Tuesday, June 23, 2009

Doctors Who Don't See Patients

I wish someone would do a study on how many doctors complete medical school but never go into any type of patient care practice. I suspect the number is higher than we think.

I was at an upscale art party last weekend, filled with beautiful art and beautiful young people. I sat next to an attractive "early thirty-something" woman, confident and well dressed. She mentioned that her business partner was friends with the host and when I asked her what the business was, she said she was starting a "pharmaceutical business".

That certainly got my attention. Starting a pharmaceutical business? That is hardly what I think of as a "start-up". I made a few more inquiries, "Are you doing R&D? What types of drugs are you focused on?" She didn't answer my questions but proudly told me, "Oh, I am a physician." She trained in nephrology (kidney specialist) at UCSF...graduated...and now is starting a pharmaceutical business. She's never seen patients since her training.

The conversation didn't go much further but it did make me think about how many young physicians I know that do not see patients at all, but parlay their medical degree into some type of business venture.

It seems like a medical degree is becoming like a law degree. Very few attorneys actually see the inside of a court room or defend people against injustice. Are fewer young doctors actually seeing sick patients?

I can think of about two dozen young physicians that I know, who have left patient care completely over the past 10 years. Some started medical related business, some are in real estate, some joined pharmaceutical companies, some just retired to stay home with the kids. One teaches dance and one does a little moonlighting.

I keep up with the journals but have not seen this question addressed in any studies. Where do medical graduates go? How many stay in patient care vs. other aspects of medicine like research or teaching? How many "retire" early? How many start a "little pharmaceutical business"?

In this day of physician shortage, it is a question that needs an answer.


Lemon said...
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tracy said...

i know a brillant, very caring young lady who just finished her internship year and it was the most horrible time of her life, ever. Seriously, it wasn't just hard, it nearly broke her soul. She is currently taking a break, just trying to get her life and health back.

Toni Brayer MD said...

tracy: taking a break is critical for her so I'm glad she sees that.

Raymond Bouchayer said...

Well Dr. Brayer I think that the young Lady laid it out pretty clearly . I bet that for every patient that you see , you spend maybe more then twice that time dealing with paper work for the Insurance Companies , who's only interest is the "bottom line " and that is reflected in the stock Market and large bonuses are distributed . Why would someone that dedicated their life and years of very hard studies being subjected to opinions/orders from Insurance Companies /drug industries . Much is being debated about "one Payer Plan" ....my thought is that it will never happens , most of our Senators and Congress people own lots of stock in the Insurance and drug industry and then there is the bunch of "lobbyist" that come along with large sums of money to make sure that the "one Payer Plan " never happens and that is why new Physician choose another avenue to make a living . How can you practice your dedicated vocation if it is undermined by Corporations .

Healthnut said...

It will not surprise me if there are more MDs working in the pharmaceutical industry than there are working for the public. Many with duo degrees, actually work inside the pharmaceutical industry, ie. MDs with JDs, MDs with PhDs, MDs with MSc, etc.

Kellie said...

I kmow a pediatrician who only saw patients for a few years after medical school. She was wonderful, very youthful and enthuastic with patients and parents and children loved her. Once she had her own children she wanted to stay home with them and I had also had seen her get discouraged with the ways things were in medicine. Her father was a physician and she had alot of expectation placed on her. I remember another doctor saying she should keep up her skils, but she was happy.
On the other side of that I know a physician who was a teacher and didn't like it so became a doctor who had other physicians in her family.

Linda Leighton said...

Interesting question! There should be a study done on that.

Anonymous said...

Medicine can burn out very talented people in a short time. I have two colleagues, one an ophthalmologist and the other a neurologist, a couple, who walked away less than a decade into their practice careers. It seems they had had enough of both patients and of practice.

Quitting isn't rare at all. And more and more, there is less and less that one is walking away from. Doctors are by and large resourceful and talented people. They are pretty good at startups and second acts.

Deanna said...

I talked to a doc who is in BigPharma, did the same thing minus the whole start-up of his own business. It's appealing. Doing internal medicine for a residency is grueling; you are one of the hardest worked, underpaid, and under-appreciated.

If this country wants to go universal healthcare, and not pay for our medical student's education (like the European system)... then there's no reason to fret when some of the best and brightest want to be PAID accordingly. Being a doctor is no longer a glorious career where everyone drives Jags. That era is long over.

Anonymous said...

Kellie - ".........On the other side of that I know a physician who was a teacher and didn't like it so became a doctor...."

I'll go one further. I worked with a doctor who was a teacher. Taught high school science. He thought he could become a doctor, went to medical school and became a doctor, finished residency, practiced a few years.......

......then realized medicine sucked.

He went back to teaching.

Anonymous said...

Teaching high school, I mean. Sorry to be unclear. Didn't teach medicine, he left medicine completely and taught high school again. A very well qualified biology teacher I guess.

Dr. Joseph Kim said...

I run a blog called
and I've met many interesting people who have left clinical medicine. In fact, I'm writing a book about this very thing. People often jump to the conclusion that money is the motivating factor. That may be the case for some, but many others leave clinical medicine for so many other reasons.

Gregory said...

Very interesting read. I am also sensing that more physicians are leaving (or attempting to leave) clinical medicine. I have recently written a series of posts on my Medical Fusion Blog about this subject ( www.MedFusionBlog.org ) and we will be organizing a conference this November for physicians who are interested in finding out more about alternative career opportunities ( www.MedFusionConf.org ). It's sad that it has come to this, but many physicians are fed up with the frustrations of clinical medicine and the lectures of those who think physicians matter little but should be compelled (through law or other strong-armed tactics) to continue clinical medicine regardless of their personal preferences.

Anonymous said...

My best guess is about a 15-20% attrition rate during the first 10 years of clinical practice.

I closed my practice after 5 years when I had a unique opportunity to start a new medical device company. I haven't looked back and its been great. My doc friends, who initially thought I was crazy, are now green with envy.

I agree that an MD degree should be just like a JD: An academic qualification with many potential applications or career paths. This is the way it ought to be - clinical practice is only one application of medical knowledge.

Anonymous said...

I think this is not that high of a percentage, but higher than people think.

I don't know many who never see patients, but quite a few who quit or do something else after a few years of clinical practice.

The vast majority are women who get married to another doc or dentist or professional, and simply lose their drive to work after they complete their training, and stay home with kids

With 50% or more of med school students being women, this is already causing severe workforce issues, but no one is going to touch the issue with a 10 foot poll for fear of being labled sexist.

Many, many women who I've worked with never truly work full time ever, which is a massive waste of educational money for society-- remember, the average medical degree at a public med school is subsidized by over $100,000 by taxpayers in many states

The fact is, a lot of people go into medicine for poor reasons, don't do their homework, or make a bad choice in specialty, and end up quitting or doing something else.

I predict this problem will get crucially worse in the next generation.

I love my specialty and my job, but if things get much worse financially with medicare pay cuts, a single payer system dictating treatments, etc-- I will be joining the ranks of the disgruntled who quit seeing patients

We docs are often highly intelligent, hard-working, driven people-- it's shameful to waste our educations and skills, but we have options

Kellie said...

Last year a female surgeon I know told me that she loves her job and what she does. That was unusually refreshing to hear and it reflects in her thoughts, the ways she operates her practice,
and even in the feeling of the design of her waiting waiting room and office.

Kamagra Oral Jelly said...

in fact maby of the students that finish this career, can't find work and for that reason end in place like private clinics or drug stores.

Philip said...
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Anonymous said...

I am a male general internal medicine physician in my 2nd year of practice. I'm already dissatisfied with my job. My job is not very much appreciated and I actually even find it boring at times. There is not much medicine in what I do. I think if I could actually apply the vast knowledge base I had to acquire through training, it might be more enjoyable. But filling out disability paperwork, answering 100 faxes per day from the nursing homes/home health companies/insurance companies, and not getting to apply my knowledge to the extent that would make it enjoyable... leads to my low job satisfaction. I've tried to branch out a little. I see wound care patients a half day a week and am a hospice medical director. I'm going to try getting certified in obesity medicine. Still don't get very excited to wake up and come to work each day. The pay is great. The only thing that keeps me going is the pay so I can take care of my family. But of coarse, doctors aren't supposed to care about money. The job unfortunately has turned into just a job and is no longer a passionate calling for me. I'm hoping to keep expanding my skills, read a few motivational books, etc. like I've been doing, but so far nothing has really given the drive and passion I used to have in medicine. Did I mention I've only been out of residency training for two years? Physicians are leaving my hospital system in droves, and I don't think it's the pay or even the hospital system which is pretty supportive. I just think medicine has become dissatisfying.

Toni Brayer, MD said...

Anonymous above: It makes me sad to read your post yet I do understand your feelings. Please do keep looking for other clinical ways you can get fulfillment. If you are with a large system try to make change from within to get that awful paperwork off your plate. The MAs and LVNs shoulda be working at the top of their license so you can be a valuable clinician. You may need to work elsewhere. You are too young to feel this dissatisfied. Branch out. Get your mojo back. Keep learning new skills that will differentiate you. You are valuable to patients. . Don't forget that.

Coffee, Tea and Heart Disease