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New Doctor Considering Primary Care? Show Me The Money

There are plenty of reasons why medical students aren’t choosing primary care as careers. Lack of role models. Perception of professional dissatisfaction. High burnout rate among generalist doctors. Long, uncontrollable hours.

But what about salary? Until now, the wage disparity between primary care doctors and specialists has only been an assumed reason; the evidence was largely circumstantial. After all, the average medical school debt exceeds $160,000, so why not go into a specialty that pays several times more, with better hours?

Thanks to Robert Centor, there’s a study published in Medscape that shows how money affects career choice among medical students. Here’s what they found:

Sixty-six percent of students did not apply for a primary care residency. Of these, 30 percent would have applied for primary care if they had been given a median bonus of $27,500 before and after residency. Forty-one percent of students would have considered applying for primary care for a median military annual salary after residency of $175,000.

And in conclusion:

U.S. medical students, particularly those considering primary care but selecting controllable lifestyle specialties, are more likely to consider applying for a primary care specialty if provided a financial incentive.

Money matters. There should be no shame for new doctors to admit that. After all, they’re human too, and respond to financial incentives just like anyone else. And when most medical students graduate with mortgage-sized school loans, salary should be a factor when considering a career. Read more »

*This blog post was originally published at*

Physician Burnout: Depression And Suicide In Surgeons

I wrote last year in USA Today about the impact of physician burnout. Not only do doctors suffer, but so do their patients.

Burnout starts early in residency, with entering interns having a depression rate of 4 percent, similar to the general public. But after the first year of residency, that number balloons to 25 percent.

Now another study adds fuel to this disturbing trend. A paper published in the Archives of General Surgery looks at the prevalence of physician burnout in surgeons:

In a national survey, one in 16 surgeons reported contemplating suicide, researchers reported.

An increased risk of suicidal ideation was linked to three factors: depression, burnout, and the perception of having made a recent major medical error …

… But only about one in four of those who reported thinking about taking their own lives sought psychiatric or psychologic help.

The rate of suicidal ideation in surgeons, at 6.3 percent, was almost double of that in the general population (3.3 percent).

Physician burnout is a phenomenon that’s often ignored. The practice environment is deteriorating, with increasing time pressures and worsening bureaucratic burdens. Little of this is addressed in the national health conversation, or in the recently passed health reform law. Read more »

*This blog post was originally published at*

ER Doctors And Burnout

Via Balkans Business News:

One in two emergency care doctors will suffer a burnout during their career, according to a survey of French physicians, published online in Emergency Medicine Journal. The research was funded in part by the NEXT NURSES’ EXIT STUDY (‘Sustaining working ability in the nursing profession – investigation of premature departure from work’) project, which received more than EUR 2 million under the ‘Quality of life and management of living resources’ Programme of the EU’s Fifth Framework Programme (FP5).

The responses showed that the prevalence of burnout was high, with 1 in 2 emergency care doctors identified as suffering from it, compared with more than 4 out of 10 of the representative sample. Physicians had the highest burnout rate in the two age groups, between 35 and 44 and between 45 and 54.

Expectedly, it’s international…

*This blog post was originally published at GruntDoc*

Physician Lifestyle Is Criteria When Choosing A Medical Specialty

Medical students today consider lifestyle an essential criteria when choosing a specialty. It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.

There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands. Claudia Golden, a Harvard economics professor, recently noted that,

high-paying careers that offer more help in balancing work and family are the ones that end up luring the largest numbers of women. Surprisingly, colon and rectal surgery is one of these, because of rapid growth in routine colonoscopies that can be scheduled in advance, giving doctors control over their time. Goldin says 31% of colon and rectal surgeons under 35 years of age were female in 2007, compared with only 3% of those ages 55 to 64, and 12% of those ages 45 to 54, reflecting the fact that younger women are flocking to the field.

Of course, what’s not said is the grueling training that it takes to become a colorectal surgeon — but the numbers cited above do not lie. The new generation of doctors — both men and women — want greater control of their time. That means more shift-work and a predictable call schedule. Read more »

*This blog post was originally published at*

When I Really Felt Like A Doctor

PalMD over at The White Coat Underground recently asked: “When did you really feel like a doctor?” Interesting question that I could answer in a number of ways.

While I didn’t know it at the time, I felt like a doctor around 4am during my first night on call. I was an intern on the hematology ward at Texas Children’s Hospital. I was fresh out of medical school, I had chosen a residency known for its mind-boggling volume, and the kids were really sick. I had hit a point where I simply couldn’t keep up with what was in front of me. I stole away into the 6th-floor stairwell in the Children’s Abercrombie building, put my face into my hands, and began to cry.

My first call night was a metaphor for my career. I had no idea at the time that the idea of simply keeping up would be a theme that would follow me through my training and into my day-to-day work.

While I can’t remember the last time I cried at the hospital, I continue to struggle with input. I work to keep up with inbound information and professional social dialog. How I handle information or how I appear to handle it defines me as a physician. Harnessing this attention crash through technology will represent a major defining moment for the next generation of physicians.

*This blog post was originally published at 33 Charts*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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