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Why Doctors Really Quit

This article is more than 8 years old.

In September 2009, Terry Jones wrote in Investor's Business Daily that the United States was barreling toward catastrophe: Nearly half the nation's physicians were on the verge of hanging up their stethoscopes.

"Four of nine doctors, or 45%, said they 'would consider leaving their practice or taking an early retirement' if Congress passes the plan the Democratic majority and White House have in mind," Jones warned.

"Projecting the poll's finding … 360,000 doctors would consider quitting."

Well, Congress did pass that plan six months later. (You might have heard: It's called the Affordable Care Act.)

But our doctors didn't go away.

In fact, rather than lose 360,000 physicians, the nation's gained nearly 100,000 practicing doctors in the past six years.

Time and again, surveys have predicted that physicians' anger over Obamacare, over regulations, over declining reimbursement is driving them out of the industry. That doctors' gloom will lead to doom for American health care.

"Six in 10 physicians say that it is likely that many physicians will retire earlier than planned in the next one to three years," Deloitte warned in 2013.

"Recent anecdotes suggest more physicians may be retiring earlier than in the past and [in] a large cohort," the Lewin Group concluded — in 2004.

But we see again and again: Intent doesn't equal action. At least, not on a national scale.

For instance, the Wall Street Journal in 2013 implied that doctors were leaving Medicare en masse. It wasn't true.

Last Friday, the latest high-profile pessimist popped up — Charles Krauthammer, a Harvard Medical School-trained doctor and a columnist for the Washington Post.

In an essay carried in hundreds of newspapers, and originally called "Why Doctors Quit," Krauthammer argued that the Obama administration has "demoralized doctors and degraded care" by pushing providers to quickly adopt electronic health records, known in shorthand as EHRs.

In Krauthammer's telling, EHRs have turned out to be "health care’s Solyndra" — they haven't justified the $27 billion in incentive payments that the White House used to get doctors to go digital.

"Many, no doubt, feasted nicely on the $27 billion, but the rest is waste: money squandered, patients neglected, good physicians demoralized," Krauthammer wrote.

The stress of EHRs is so bad that many of his Harvard classmates from 1975 are thinking about quitting medicine, Krauthammer added. He writes:

Virtually every doctor and doctors’ group I speak to cites the same litany, with particular bitterness about the EHR mandate. As another classmate wrote, “The introduction of the electronic medical record into our office has created so much more need for documentation that I can only see about three-quarters of the patients I could before, and has prompted me to seriously consider leaving for the first time.”

You may have zero sympathy for doctors, but think about the extraordinary loss to society — and maybe to you, one day — of driving away 40 years of irreplaceable clinical experience.

It's true that doctors — especially older ones — are frustrated about the shift to electronic health records.

And understandably so! EHRs have added a burden to a busy workday. The added value of digitized data isn't always obvious. There's evidence they hurt productivity.

As a journalist, I've heard these complaints over and over again from doctors. And as a patient, I've witnessed doctors' anger firsthand.

A few years ago, I was in the office of a middle-aged neurologist, one of the greatest diagnosticians I've ever met. It was a routine check-up, but he spent more time looking at his computer screen than at me.

"This gets in the way of patient care," he groused, his eyes locked on the screen.

"Why don't you hire a medical scribe?" I asked the doctor. "Someone who can keep the notes while you see patients?"

He swiveled around and scowled. "The hospital doesn't want to pay," he said, as his eyebrows scrunched. "I don't know how much longer I can keep doing this."

But that doctor didn't go anywhere. He's got kids in Ivy League colleges and a D.C.-area household to fund. He's got years invested in building a practice. And walking away from that will take more than frustration over a computer system.

In fact, the real reason why doctors are quitting is less dramatic: They're aging.

For the first time, the number of U.S. physicians in their mid-50s (or older) has outpaced the number of physicians between the ages of 35 and 54. Not all of these older doctors are still in practice, but a surprising number have stayed in the workforce.

One major reason? Money. The sunk cost of being a doctor — the years of training; the enormous student loans — also can take decades to pay off. And physician reimbursement has steadily tightened in recent decades, forcing older doctors to work harder and stay longer if they want to maintain their earlier standard of living or fund ambitious retirement plans.

The recession had a similar effect on doctors' decisions, too. According to a 2011 survey, 70% of doctors said they planned to work longer because of the economic downturn.

But now that the economy is in recovery, more of these older doctors are leaving, sparking a jump in retirement rates.

Sure, EHRs may be pushing a few doctors out the door. But these tend to be physicians who already had a foot dangling over the threshold.

Just look at Charles Krauthammer's article, where the only evidence he has that EHRs are forcing doctors to quit is the grousing of his elderly classmates.

Let's be real: 65-year-old doctors retire for more reasons than EHRs.

Of course, not all doctors think electronic records are an albatross.

"We know that when some physicians adopt EHR systems, they are worse off – slower, less efficient, struggling to provide high-quality care," Julia Adler-Milstein, a University of Michigan professor, recently testified to Congress. "But for others, the experience is very different: they see big gains in productivity and the quality of care they provide."

"Why do some do so well with technology while others struggle?" she mused. "The answers are not as simple as age or tech savviness. It’s likely much more about how the IT is used, and the context in which it is used."

But ultimately, Krauthammer's article is short-sighted because it's so prehistoric. Fighting against digital records is like fighting the sun. The era of EHR is rising because it needs to.

Yes, it's created an unsettled, and unsettling, moment in medicine. Sure, EHRs are imperfect and need to improve.

But it's a necessary transition from today's fragmented health care system to tomorrow's team-based health care model.

"We are at a cusp point in medical generations," surgeon and author Atul Gawande told the Harvard Medical School class of 2011, at their graduation. "The doctors of former generations lament what medicine has become. If they could start over, the surveys tell us, they wouldn’t choose the profession today. "

"Many doctors fear the future will end daring, creativity, and the joys of thinking that medicine has had."

"Making systems work in health care — shifting from corralling cowboys to producing pit crews — is the great task of your and my generation of clinicians and scientists," Gawande added.

"[And] nothing says teams cannot be daring or creative or that your work with others will not require hard thinking and wise judgment."

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