Start out
passionate-end up disappointed or worse.
Never in the
history of medicine have doctors faced such a ruthless gauntlet of threats,
financial debts, and practice restrictions than they do today. These factors,
among others just as crucial, don't begin to tell the story about why 40% of
medical doctors readily admit to intense frustration in their practices, in
addition to the percentage of doctors quitting medical practice completely.
They're not
retiring. They're adapting. Extended hours to see more patients to make enough
income to stay financially solvent is just one highly stressful necessity
causing eventual burnout. Coupled with the recognition that private medical
office practice for most doctors is not lucrative enough to reach their
original goals and dreams for their careers, reasonable satisfaction with
medical practice becomes a moot point.
Profound
disappointment increases as they realize it will take them a couple decades to
pay off their education debts (avg. $150,000 plus), let alone make enough
revenue to support a family and cover office overhead. If you have missed the
obvious, doctors the day they graduate, are financially hamstrung right from
the start. The roots of this dilemma are found in the medical education program
itself.
Discouragement
intensifies dramatically when they ärzte
siegen are faced with malpractice litigation. You know...it's the
penalty for using all their best medical knowledge, skills, and judgments to
prevent and to treat illness, yet isn't enough. The most well trained and
experienced doctors are subject to malpractice lawsuits, even when they haven't
done anything wrong in their medical practice treatment of patients.
Governmental
fee restrictions and intrusions are constantly increasing, which is firm
validation that it will be harder to financially survive in practice. Their
future practice income for the majority of physicians will barely keep them in
the middle class of Americans. For those minority of physicians in the highly
profitable surgical specialties such as plastic surgery, orthopedics, cardiac
surgery, and anesthesiology, most do quite well in their practices.
The easy
solution for most medical school graduates is to join a managed care group as
an employee where they at least can earn some money right away. Once they
become aware that they aren't able to practice medicine the way they intended
to, they try private practice.
The path
into a medical practice career has other unexpected potholes:
Upon
entering college and into their pre-med curriculum the idea of becoming a
doctor is challenged repeatedly. The high competition for getting into medical
school is strongly influenced by their grades. The hard studies and required
courses weeds out many pre-meds. Of the one's who make the grade after four
years, there is no guarantee they will even be accepted by a medical school.
Who wants to academically struggle for four years only to discover your dreams
have just been squashed on the rocks?
Individuals
not accepted to a medical school may keep re-applying yearly with the
expectation of being accepted later. Rather than wait and hope, pre-med
students can apply to dental schools where the competition is considerably
less, with the idea they can get into medical school later.
The way
things are today, they'd be a lot better off being a dentist for many reasons.
So, here's a student who wanted to become a medical doctor and is often left
stranded without a backup career in mind-didn't think he needed one.
Once
accepted to medical school, a student is expected to graduate in four years. In
days past some medical schools apparently had programs for planned attrition
the first year-like the bottom 10% of the class would be dropped from the
school. I'm not aware of any of the 142 medical schools in the USA doing that
today.
Medical
students eventually choose the area of medicine they want to practice. Some
choose a surgical specialty and discover they don't have a surgical talent or
skill. Others, for the first time, begin to understand what they are talented
to do, as opposed to what they think they want to do. This tendency may lead a
student to becoming a specialist in something they are not skilled to do, but
manage to practice in a career in that medical category anyway. It's not a rare
circumstance.
After all of
these hurdles have been accomplished, the new set of hurdles comes into
view-specialty training and/or medical practice. Let me paint a mental picture
of this new doctor's situation at this time in his/her medical career path.
1. The
average new doctor now has an educational debt to pay around
$150,000 or
more.
2. The new
doctor does not have a job, but may have some connections.
3. To open a
private practice requires either family money or bank loans-estimated to be
around $50,000 at the very least. Debt is now $200,000 plus. How long would it
take you to pay that debt off?
4. Common
practice choices are:
A. Private
solo practice if the money is available to get started.
B. HMO
managed care organization if spots are open.
C. Group
practice if one is available.
D. Contract
partner with another physician already in practice.
E.
Hospitalist (employee)
F. Join the
military, get further training there.
G. Concierge
practice (Cash only).
5. Often,
they are supporting a spouse and children.
6. The
geographical area where they will practice, and the situation they will
practice in often is not even close to what they intended or wanted.
7. Surveys
by the AMA indicate that about 14% of doctors move their practice, or move to
another area to practice each year. It means their first choice was not good
enough---but who can predict outcomes?
The tragedy
is in having no reliable options that guarantee any degree of medical practice
success (whatever that is to you):
Like all
professionals starting in any business, there are no guarantees. The hope is
that with one's passion, entrepreneurial attitude, and persistence will inspire
ärzte siegen the survival of their
medical career. Those aspirations at their most earthshaking levels must not
only be maintained for the duration of a medical practice career, but also must
be fortified intermittently with signs of professional progress and practice
profitability for those inspirational drivers to continue to exist.
Unfortunately,
passion dissipates with time; hope falls short of the mark and medical
professional careers relapse into mediocrity because of a doctor's expectations
for their highest career potential turns to, "I'll just have to settle for
what I can get from my practice."
At this
point in their practice, usually about 5 to 7 years after starting medical
practice, 95% of physicians have absolutely no idea how to go about improving
their practice income. That's because they have never been educated in
successful business management and the business knowledge required to reach
their full potential. Without it they simply limp along doing the best they
know how-they don't know what they don't know.
The highly
regarded business expert, Michael Gerber, describes the realistic dynamics of
this in his book, The E-Myth: Physician. It should be required reading for
every pre-med student.
WAIT-There
may be a couple secrets that can salvage the medical careers of the majority of
the medical professionals in trouble.
First, for
any health care provider in June 2011 and disregarding the ominous December 21,
2012 prophecies, understanding that medical practice is a business, provides a
proven foundation for success. The most profound whitewashing of that one fact
by the medical schools today should be punishable by law. It should also be
extended to all pre-med programs across this nation.
Every
successful small business owner in the world understands that their business
profitability and survival depends on the foundational business principles and
time validated concepts that must, not should, be followed. It's rare to find a
doctor who has been educated in business strategies and the more complex issues
of how to use them profitably and efficiently.
Can you
rationalize with any degree of intellectual logic why there is such a
widespread neglect by the medical academicians to institute business education
as a primary curriculum element for all physicians? There isn't any today! If
medical practice is a business, then why should anyone expect a doctor to
survive in medical practice with no academic knowledge about business? It
defies logic and common sense.
Second, why
should any physician or other health care professional expect to do well, earn
a good income, have a successful business from medical practice, or even
survive financially without any, even basic, business knowledge?
The
traditional belief, "if you hang up your shingle, patients will
come," is the greatest mental deterrent to successful medical practice
that exists. You might wonder why so many medical practices today are failing
because of financial deficiencies. What could possibly be the cause of that?
Third,
considering the tsunami of attrition of medical doctors and their medical
practices happening today, you must be aware of the causes. If we were able to
eliminate the many current devouring parasites destroying medical practice
today and deal with the one issue of physicians lacking even basic business
knowledge, practices would continue to fail.
Doctors
would be exactly in the same situation as they are now in-living with mediocre,
or just plain lousy, medical practice profits and unable to fund a retirement
plan.
It's an
acceptable fact that the parasites of malpractice, law tort reform, litigious
patients, and governmental control of health care will not change from how they
are today or in the foreseeable future. It seems quite obvious that I will find
rare supporters who believe as I do.
Time to
eliminate private practice altogether?
A tour spent
on an HMO medical staff will convince any doctor that private practitioners
should hang around a while longer. Concierge medical practice does seem the
safest of all the private medical practice models for a doctor to use in the
present medical political environment.
With the
increasing pressure and restrictions by our government on private practice
doctors, even the smartest business and marketing experts such as Dan Kennedy
are forecasting the quick rise in numbers of the cash-only models of medical
practices.
Comparisons
with other professional career choices show a significant difference in profits
and satisfaction between a medical career and almost all others. For the time
spent in academic education, cost of education, the skills, talent and
intelligence required, the stress of long hours and critical actions, among
others, doctors are at the ultimate bottom of the income and lifestyle list.
The reasons for that are many. The solutions to that dilemma are
unresolved-just floating along with the current.
And, now I'm
back full circle to my original premise, what idiot would ever consider a
career in medical practice? If they would take the time to investigate what's
in front of them, it would be a blessing to them.
Winston
Churchill made a point about a crisis during WWII, which seems appropriate
here-"It's not enough that we do our best; sometimes we have to do what's
required." Private medical practice is increasingly required to bend to the
external forces that make the rules, but that doesn't mean there aren't other
alternatives.
Alternatives
more enticing are those in other businesses separate from medical office
practice. This is especially disheartening when physicians discover that most
successful business owners earn much more income than physicians. And, they
need much less education and spend much less on education than medical doctors.
More disturbing than that are the thousands upon thousands of people who barely
made it through high school or dropped out of college who now earn three times
the income of doctors, and work much less.
The question
really is, why are there still college students who will continue on into the
medical profession knowing all these drawbacks of the profession? Would you
judge them dedicated, just masochistic, or plain ignorant of the issues?
The practice
of medicine is a highly honorable profession to be a part of. No question about
that. However, honor attained at the detriment of so many sacrifices being
made, may not be a virtue, but an illusion.
These health
care warriors seem undeniably capable of withstanding the perpetual onslaught
of our society, which dwells on them as prey. One has to wonder what it is that
makes them think it's worth compromising most everything in their lives, from
family to free time, just to continue a struggle against everything that can
destroy them and their private medical practice at any point in time.
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