Wednesday, January 29, 2014

The Worst Lifestyle in Medicine

Thanks to the latest Medscape survey, dermatologists were crowned as having the best lifestyle in all of medicine, confirming what every medical student, resident, and attending physician already knew. On the flip side, who did Medscape consider to lead the worst lifestyle? It probably comes as a surprise to no one that family medicine and internal medicine were singled out as having the worst quality of life in the medical field.

What makes FP and IM so lacking in appeal? First of all, they appear to be the unhappiest doctors at work. Only 36% of FP's were satisfied at work, tying with emergency medicine at the bottom of the list. IM was not far behind, with a 37% satisfaction rate, tied with radiology for third/fourth worst positions. All this misery carries over to the home life too, with only 61% of FP's being happy when they leave work. This leaves them below the median of doctors surveyed.

Perhaps primary doctors would feel better if they got away from all that stress at the office. But unfortunately, only 13% of FP's and internists took four or more weeks of vacation last year, near the bottom of the list. By comparison, anesthesiologists were the most generous at giving themselves some R&R, with almost half getting at least four weeks of time off. This has contributed to FP's being the second heaviest group in the survey. Forty-eight percent of FP's say they are overweight or obese, being outweighed only by the other stressful field, general surgery.

To make things even worse, the terrible reimbursements given to primary doctors for talking and listening to patients have left their finances in shambles. FP and IM rank at the very bottom of physicians who feel they have adequate savings stored up. By comparison, the ROAD fields all rank near the very top in amount of money saved up for future retirement. That is not good news for policy makers who are trying to recruit more medical students into primary care.

So all this talk about training more primary care doctors to treat the tsunami of sick patients with their new Obamacare insurance cards is quixotic at best. The law's promise of paying Medicare rates for all these new Medicaid patients for a very temporary two years is laughable. Nobody plans his career for only the next two years. All these patients will still have nowhere to go when they get sick except the emergency room because there won't be enough doctors to see them for the money they are getting paid.

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