. It's hard to decide which is worse, losing autonomy or losing income. Those docs still accepting Medicare stare at a now 27% cut that comes up every year. That's not a 27% cut in the physician's pay from medicare. That's a 27% cut in the practice's income. If the doc were 100% Medicare, a 27% cut may put him out of business completely.

Fifth, there's the factor that you enter a pipeline to learn how to do a job and then exit it 10-15 years later. You're different, the job is different, and it's really too late, time-wise and money-wise, to do something else. You feel a bit trapped.

Sixth, the hours suck for many docs. It might be that there are a lot of hours, or it might be that so many of them are in the evenings, at night, on weekends, or on holidays. Every year I get to decide whether I want Thanksgiving, Christmas, OR New Years' Day off, knowing I'll be working the other two. Could be worse, one of my med school classmates worked 120-130 hours last week.
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Re: Why are so many physicians unhappy with their careers?

Post by Ged » Sun Oct 13, 2013 11:40 am

When I was an undergraduate I took a curriculum that prepared me for both medical school and chemical engineering. As did a few of my friends.

I also graduated with high honors and did well on the MCAT. At the end of the day I decided to go to engineering graduate school instead of medical school. For me I think it was one of the best choices I ever made. Yes I would have earned 2-5 times more money as a doctor. However would I have been happier? I seriously doubt it. I have found my engineering career to be personally satisfying, and the compensation has made me financially secure. Not that many people get this much from their careers.

One thing that disturbs me in this thread is doctors talking about their compensation being unfairly low. Clearly if doctors averaged 7 figures medical care would be priced out of reach of most of the population. Doctors in the US are already overpaid by world standards and earn twice of what doctors in most other developed countries are paid.

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Re: Why are so many physicians unhappy with their careers?

Post by steve roy » Sun Oct 13, 2013 11:43 am

I have friend who has an MD from Stanford and a psychiatric specialty from UCLA. But he hasn't practiced medicine in over a decade and a half. He's worked as an animator at DreamWorks Animation, Blue Sky Studios (they do the "Ice Age" movies) and Warner Bros. Animation on dozens of animated features and projects. He's now a supervising animator with a smaller animation house outside California. I've asked him more than once if he'll ever return to doctoring. He says he doesn't think so.

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Re: Why are so many physicians unhappy with their careers?

Post by slick_dealer_05 » Sun Oct 13, 2013 11:53 am

My 84 year old grandmother is a doctor in a small village in India.
She still consults her poor patients, loves them, and worked for peanuts.

By contrast, my physician friends in the USA can't wait to reach their $10 million+ mark and retire. Sad to see the lack the lack of social service by doctors in the richest country of the world.

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Re: Why are so many physicians unhappy with their careers?

Post by DireWolf » Sun Oct 13, 2013 11:56 am

Ged wrote:One thing that disturbs me in this thread is doctors talking about their compensation being unfairly low. Clearly if doctors averaged 7 figures medical care would be priced out of reach of most of the population. Doctors in the US are already overpaid by world standards and earn twice of what doctors in most other developed countries are paid.
Like most others who claim US physicians are overpaid, you fail to mention things like education is free in those countries = no education debt, no outrageous malpractice premiums, EMR costs, insurance/billing costs, etc. The cost of "doing business" in the US is much higher. And I would argue that physicians in other countries are underpaid, not the other way around.

Also, you fail to recognize that physician salaries only make up 8% of all health care costs in this country and have remained stagnant or dropped for the past decade. So physician salaries are not the driver for inflated health care costs.

Another example of the public not fully understanding the system and bashing "greedy physicians" based on inaccurate and/or incomplete knowledge. Sorry to disturb you.

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Re: Why are so many physicians unhappy with their careers?

Post by gerrym51 » Sun Oct 13, 2013 11:56 am

slick_dealer_05 wrote:My 84 year old grandmother is a doctor in a small village in India.
She still consults her poor patients, loves them, and worked for peanuts.

By contrast, my physician friends in the USA can't wait to reach their $10 million+ mark and retire. Sad to see the lack the lack of social service by doctors in the richest country of the world.

this is the goal of most Bogelheads. to each his own :mrgreen:

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Re: Why are so many physicians unhappy with their careers?

Post by lostInFinance » Sun Oct 13, 2013 12:00 pm

EmergDoc wrote: Third, liability is an overarching concern. I doubt that every time an accountant or engineer meets with a client he is thinking about what he is going to do when this person sues him. But literally, for many physicians, this is something they think about, if not with every patient, at least several times a day. Guess what? It gets old. There's a prominent emergency doc in the country who recently had a $6 Million malpractice judgment against him. Like most docs, he carries a $1 Million policy. Now what? That's what docs think about. It's not logical or rational (that type of judgement is extremely rare), but it wears on you.
How many emergency docs practice in the country and how many $1M+ malpractice judgments are awarded each year against emergency doctors? Out of those $1M+ malpractice judgments, how many are reduced on appeal?

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