America, we have a problem.
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Dropped by my family practice guy's office this week for a wellness visit and we spent most of the time talking about the sorry state of medicine as we know it. Since I've known this guy for 46 years, we have frank discussions.
He's 67, and working for a medical corporation since he closed his private practice down a decade ago. Current salary? $100/hr. Current patient load? 28-30/day, maybe a few less, depending on what he is doing. The family practice clinic in which he works is staffed by three FP docs and two NP's. Onsite lab is limited to UPreg's, dipstick urines, POC A1c, POC glucose and POC coag...Anything else is kicked to Quest.
Problems we discussed?
- Doctor shortages. Can't beg, borrow or steal them. His clinic has been looking for three years, no joy. Worse, they've only had one candidate even complete the interview process and he took a job in a bigger city, at a bigger practice.
The shortage was accelerated by COVID in his opinion. Over 200,000 healthcare workers left the field during COVID and a lot of those guys were docs. Med schools have not tried to put out more physicians. Maybe they don't have the money or the hospital slots, but education is failing us.
Another problem is the number of female docs. Not that they don't make good docs, they do, but they don't last in the "hard" specialties, at least as much as their male counterparts. Surgeons and orthopods work some hellatious hours. Many women, after fighting the good fight for 8-10 years, look around and decide to leave their practice or shift gears and change. Working long hours and pulling call impinges on their family life and something has to go. Since females make up just a hair over 50% of med school students, this has some chain reaction effects.
Lastly, just the headache of being a physician today. The administrative duties have become time-swamping, as everybody needs just one more sheet of paper (or electronic document). The insurance companies (private and government programs) constraint on what you can do and when you can do it. The CYA nature of today's medicine.
- NP's. They don't suck, but they are not doctors. Furthermore, it takes about 4-5 years working as an NP, before they start to become proficient, unless they have been a MedSurg nurse for a few years before completing their NP, and the experience helps.
They also need immediate backup, which they don't receive as they should. My friend said both of the NP's were good, but they still came to him with questions on a daily basis. Too many NP's are being thrown to the wolves in small clinics or offices where they have inadequate physician back-up.
- Nursing shortage, as exacerbated by the travelers. When the money spiked up North and NE, we had a lot of nurses leave for the big money. So we went up on salaries and Northern nurses started to flow down here. None of us created any more nurses, we were just swapping what we had.
We need national reciprocity on licenses for nurses (and allied health personnel). We need one set of recognized courses and an appropriate NCLEX geared towards taking care of patients, not esoteric academic questions. We need more nursing education slots and we need more partnership with hospitals as teaching sites.
There were a few other things (How'd you like that homeplate ump in the first LSU/Wake game?) but that's most of what we talked about...
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very sad
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thats all i can say
