Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

The Physician Exodus: When Doctors Leave Hospitals Behind

My partners and I have long struggled with the lack of specialty back-up at our hospital. Semi-rural hospitals, out of the way facilities, just can’t always attract specialists. So, we’re happy to have cardiologists every night, but understand that we only have an ENT every third night. We’re thankful to have neurologists, even if they don’t admit anyone. We’re glad to have radiologists, even if they don’t read plain films after 5PM on weekdays.

Still, I continue to scratch my head about why only three of seven community pediatricians take call, such that family physicians have to admit their patients. I was bumfuzzled that our neurologists were previously going to require us to use telemedicine for stroke evaluation when their offices were close by the hospital. (In the same year they were called in roughly three times per neurologist for urgent stroke evaluation.) That problem was resolved, thank goodness.

Now, I find that the problem has returned and grown. We will, very soon, have no ophthalmologist on call, despite the fact that we have three in the community and that they are contacted with remarkable rarity to deal with on-call emergencies. Soon, we will have no neurologist on the weekend. And the pediatric problem remains.

Of course, I’m using my local experience to highlight something that isn’t a local problem at all. It’s a national problem. All over America, specialists are relinquishing their hospital priveleges and staying in the office. Proceduralists are opening surgery centers that are free from the burdens of indigent care. Primary care physicians are allowing hospitalists to do all of their admissions.

In the process, not only are patients losing out, but referral centers are being absolutely overwhelmed. The cities and counties that lie around teaching hospitals are sending steady streams of patients, since they have fewer and fewer specialists. Those referral and teaching centers want patients, but they can’t take all of the non-paying patients, all of the complicated, or even all of the mundane patients with no local coverage. Those facilities, for all their shiny billboards and “center of excellence” marketing, will collapse.

They will collapse both financially and from the shear exhaustion that will crush their staff physicians and residents. I already hear it in their voices. “Am I on call for your hospital? Where’s your doctor? Fine, send them. We’ll figure something out.” Many of those docs will ultimately join the exodus as well, simply to keep their sanity.

My partners and I understand everyone’s frustration. We face some of the same struggles; too many patients, too little reimbursement, overwhelming rules and regulations. I think that the federal government has made our jobs inefficient, unpleasant and in many instances unsustainable. Laws like EMTALA, and quasi-governmental regulatory bodies with their endless rules, make physicians go crazy. And they certainly explain why owning and practicing in a surgery center, or the act of simply abandoning call duties, is preferable to working in a hospital. I also know that lifestyle matters. I still work evening shifts that keep me out until 2am. I occasionally work nights, as do many of my partners. Fatigue is miserable.

Maybe the combination of regulations, financial constraints and weariness is driving physicians away from what they once loved. However, despite those issues, physicians are choosing to make themselves unavailable and ultimately perhaps irrelevant. And they are taking the amazing, critical skills they have and depriving patients of them.

So I implore physicians across the country to think a little before leaving. To think about the fact that their absence only passes the patient, the responsibility, the opportunity, down the line, to a colleague in another town. To consider the fact that patients, real patients with real illnesses and injuries, desperately need their abilities. And equally important, to remember that emergency physicians can’t do it all, not nearly as well as their specialist co-workers.

I also beg administrators and government agencies to observe this migration, from hospital to office, and ultimately from office to early retirement, and ask how it can be reversed. I hope that both groups will not ask, “what’s wrong with those doctors,” but will ask, “how did we contribute to the problem?”

Many of us, our children or grandchildren, may one day end up in a hospital with a genuine, urgent need for some speciality intervention. And because it is after 5PM, or because it is a weekend, because no one is available or only available 100 miles away, they may suffer or die.

If nothing else, that’s worth serious consideration all around by a profession, and a government, purportedly dedicated to the well-being and health of real human beings.


*This blog post was originally published at*

You may also like these posts

    None Found

Read comments »

Comments are closed.

Return to article »

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…

Read more »

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…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

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…

Read more »

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…

Read more »

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…

Read more »

See all book reviews »