"I can’t believe what I’ve gotten myself into. Medicine has become, almost weekly, and certainly monthly and yearly, more and more bureaucratized," says one urologist.
"It’s affected my plans because the distribution of reimbursement favors the technology component in compensation. The professional side is dwarfed by people providing technology, but it’s not minimizing the physician’s role. Even though technicians provide the service, urologists bear the responsibility. If there’s a problem during a ureteroscopy, you never see the ureteroscope manufacturer blamed; the physician takes the brunt.
The urology establishment also tends to promote technology. There’s an attitude that if you do an open nephrectomy, you should be driving a horse and buggy. There’s nothing wrong with it; it’s a good operation. Technology is glorified rather than craftsmanship.
Urology should take a stand and say, ‘The king has no clothes.’ We’ve seen technologies come and go. Balloon dilation of the prostate went by the wayside because it wasn’t effective. The urology establishment has to be more assertive that the craftsmanship of urology is as important as the technology.
Most likely, I will retire earlier than I originally planned. At one time, I thought I’d work until I was 70, but I don’t see that now. You can’t just close a solo practice; you have to phase it out or hand it over to somebody else. If you’re in a group, you can decide one day to retire and a partner will take care of your patients. If you’re an employee, the company will find someone, but if you’re a solo practitioner your ultimate responsibility is to the patient.”
Abraham Steinberg, MD
Dr. Yee"The Golden Age of medicine, where reimbursement was much higher, is no longer here, but I went into medicine partly because of my own passion and because of my family’s legacy. My great-great-great grandfather emigrated from China in 1850 looking for gold and settled in a small town in gold country called Fiddletown, CA. He was also an herbalist. Because he wasn’t successful at finding gold, he treated Chinese miners and later those building the transcontinental railroad. Since he helped establish the family tradition, a lot of our family has entered medicine and dentistry through the generations.
Even with the changes in the health care system, I still love what I’m doing. Coming into medicine, I knew it would not be as lucrative as it was in the past. I came in with my eyes open.
That’s the nice thing about physicians coming into medicine now. They’re here for the right reasons. I’m not happy about all the changes, but I also have a Masters in Public Health studying health policy and management. As an individual physician, I hope to help effect change so we can improve health care for all Americans.
I know there’s more concern about finances after you retire, but that’s part of being a medical doctor now. Overall, my passion and family’s history in medicine hasn’t changed, so I’m happy to be a part of it.”
David S. Yee, MD, MPH
"It tremendously affects how I think about the next 20 years. It’s ridiculous. I can’t believe what I’ve gotten myself into.
Medicine has become, almost weekly, and certainly monthly and yearly, more and more bureaucratized. As a young physician, I never imagined the amount of paperwork, the amount of medicine unrelated to clinical work, that takes up so much of my time.
I guess the advice would be to hire more people-concentrate on what you, as a physician, are trained to do. But then you’d go broke. We don’t get paid more for ancillary help to deal with all the minutiae.
The average person would think this is ridiculous. It’s not a way to practice; it’s not a way to live. You feel more and more like a cog in a wheel or a secretary jumping through hoops.
In my heart of hearts, I think I have to completely reinvent how I practice medicine; maybe that’s the only way to get through it.
I still get satisfaction from practicing urology. The problem is finding glimmers of sunshine through clouds. Hospitals would like to vertically integrate everyone and say, ‘Work as an employee and we’ll take care of all these aggravations,’ but I don’t know anyone who works as an employee who doesn’t still have to deal with those issues. If anyone thinks they’ve found the perfect solution, call me.”
Andrew B. Sher, MD