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 [INLINE] Home Search Site Map Talk to Us Help INTERACT [INLINE] Email this article to a colleague. [INLINE] RECOMMENDED LINKS STACEY J. CHILDS, MD EDITORIAL [INLINE] Column Index _________________________________________________________________ RELATED SPECIALTIES [INLINE] Urology _________________________________________________________________ Straightforward information for impotence Site Tools Map [INLINE] For: _____________________________________ [in Full-Text.........] ______ help Advanced Searching: Full-Text | MEDLINE | TOXLINE | AIDSLINE | Bookstore | Dic tionary | Drugs Site Navigation Map Produced by Medscape, Inc. All material on this server Copyright © 1994-1998 by the publishers involved.
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. MedscapeEmail me, Bill Hammel at