Finding Physicians

This article appeared in the New York Times.

Where Have All the Doctors Gone?
by Pauline W. Chen, MD

http://www.nytimes.com/2008/12/12/health/11doctors.html?ref=health

In it, the author discusses the challenges President-elect Obama faces in making health care accessible to all -- particularly, the supply of primary care doctors...or lack thereof. She discusses the reasons why doctors favor specialty practice (better hours, better pay) and why doctors leave primary care practice (too much paperwork, overextension).

It was a skillfully written piece by Chen. She ties an anecdote from her life as a doctor to a cultural metaphor and applies it to politics and policy. She cites recent journal articles addressing physician supply issues without awkwardness. On top of that, the article is efficient and succinct and easy to read.

In medical school, among my clinical rotations, I liked internal medicine and neurology. My impression was that the internists worked way too hard and their work was never done: rounding in the hospital before office hours, seeing office patients all day, rounding again in the evening. I liked that neurology was more office based (hence, more controllable hours), and that neurological emergencies were such that the ER or other physicians could generally take care of things until I could get there.

As a recently retired clinician, I can relate to the burnout and the overextension. It's tough to do the same thing over and over again, every 15 minutes. And do that day after day. As a reporter, the whole day is a project, with the fruit of the day's labor appearing on the evening news as evidence of my toil.

I share Chen's concern -- for there to be access, there must be supply. But the reality is that the practicing lifetime of a physician is rapidly shortening, for a variety of reasons. Those reasons aren't going away. Where to get more doctors and how to alleviate the pressures that cause doctors to quit are not easy to answer.