Medscape Urology 
   
   From
   Infections in Urology®
   
   Editorial
   The New Millennium: A New Breed of Physician
   
   Stacy J. Childs, MD, University of Colorado Health Sciences Center,
   Denver, Colo.
     _________________________________________________________________
   
   Along with the new millennium comes a new breed of physician -- a
   clinician unwilling to settle for longer hours of work for less income
   and diminished respect from patients as a result of less patient
   contact. [Infect Urol 11(6):164, 1998. © 1998 SCP Communications,
   Inc.]
            ____________________________________________________
                                      
   I was recently sitting in an airport awaiting a return flight home. My
   companion, an esteemed academic urologist, began talking about the new
   breed of urology residents in his program. The urologists of the new
   millennium are not expecting the big bucks that cardiologists,
   orthopedists, cardiac surgeons, and radiologists accrued in the 1980s.
   They are also not looking forward to solo practice; rather, they hope
   to work for a large multispecialty group or managed care organization.
   Nor do they expect to work 60 to 70 hours per week, but hope instead
   to spend 40 to 50 hours at their job to find a better-quality
   lifestyle and family relationship than the previous generation had. I
   would say that is admirable.
   
   Fifty years ago, a physician's gratification from practicing medicine
   came mostly from pleasing his or her patients, then from respect in
   the community, and last from modest financial reward. Time spent
   talking with each patient about his or her job, family, hobbies, and
   so on was important. Surely, healing incorporated a significant
   placebo effect of time spent listening to the patient that can be seen
   after visits to a chiropractor or naturalist.
   
   How has managed care changed this picture? Physicians who insist on
   preserving income levels approximating those of the pre-managed care
   era are forced to see high numbers of patients and spend longer hours
   at their trade -- translating into fewer minutes with more patients --
   thus drastically decreasing patient satisfaction and lessening the
   chance of a placebo effect. So, while the financial reward diminishes,
   the respect from dissatisfied patients also will be proportional.
   Physician self-disappointment will then follow. The threat of lawsuits
   encourages overutilization, but managed care teaches underutilization;
   physicians are caught in the middle. The new millennium urologist will
   rebel, will not tolerate irate patients and managed care
   organizations, and subsequently will be deselected from the HMO.
   Eventually, managed care organizations will run out of docs to fire --
   we will all retire at age 55.
   
   A recent article in AMA News indicated that the salary for a top CEO
   of a managed care organization topped $30 million per year. The head
   of this executive's professional organization said that the
   compensation "fell woefully short" of what comparable CEOs in other
   businesses commanded. As a urologist, I examine male patients every
   day who complain that they are "woefully short," when they actually
   measure average or even better than average. And, as they say down
   South, "It is not how deep the well nor how long the rope, but how you
   dangle the bucket that is important anyway." CEOs of HMOs better
   dangle a little better if doctors are going to stay in this system.
   
   Think for a moment about the compensation awarded to teachers, who
   shape the minds of future generations; of clergy, who help direct the
   morals of society; of those charged with taking care of the elderly
   when no one else wants to do it; of housewives who teach values and
   ethics to our kids. Now think again of multimillion dollar health
   insurance CEOs and what they do for you, me, our patients, and
   society. Talk about getting sick!
     _________________________________________________________________
   
   Dr. Childs is Associate Clinical Professor of Urology at the
   University of Colorado Health Sciences Center in Denver, Colo., and
   has a private practice in Cheyenne, Wyo. He is Editor-in-Chief of
   Infections in Urology.
   
   
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   Medscape Urology 
   
   From
   Infections in Urology®
   
   Editorial
   The New Millennium: A New Breed of Physician
   
   Stacy J. Childs, MD, University of Colorado Health Sciences Center,
   Denver, Colo.
     _________________________________________________________________
   
   Along with the new millennium comes a new breed of physician -- a
   clinician unwilling to settle for longer hours of work for less income
   and diminished respect from patients as a result of less patient
   contact. [Infect Urol 11(6):164, 1998. © 1998 SCP Communications,
   Inc.]
            ____________________________________________________
                                      
   I was recently sitting in an airport awaiting a return flight home. My
   companion, an esteemed academic urologist, began talking about the new
   breed of urology residents in his program. The urologists of the new
   millennium are not expecting the big bucks that cardiologists,
   orthopedists, cardiac surgeons, and radiologists accrued in the 1980s.
   They are also not looking forward to solo practice; rather, they hope
   to work for a large multispecialty group or managed care organization.
   Nor do they expect to work 60 to 70 hours per week, but hope instead
   to spend 40 to 50 hours at their job to find a better-quality
   lifestyle and family relationship than the previous generation had. I
   would say that is admirable.
   
   Fifty years ago, a physician's gratification from practicing medicine
   came mostly from pleasing his or her patients, then from respect in
   the community, and last from modest financial reward. Time spent
   talking with each patient about his or her job, family, hobbies, and
   so on was important. Surely, healing incorporated a significant
   placebo effect of time spent listening to the patient that can be seen
   after visits to a chiropractor or naturalist.
   
   How has managed care changed this picture? Physicians who insist on
   preserving income levels approximating those of the pre-managed care
   era are forced to see high numbers of patients and spend longer hours
   at their trade -- translating into fewer minutes with more patients --
   thus drastically decreasing patient satisfaction and lessening the
   chance of a placebo effect. So, while the financial reward diminishes,
   the respect from dissatisfied patients also will be proportional.
   Physician self-disappointment will then follow. The threat of lawsuits
   encourages overutilization, but managed care teaches underutilization;
   physicians are caught in the middle. The new millennium urologist will
   rebel, will not tolerate irate patients and managed care
   organizations, and subsequently will be deselected from the HMO.
   Eventually, managed care organizations will run out of docs to fire --
   we will all retire at age 55.
   
   A recent article in AMA News indicated that the salary for a top CEO
   of a managed care organization topped $30 million per year. The head
   of this executive's professional organization said that the
   compensation "fell woefully short" of what comparable CEOs in other
   businesses commanded. As a urologist, I examine male patients every
   day who complain that they are "woefully short," when they actually
   measure average or even better than average. And, as they say down
   South, "It is not how deep the well nor how long the rope, but how you
   dangle the bucket that is important anyway." CEOs of HMOs better
   dangle a little better if doctors are going to stay in this system.
   
   Think for a moment about the compensation awarded to teachers, who
   shape the minds of future generations; of clergy, who help direct the
   morals of society; of those charged with taking care of the elderly
   when no one else wants to do it; of housewives who teach values and
   ethics to our kids. Now think again of multimillion dollar health
   insurance CEOs and what they do for you, me, our patients, and
   society. Talk about getting sick!
     _________________________________________________________________
   
   Dr. Childs is Associate Clinical Professor of Urology at the
   University of Colorado Health Sciences Center in Denver, Colo., and
   has a private practice in Cheyenne, Wyo. He is Editor-in-Chief of
   Infections in Urology.
   
   
   Medscape