Tag Archives: doctor-patient relationship

Sick of the part-time debate yet?

There’s been a lot of fallout over this weekend’s New York Times Op-Ed piece about doctors, particularly female doctors, working part time. I enjoyed reading the multiple reactions and reader comments and have been thinking about it quite a bit over the past few days. On my recent half day off I joined one of my partners at a conference reviewing Rheumatology board questions with the residents. Afterwards, since I was close to the office, I stopped by to sign some papers, review labs and make a few follow up calls.

Walking in, my partner says, “Hey, what are you doing here? Isn’t this your day off?”

Me: “Yeah, well, haven’t you heard? I’m ruining medicine with this part time nonsense!”

What exactly is part-time? In this world of “widget” medicine where we’re only paid for patients seen face-to-face in the office, we need to assign a value to the hours of uncompensated time outside normal office hours. Indeed, my “time off” is often spent attending meetings, participating in teaching sessions, reviewing research projects, filling out patient forms, catching up on labs, phone calls and emails and coordinating care for patients with difficult or complex cases. Things I maybe didn’t have a chance to do or couldn’t do before the office opens at 8am or after the doors close for the day. Fortunately or unfortunately, the fact that I can access my EMR from my laptop means I’m (and probably a lot of other “part-timers” are) never really away from work.

Is it easier to work a full-time schedule in more of a shift-based specialty like anesthesia, hospital medicine or EM where there seem to be less demands outside of one’s actual on-site work? I certainly don’t want to speak for my colleagues in primary care, as I know my office paperwork burden is a fraction of theirs. However, until there is less bureaucracy in medicine, compensation for time spent in non-contact care coordination and, yes, malpractice reform, physicians (male and female) will continue to seek part-time work or explore other practice environments. I applaud those who have made this lifestyle choice, whether to spend more time with kids, write a book (or blog) or pursue other interests related or not related to medicine. Thanks to those who have echoed Dr. Centor’s assertion that he would rather see a committed part-time doc than a full-time doc who is burned out.

Here are some links to related articles:

Dr. Centor – medrants.com

Dr.Jen

WSJ Blog

KevinMD

Dr. Au’s response

NYT parenting blog

The difference between men and women?

Many of the medbloggers I follow have chimed in on the recent discussion about the difference between male and female physicians’ salaries. However, I thought I’d repost the entry from KevinMD for some of my non-medblogger readers. Really fascinating and I totally agree! Here’s the post in its entirety, but also the comments are worth a read. Thanks, Dr. Kevin!

Female doctors make less than male physicians.

That conclusion gained major media traction recently.  A recent post on KevinMD.com by medical student Emily Lu had some great conversation discussing some reasons why women make less money in medicine.

To recap, the study from Health Affairs concluded that,

newly trained physicians who are women are being paid significantly lower salaries than their male counterparts according to a new study. The authors identify an unexplained gender gap in starting salaries for physicians that has been growing steadily since 1999, increasing from a difference of $3,600 in 1999 to $16,819 in 2008. This gap exists even after accounting for gender differences in determinants of salary including medical specialty, hours worked, and practice type, say the authors.

Everyone hypothesized all sorts of reasons.  Female doctors prefer more family-friendly hours and less call, which may impact their salary.  Women are simply worse negotiators than men.  Blatant sexism exists when hiring new physicians.  Money isn’t as important to women as it is to men.

All of which may, or may not, be true.

Of course, the reasons probably are multi-factorial.  But there’s one that I haven’t seen discussed much.

Women, in general, spend more time with patients — up to 10% more.  Pauline Chen, in a New York Times column last year, noted stark differences in how men and women practice medicine, and whether, in fact, women make better doctors by spending more time in the exam room.

So, even though women may work the same number of hours as their male counterparts, they’re likely to see less patients during that time.  And since physician compensation is still mostly based on fee for service or productivity-based incentives, women doctors are going to come up short on compensation scale.

As I commented to CBS News, “By spending more time with patients, female physicians are financially penalized by seeing less patients during the day.  It’s another reason why we need to change the way doctors are paid, and reward them for spending time with patients, instead of penalizing them.”

A Love Letter to Primary Care

Faneuil Hall, Boston

Living in a major metropolitan area means taking a lot of things for granted. Especially here in the Boston area, with its many renowned hospitals and universities, one can find physicians practicing and conducting research in specialties within specialties. Nothing seems too far out of reach. However, this city mouse recently traveled down the Blue Ridge Parkway for some R&R and to learn how the country mice work and play.

My FP friend's happy old horse

I was thrilled to meet up with a medical school friend who practices family medicine in a rural area a bit further south. We spent a lot of time catching up and reminiscing, of course, but we also did a fair amount of “shop talk.” Touring her office space, she shared with me some examples of what her typical day might be like. The pride in her voice was evident as she talked about what it means to be a family doctor. I was surprised to hear about all the office procedures done on site, as I think locally a lot of procedures here in the city are referred out to specialists. We hear so much about how medical students these days don’t want to go into primary care. Maybe they need to spend more time seeing what it truly means to be someone’s family doctor. Through blogging I’ve been touched by the words of some fantastic doctors who are living and sharing this life, but it was also wonderful to hear about the struggles and inspirations from my friend over lunch. “You know what I wish,” she said, “That people didn’t think you only go into primary care if you’re not smart enough to specialize.”

Barn cat

Maybe this sounds strange coming from a specialist, but I couldn’t be a bigger advocate of primary care. And the further I get away from my general internal medicine training, the more I’m struck by just how hard it is to have to keep up to date with ALL the body systems! Not only do I value the teamwork and co-management of the primary care providers I work with, but I want my OWN doctor too. Everyone is a patient, and don’t we all want someone to call “my doctor?” Having gone to medical school at an institution with a strong primary care commitment, I don’t think this value has ever been far from my mind. In fact, of my group of close friends from medical school, the majority are family doctors, one is a pediatric specialist and one is an internal medicine hospitalist. Then there’s me, in rheumatology, which I do love for the multi-system nature of many of the conditions I see.

Some medical student blogs I follow occasionally talk about “specialty bashing” or how residents and attendings they encounter put down other areas of medicine. Some have said, “Oh, I could never be a XXX doctor. How boring! What torture!” (Well, more colorful language may have been used, but you get the picture). I’m GLAD we all find some things boring and some things exciting. What if every medical student in the world wanted to practice in the same field? That wouldn’t work at all. This post didn’t start out as a love letter to primary care. My original intent was just to say thanks to my good friend for the visit and share some photos. But after thinking about it, I want to also say thanks to all the primary care internists and family docs for what they do. Thanks for inspiring my friends and colleagues, who will hopefully be able to inspire today’s medical students to follow in their footsteps.

Dr. Fix-It

A few months ago at my house, as the oil burner kicked on, black smoke started billowing out of the chimney and the smell of burning oil permeated the house. CRAP! What’s going on? Is my oil burner going to explode? Do I have a leak worthy of the BP engineers? Should I gather my valuables (i.e. dog, laptop and eyeglasses) and vacate? Will my vacation budget get blown on a new furnace? Will I even have a house left???

I make the early morning call to the emergency answering service. “Someone will call you back,” I’m told. I wait a while, thinking the worst, then get the call, “Someone will be with you today.” Several anxious hours later the repair man shows up. “Soot,” he says immediately, as he looks at the furnace, “Something’s clogged. I’ll have to sweep this out.” He didn’t seem too concerned, quickly got to work and all I heard was a lot of banging and vacuuming. Problem solved.

Now, what does this have to do with medicine?

I don’t know a thing about oil burners and heating systems but I know a lot about the human body. When I didn’t know what was wrong with my furnace, aside from alarming symptoms of oil smell and black smoke, I panicked. I had myself thinking the house was going to imminently explode. However, two seconds and the technician knew what to do. Similarly, when my patients come in with back pain or a swollen knee or fatigue and joint pain, in their minds their “house,” or body, is going to explode. Is it cancer? Are my bones collapsing? Will I be in a wheelchair by the time I’m 50? Will I be able to work? Will I die? Sometimes medical conditions take a while to diagnose, but sometimes I know in two seconds, “Oh, that’s just osteoarthritis of the knee,” just like my heating technician knew “Oh, that’s just a clog.”  However, just like I did, my patient has other concerns.

One of the challenges of medicine, especially in the outpatient setting where time can often run short, is balancing the wants and needs of doctor and patient. It may only take a few minutes to inject an arthritic knee and in the doctor’s mind the problem is solved. However, the patient may still leave with fears about why he or she has this scary condition called “degenerative arthritis” and what that means in the scheme of his or her life.  Always useful is this reminder that everyone has a backstory, an agenda, fears and expectations. Usually when rushed and stressed is the time we need to remember this the most.

‘Tis the season of giving?

[picapp align=”left” wrap=”false” link=”term=gift&iid=295533″ src=”0292/f536e6bd-dfa6-4a7e-a03c-9d094a52ca53.jpg?adImageId=7971122&imageId=295533″ width=”234″ height=”353″ /]As the calendar page flips to December 1st and thoughts turn to holiday gift buying, I have been reflecting upon gifts to medical providers. During my medical school surgery rotation, which happened to be during December, I still recall the countertops piled high with cookie trays, nut tins, fruit baskets and flowers. Now, this was an office of a very loved and respected surgeon in the community, a man not too far from retirement, with seemingly endless thankful patients. I can’t say I’ve ever seen anything similar since then. However, likely all doctors will have stories about gifts they have received over the years. Primarily patients bring in handmade goods. I have received baked goods on many occasions, a hand-knit afghan, a dried flower wreath, candles and other similar items. It is always very touching and I’m honored when patients think of me and want to express appreciation. I recently was given a CD, which I’m pretty sure was from the patient’s own collection, weeks after he and I had a song lyric Q&A about some Sinatra. Of course, gifts are by no means expected and, truth be told, sometimes it is difficult to know how to respond. I did a little search to see if there are any formal guidelines about physicians accepting gifts from patients but I didn’t find anything on the Mass Med Society site about it. I did find this entry from the NYT Well blog, including the following quote:

As it turns out, the medical community is deep into a discussion about whether it’s appropriate to accept gifts from patients. Although small tokens like cookies or fruit baskets don’t usually pose a problem, physicians struggle with the ethics of accepting more costly or more personal gifts from patients. Doctors must maintain professional boundaries and don’t want patients to get the idea that gifts are necessary or that they might influence care. At the same time, doctors don’t want to insult or alienate patients by refusing gifts.

I’m curious: have you, as a patient, given a gift to a doctor or other medical provider? Do providers have any memorable gifts to share?