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Inbox: Docs Ask 'What Career Should I Have Pursued?'


In our recurring blog "Inbox" we share comments from physicians and practice administrators telling us what keeps them awake at night.

Editor's note: We work hard to write about issues that will help physicians run their practices in a manner that is both prosperous and efficient, while still delivering quality patient care. And we are delighted when our readers let us know what they are thinking.

This month we are excerpting articles by managing editor Gabriel Perna on physicians' alternate careers, the burdens of MOC by primary-care physician KrisEmily McCrory, and why a 15-minute patient visit just doesn't cut it by primary-care physician Jennifer Frank. The articles has been edited for space and are followed by comments made by readers at PhysiciansPractice.com.

If I Hadn't Been a Physician …

It's always fun to look back and see where your career could have gone if you had made a left turn instead of a right one. We asked members of our editorial advisory board to reveal what career path they would have gone on if they hadn't gone into medicine.

We are also interested in your thoughts on alternate career paths. What career would you choose if you hadn't gone into medicine? Share your thoughts in the comments section of the article or by tweeting us @PhysiciansPract.

Tim says: Wall Street or pharma executive or research scientist.

Nazeer writes: In the dark days of apartheid in South Africa, people of color had educational restrictions. For instance they were not granted admission for study in most faculties at the top universities. Exceptions included architecture and medicine, but even here their numbers were restricted to 10 percent of the student intake. And so I studied medicine which of course was not out of choice. In the absence of apartheid, [I would have studied] likely physics and/or aeronautics.

Patricia says: Veterinarian or horse trainer/barrel racer; maybe country western singer.

Robin comments: I would have been a Veterinarian maybe, but I put myself through college as a bartender at a live rock & roll bar. It was the best job I ever had. There were so many people out back then and so many people to meet. It was a magical time back then. I am the last year of the Baby Boomers and every place was packed with people where ever you went. I sometimes think I should open a live entertainment acoustic bar, just so I can experience those fun times of listening to live music and getting to know the people in an environment so opposite from a hospital.

The Unnecessary Burden of Maintenance of Certification

Approximately 10 years ago, the America Board of Medical Specialties decided that the system for physician certification was insufficient and the new era of maintenance of certification dawned. Since that time, physicians have struggled to keep track of often changing requirements, point systems, and looming recertification exams. Although an undercurrent of despair with this process has been present throughout the country, it is often overshadowed by other threats to physicians such as MACRA, MIPS, and APMs. Recently, however, some specialty societies have begun to speak out against the current system, including the American Medical Association, as have states like Michigan and Oklahoma which have recently seen legislation regarding mandatory board certification for hospital privileges and medical licensure.

Why should physicians stand by while a private credentialing company forces physicians to undergo unreasonable, costly, time consuming, and sometimes irrelevant modules and an exam in order to maintain board certification? ABMS claims that physician recertification shows a commitment to lifelong learning and better patient outcomes; however, evidence showing an association with positive and meaningful patient outcomes is far from absolute.

There is absolutely NO evidence that passing Board Exam equates to being a better doctor. How does one test a physician in being empathetic and skillful? Knowledge does not translate to being a better physician.
Is there any study that has shown that board certified physicians have had less law suits then those that have not?! How many times does one need to take Board certification to prove their competence?

Asphendiar says: The board has empowered the insurance companies to find yet another reason to pay less for services of physicians who are not re- re- re-certified. The majority of physicians believe this is a system rigged to make money. Patients weed out bad physicians.

George writes: Quite right -nothing I have ever done in "review" for the test has ever added or changed anything toward my care of patients, but it has at times eaten up all of my CME time and money for that year. The test has very little to do general family medicine and review courses are geared to studying for the test, not actually learning anything. We should all remember the "zebras" from medical school, but this is not the most efficient way to do that. The costs have gotten exorbitant.

KrisEmily responds: The costs in time, money, and effort are all exorbitant for a process that has little to no evidence of improving meaningful patient outcomes.

Williams says: MOC is like being raped all over again. Patients think we are criminals. We can no longer practice independent medicine and earn a living. We get burned out practicing computer medicine. And no matter how hard you try, you can never document enough to please Medicare. We have little free time, and must spend it doing costly review that doesn't help with my area of practice. It should be criminal!

Cindy writes: Just another way for the tail to wag the dog.

Charles comments: Follow the money.

Why the 15-Minute Doctor's Appointment Is Unrealistic

Our organization is undergoing primary-care redesign like many other health systems and practices across the country. As part of this process, we are looking at what are the key problems in the current delivery of primary care. One issue we’ve identified is that patients are more complex overall. Primary-care clinicians are not seeing the patients with strep throat, ring worm, UTI, or uncomplicated hypertension as much as we once did.

When I was a high school student, I worked for our local general practitioner. He would double and triple book 15- minute appointment slots. Today, this seems ludicrous to me as I can do almost no single visit in just 15 minutes.

While I’m not advocating for a system designed around two to three minutes for the patient-physician interaction, the reason he could keep up this pace is because the majority of issues were self-limited concerns. Those with chronic disease had far fewer treatment options. Payment was less complicated as well.

Leslie says: Thank you for expressing this so eloquently. When I voice this opinion to my specialist colleagues, they seem surprised but do not recognize all of the elements you are describing. We want to give the best of care to our patients, and strive to affect their health beyond the moment of office contact. The root of the problems you are describing revolve around our nation's current issues with job equality, equal health access, adequate education, and mental health; issues which the physician cannot possibly remedy in the office. Yet physicians are given an ever growing list of mandates by governmental and professional organizations who mean well but don't walk in our shoes. My 30 minutes with a social worker regarding one family may do more [good] than 15 minutes in the office doing a sports physical with unproven benefits. And yet the most recent celebratory e-mail from administration was about a landmark increase in patient volume without acknowledging the stress, disrupted care, physical crowding, and unpleasant waiting this causes our patients.

Erin writes: Thank you for your article! Agreed 100 percent. Correct 100 percent. Are we able to change?

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