Saturday, July 24, 2010

The Top Ten Worst Paying Jobs For Doctors

Was surfing the net the other day and found this at According to the medical search and consulting firm Merritt Hawkins & Associates' 2010 Review of Physician Recruiting Incentives, the ten worst paying specialties are:

Neurology ($282,000)
Obstetrics/Gynecology ($272,000)
Emergency Medicine ($247,000)
Endocrinologist ($219,000)
Psychiatry ($209,000)
Hospitalist ($208,000)
Family Practice with Obstetrics ($200,000)
Internal Medicine ($191,000)
Pediatrics ($180,000)
Family Practice ($175,000)

Now, I find it odd but not surprising, that half of the specialties on that list are currently experiencing shortages across the country. After all, how can you practice medicine, even medicine that’s your passion if it doesn’t pay even a living wage? (The figures above are gross income and don’t include the $60-100,000 a year malpractice insurance charges, clinical overhead, such as lab tests and new equipment, or the $140,000 in student loans the average medical student racks up.)

So how did we, as a nation and a society, end up paying the doctors we’re most in need of the least money? So little, in fact, that even the medical students across the country that have a passion for family or internal medicine end up in other specialties simply because they can’t afford to do anything else.

A lot of the problem comes directly from the AMA (American Medical Association) which sponsors a committee charged with deciding how much a doctor's time is worth in Relative Value Units (RVU’s). These RVU’s determine how much Medicare will pay a doctor for a procedure. They also determine, in a roundabout way, how much your insurance will pay, since insurance carries take their cue from Medicare when deciding how much to pay. Basically, the more difficult a procedure is, the more it’s worth. By their reckoning, intubating a patient is more valuable, monetarily at least, than face to face time with a patient in the office for a fifteen minute check-up even though the first takes much less time.

This system leaves physicians in primary care making half the money of specialists in a lot of cases. Not surprisingly, less money means less PCP’s, and we need those providers. Thanks to a not very well thought out new national healthcare plan, the demand for PCP’s is set to increase exponentially while the supply will only continue to decrease.

Something’s gonna have to give.

Wednesday, July 21, 2010

Electronic Medical Records

So… more from the I’m going to college this fall and why does it have to be so complicated front, I turned in my immunizations at Student Health Services today in hopes that it would cause them to take the hold off my registration so I can pick up the one last class I’ve been wanting before classes, you know, start.

Turns out that they did, indeed get it the first time I turned it in but there are not “enough” immunizations on it. Not enough meaning there is only one MMR recorded. Now, I know for a fact that I received my second MMR when I was twelve because a.) I remember getting it and b.) they let me attend high school which (at least around here) they won’t if you don’t have record of two MMR’s.

So, how could this have happened? Electronic medical records, the newest brilliant brainchild of the medical establishment. Now, I’ll admit, that when I first heard of the movement towards EMR’s I thought it sounded awesome. In theory, it should make records more accessible, care more coordinated and errors less likely.

The problem is that they only works if you use them and use them all the way and all the time. In my case and at the clinic I’m at they didn’t. They started using the EMR system and didn't transfer any of the older files over. So, despite the fact that I’ve been getting my medical care in the same place since I was three months old, when I ordered my complete medical record, the immunization records weren’t there. Not only that, all of my (and my oldest son’s) records weren’t even AT the main clinic location. I finally ended up having to go to the separate file storage area at the satellite clinic where my doctor practices and have them go through my medical record page by page to find the record I needed.

Imagine my frustration when it turned out that the record we found wasn’t even the complete record. It was missing my first MMR and heaven knows where the record of that shot lives now.

So, in short, there’s no centralized records. The computers, as efficient as they sounded, don’t talk, even within the same clinic system. I have all my labor and birth records at the (associated!) birthing center, all of my E.D. records at the E.D., a select few of my records at the central clinic office (still in hard copy), my records from after 2005 in the EMR computer system, and the rest of them at the satellite clinic where my doctor actually practices (also still in hard copy). A far cry from the “centralized records” that were promised when they switched over to the EMR.

How did this happen? How did everything get so spread out? And what does it say about the coordination of care that most patients receive?

I’m generally healthy, so the inability to find my records is really nothing more than a minor annoyance, but what if I had a chronic condition? I’m pretty sure that there’s no way my records would transfer seamlessly between my primary care provider (the proposed “medical home”) and the specialists I’m seeing or vice versa the way that the EMR‘s were supposed to facilitate. As a matter of fact, I’d be lucky if they ever got transferred at all.

The only “coordinated care” I’ve ever gotten from the EMR system is a repetitive list of medications that I haven’t been on since 2005. So much for innovations in coordinated care. There has got to be a better way.

Sunday, July 18, 2010


…With bated breath for school to start up. It feels like I’ve been waiting my whole life to do this and now that I’m almost there it’s taking forever. Only seven more weeks to go. I’m torn (aren’t I always) between wishing that school would just start already and trying to relish every single one of my last moments as a stay-at-home mom. Surely enough it’ll never be like this again.

My life seems pretty uninteresting right now compared to what’s ahead. I have to keep reminding myself to stop, breathe, be present with my children. They’ll never be this size again and I know a time will come when I‘ll really miss all these long crazy days. Part of me, I think, is hoping that maybe, enough love and attention and time now will be enough to get them through the next few months until the semester ends. Months when I may not have the kind of time and attention available to give that I have now.

So, with that in mind, I didn’t do anything today. (Well, I cleaned my house. That’s always a pretty major accomplishment.) The kids had their lunch picnic style in the front yard, I made silly faces with our two-year-old, I nursed the baby, we all sat around and ate popcorn before bed, and I sat around waiting and waiting...

Saturday, July 17, 2010

A Lazy Saturday

Lazy days are sweet. You know those days, where you never once get in the car (or sometimes even out of your pajamas). Where you get the dishes done early and get to play some board games (or video games) with the kids. I must have read seven board books today and I loved every moment.

I sometimes feel as if I don’t get enough of those days anymore. Not that I’m complaining, really, but, contrary to the popular belief that being a stay at home mom makes you feel trapped and lonely, I miss the times when I could go three or four days without ever leaving the house. What can I say? My kids are good company.

We did go to the grocery store today, something I was hoping to avoid. There’s nothing like a refrigerator decked out in nothing but condiments and moldy cheese to provide a bit of motivation for an outing. It was good though. Not one of those four hour long, everyone’s cranky, exhausted and homicidal by the end of it, marathon shopping trips. I actually hadn’t known until today that a family of six could get into and out of Wal Mart in under two hours.

I wonder how many of these lazy days I’ll have when I start school. Won’t it only be worse when I’m in med school or, god forbid, residency? Maybe that’s what “they” meant when they said you can’t parent children and become a doctor without neglecting them somehow. I worry about it. I worry that they’re going to miss me, that they’re going to miss out, on video games with mom, on bedtime stories, on home cooked food for almost every meal. These are all things I’ve always taken pride in providing, as a stay at home mom and wanna be June Cleaver. It’s kind of hard, I guess to reset my priorities from just being the “perfect” mom, wife and housekeeper to being pretty good at those things and getting strait A’s too.

To be honest, I don’t think they’ll end up mistreated or ignored, but I do think I’m really going to miss those lazy days.

Friday, July 16, 2010

Bigger Better And Exhausted

…or at least seriously worn out. I’m sure it’ll only get worse once I start college next month. College. Pre-med. At twenty five years old. With four children under the age of ten. What the heck am I thinking?

I always wanted to be a doctor. Seriously, always. When I was five years old I had a toy stethoscope and actually looked forward to going in for my shots. Because there were doctors there. But, well, like they say “Life is what happens while you’re busy making other plans”. I got pregnant just after my sixteenth birthday. Tragic, huh? Well I wouldn’t go that far. It’s not like I didn’t know how babies were made. But of course, having a baby in my mid-teens meant that I couldn’t possibly ever make it through med school. Right?

I thought so. I have to say, I spent the last seven and a half years since my son was born, embarrassingly convinced that, while having a baby before you were old enough to vote didn’t mean your life was over, it did put some of the bigger dreams a bit too far out of reach. Besides, I never really wanted to be a doctor anyways.

I’m sure I could make a novel length drama out of the years between then and now but memoirs are quickly going out of style, so what would be the point? A wonderful husband, a pretty satisfying life, and three more beautiful babies later, a blazingly obvious question finally occurred to me. “Why not?” My husband was convinced we could make it work and, once I was willing to be persuaded, convinced me too. So I applied to the college here in my hometown and was flabbergasted to receive a letter of acceptance despite the fact that, as I already knew, all you needed to get in were student loans and a pulse.

The ball had started rolling. I picked my major, a B.S. in biology, took my COMPASS test (a test for those of us who took the “get pregnant and drop out” career track to make sure that we can read) and met with an advisor to actually pick out classes. Like a real college student and everything!

Trust me, I’m excited. Elated. Terrified. Because you can’t go through medical school while still being a parent to your children. That’s what I’ve always been told. Because you can’t manage homework, and a family, and a household. Something’s got to give. I’m sure of it.

That’s why I’m glad there are blogs. I found some wonderful blogs written by doctors and nurses and even med students and residents. They’re all doing it. They’re all managing it just fine (or at least with a minimum of tears and anxiety). If they can do it, then maybe there’s more than a glimmer of hope that I can too.