The business of medicine is the least fun part

The following comment caught my eye on Dr. Robert Centor's blog, DB's Medical Rants. I pruned for space considerations, but you can read Dr. Centor's thought-provoking full post "Is it Time to Reinvent Medicine?" and its spirited comment section here.

Hospitalists are similar to primary care doctors. The hospitals want hospitalists to see 25-30 patients/day to efficiently provide services and get the patients in and out...Salary and insurance is about the only overhead for hospitalists.

Outpatient primary care doctors have rent, insurance, salary, employees etc for the same $48-70 per encounter. Add on mountains of paperwork, prior auths, pharmacy refills, diabetic supplies, power chairs, PT/HH/specialty referrals, etc. I can't simply write for a CT/MRI without a 20 min prior auth or a refill on an ADHD med that is brand name and not covered by a patient who has tried 3 generics and has been on the same med for two years but the prior auth has to be done every 6-10 months. Try doing this between the 30 patients on the schedule and have 4 labs, 4 xray centers, HH, PT, specialist, and other places fax you 100-200 pages a day of orders and notes to review

...Most primary care docs do enjoy seeing patients, but the financial realities of overhead/salary/lifestyle etc. do weigh in over time...The current payment system encourages procedures for financial reasons and liability prevention.

--Solo Dr

I'm a mere medical intern going into a faraway specialty, but Solo Doc's comment still resonated with me in the sense that he echoed some of the reasons I eliminated primary care from my list of career choices. His comment makes me consider that outpatient medicine may be a losing battle for docs regardless of specialty. Why would any rational person voluntarily take on the degree of responsibility he describes?

Maybe it's the long hours of internship taking their toll (duty hour limits? Ha!), but I am increasingly dismayed that I have spent the last 4+ years of my life preparing to participate in this country's medical system. It's a real mess in too many ways and already I feel punished for spending extra time with the patient, even though it's by far the part of my job I enjoy most and is one of my primary reasons for choosing my career path.

I'm aware that as a hospital employee I'm protected from some of the ridiculousness of our system. I've adapted to the rigors of internship enough that I no longer want to quit my job on a daily basis, but my rational side wonders if finding a new career would be a smarter choice than spending another 3 years and 10 months on training to enter the often senseless and demoralizing U.S. healthcare system. That said, I feel it's a true privilege to care for people and can't think of anything else I'd rather do. Ideas welcome.