Thursday, 23 August 2018

Big Gov. and Small Spirituality Are Causing Doctor Shortage; Physicians Leaving Field

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The medical profession needs a doctor — stat. This conclusion is inescapable, with stories about how fewer people are entering medicine, leading to a physician shortage; and, more shockingly, about how many doctors are leaving the field for greener pastures. The reasons? Demoralizing, stifling government bureaucracy; the rise of STEM jobs; and younger generations that value status over service.

And the stats are alarming. NBC News writes that a “recent report from the Association of American Medical Colleges projected a shortage of 42,600 to 121,300 physicians by 2030, up from its 2017 projected shortage of 40,800 to 104,900 doctors.”

In fact, it’s so bad that New York University is now offering free tuition to all medical students, regardless of merit or need, in order to attract more candidates (video below).

Nonetheless, “becoming a doctor remains one of the most challenging career paths you can embark upon. It requires extensive (and expensive) schooling followed by intensive residencies before you’re fully on your feet,” NBC also relates.

“The idea, generally, is that all the hard work will pay off not only financially, but also in terms of job satisfaction and work-life balance; then there’s the immeasurable personal benefits of helping people, and possibly even saving lives. In terms of both nobility and prestige, few occupations rank as high,” the site continues.

This sacrifice, this paying of dues, makes it all the more shocking that physicians would pack up their medical bags mid career and go home. But as Dr. Amy Baxter told NBC News, “After 20 years, I quit medicine and none of my colleagues were surprised. In fact, they all said they wish they could do the same.”

Her main gripe is a common one: electronic health records (EHRs), whose use was stimulated by the Obama-era (2009) Health Information Technology for Economic and Clinical Health Act (HITECH Act). As Baxter put it, reports NBC:

I began to feel like an easily replaceable cog in the health care machine. With the [enforcement] of EHRs, I had to spend more time as a scribe. One night a child I was treating had a seizure and I couldn’t get the medicine to enable them to breathe because their chart wasn’t in the system yet. This kid was fixing to die and I, the doctor, couldn’t get the medicine. It was demoralizing.

Baxter now heads a physiological-products company.

This revulsion at EHRs is now a recurring theme. For example, as Medical Economics reported in January, “Tom Davis, MD, FAAFP, who practiced family medicine for almost 25 years in the greater St. Louis area, says the primary reason he walked away from a successful practice was the EHR, citing its use, the ethics and the burden.” The site continued:

“I had 3,000 patients, many I’ve known for a quarter century, a few hundred of which I delivered, all immensely valuable relationships — and all burned to the ground mostly because of the burdens of the HITECH Act,” he says. “The demands of data entry, the use of that data to direct care and my overall uncertainty about how medical data was used in aggregate all helped poison the well from which my passion for serving my patients was drawn.”

He believes that the information collected through the EHR is being used (at least in aggregate) for purposes other than the direct benefit of the individual patient so it would be unethical for him to represent otherwise to the patient. As far as the burden, he notes he spent about four minutes of keyboard time for every minute of face-to-face time with a patient.

Statistics tell the same story. A 2016 report by The Physicians Foundation determined that 54 percent of doctor respondents “characterized their morale as somewhat or very negative,” writes the Advisory Board.

The site continued, “According to the survey, respondents said regulatory and paperwork burdens, as well as a loss of clinical autonomy, were the main reasons they felt dissatisfied. Respondents reported spending 21 percent of their time doing non-clinical paperwork. Further, just 14 percent of respondents said they have sufficient time to provide the highest standards of care.”

A doctor I know well echoes this. She complains of the paperwork and how there just isn’t much time now to spend with patients. And just imagine this phenomenon’s effect. A person entering medicine for the right reasons views it as a calling; he wants to be a healer and tend to patients. But then he finds himself doing piles of paperwork a day, many people’s least favorite chore. Nothing will take the shine off your calling and suck the life out of you faster than that.

Then there’s the rise of STEM jobs, “a shift that Craig Fowler, regional VP of The Medicus Firm, a national physician search and consulting agency based in Dallas, has noticed,” writes NBC.

“‘There are definitely fewer people going to [med school] and more going into careers like engineering,’ Fowler told NBC News.”

“Fowler also speaks to the desire among millennials to be in hip, urban locations — a luxury you likely won’t get when you’re fresh out of medical school and in need of a residency,” NBC also informs.

A factor in this is Americans’ diminishing faith; after all, Christianity stresses self-sacrifice and service to others. But with the descent into secularism and its corollary that everything is relative except the material world, which certainly exists, everything can become relative to oneself and the material can assume primary importance. Then self-gratification becomes the greatest “good.” A study earlier this year hinted at this, showing that (contrary to media reports) millennials are more money-obsessed than their elders.

Unfortunately, this decline in faith, and its attendant morality, leads to bigger government. For as virtue in the people diminishes and they exhibit less self-control, they will correspondingly find themselves under ever greater state control.

This breeds greater bureaucracy — increasing governmental complexity — a curse that afflicts and can kill aging civilizations. As historian and anthropologist Joseph Tainter puts it, “Systems of problem solving develop greater complexity and higher costs over long periods.” Thus, over time this increasing complexity (e.g., red tape, regulations) brings diminishing returns so that “such systems either require increasing energy subsidies [resources] or they collapse,” he states.

We see this happening today in medicine and, well, most everywhere. It’s a good reason to strive to keep government small and virtue in the people very, very big.

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