Why Do So Many Doctors Regret Their Job Choice?

In an online questionnaire of 24,000 doctors representing 25 specialties,only 54%, said they would choose medicine again as a career, down from 69% in 2011. Just 41% would choose the same specialty again. Only a quarter of doctors said they would choose the same practice setting, compared with 50% a year ago. Why such frustration and discontent among physicians? The Medscape survey cites declining incomes, excessive paperwork, and vast uncertainty about changes dictated by the Affordable Care Act.

Especially for patients over 65, doctors must fill out multiple layers of insurance forms. A single elderly patient can have Medicare, and then secondary and tertiary insurance coverage, all of which require separate forms.

The Medscape survey also describes how hospitals are buying up private practices both in primary care and other specialties. This makes some doctors feel less independent and discouraged, says Howard Forman, a professor at the Yale School of Management who researches diagnostic radiology, health policy and healthcare leadership. “The transformation of the field from independence and professionalism to being commoditized and feeling like you’re just another worker is disheartening to some,” he says.

A encruzilhada da saúde nos EUA

A saúde não é só insustentável por cá. Os doentes querem a saúde eterna. Os profissionais da saúde querem enriquecer. As corporações da saúde querem lucros ilimitados. É impossível completar tal puzzle.

Os EUA acham que ultrapassam todos os obstáculos. Mas, a saúde na América vai mal, ou mesmo muito mal, apesar dos mega-investimentos em tecnologias de informação e em novas soluções de gestão. Vejamos o que aqui se vai dizendo que se passa na terra do Uncle Sam:

• Twice I have asked Alan Greenspan what he considers the greatest threat to the U.S. economy, and both times he has answered immediately with a single word: Medicare.
• But Medicare is something else - a multitrillion-dollar problem that's about to get dramatically worse, and one that nobody wants to talk about.
• Sometime in the next President's first term, Medicare Part A (hospital insurance) will go cash-flow-negative, and it's all downhill from there. Medicare provides a wide range of services and subsidies to more than 40 million old and disabled Americans.
• As the country ages, Medicare and Medicaid (for those of any age with low incomes) will devour growing chunks of U.S. economic output.
• The federal budget has averaged about 18% of GDP over the past several decades. If that average holds and if the rules of our social insurance programs don't change, then by 2070, when today's kids are retiring, Medicare, Medicaid, and Social Security will consume the entire federal budget, with Medicare taking by far the largest share. No Army, no Navy, no Education Department - just those three programs.

Satisfeitos só porque os Americanos têm problemas maiores do que os nossos? Não, até porque a situação por cá ainda só foi correctamente vista por 3 ou 4 pessoas. Os outros continuam a achar que existirá sempre alguém que cuidará de nós!

Medicare: 'problematic'

Os gastos com a saúde são muito grandes. A situação não é portuguesa, europeia, ou sequer americana. A situação que se passa com os gastos da saúde, já o temos escrito, é global, e explica-se básicamente por duas razões: 1) a inflação com os custos clínicos é muito superior à inflação média global; 2) as pessoas exigem ilimitadamente mais saúde.

Estamos à beira da ruptura, do actual paradigma. Não significa que os sistemas de saúde, actuais, deixem de existir. Significa apenas, que os sistemas de saúde tal como os conhecemos não são sustentáveis, por mais "face-lifting" que se faça!

Tudo isto a propósito da situação do Medicare dos EUA:

• Medicare continues to be in much worse shape than Social Security, thanks to the high rate of inflation in health care costs.
• The program has already begun paying out more than it receives in payroll taxes. And the trustees now forecast that its trust fund will be depleted by 2019 (vs. 2018 a year ago), at which point Medicare would only be able to pay out 79 percent of expected expenditures.
• Over the next 75 years, to shore up the system, the trustees estimate that payroll taxes would need to increase by 3.55 percentage points, on top of the 2.9 percent of all wages that is paid by workers (who pay half) and their employers (who pay the other half). That would bring the Medicare taxes to 6.45 percent of all wages.

Resumidamente: as pessoas têm que gastar mais com a saúde e conviver mais com o fim do mito da saúde eterna!