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Friday, January 15, 2010

Doctors Continue To Flee Primary Care: Pediatricians Go Part-Time

This post by Dr. Gwenn is in appeared January 14 at Better Health.

The WSJ Blog posted recently that health care job postings are up and that the health care job market is "strong."

According to the post, "The business research group said that 'advertised vacancies for healthcare practitioners or technical occupations outnumbered the unemployed looking for work in this field by almost 3 to 1,' citing November data."

While it's true that more job openings than job hunters is typically a good thing and indicates a robust job market, the WSJ Blog failed to recognize one important issue with the health care industry: in some areas of the health care sector, namely primary care, docs are leaving the field of medicine all together, and have been for at least a decade. So, it's no wonder there are so many job openings ... there's no one around to fill them!

A recent study in the journal Pediatrics, "Part-time Work Among Pediatricians Expands," gives a great over view of the pediatric work force and confirms the experience I've had in the field for the last 15-plus years.

Part-time work isn't new to pediatrics, given the amount of women in the field, but it used to be more popular as careers advanced. According to this study, however, pediatricians are now opting for part-time work right out of the gate, just after training or during, in their 30s. And, that more men are going part time as well as subspecialists along with the women and generalists that have been steady part timers for a while. All told, as of 2006, 23% of the pediatric work force was documented as part time--and growing!

Here's another tidbit for you: Buried in the data I discovered, that not only are pediatricians going part time but many are leaving the field. In fact, 12% of pediatricians are currently in nonclinical jobs.

I couldn't find any new data on how many pediatricians are leaving the field or doing what I have done and altered the career path over time to become more nonclinical at a young age, but I can tell you anecdotally it's not a small number. I know many pediatricians not working now by choice, working incredibly part time or just opting for nonclinical paths because the current clinical paths, even part-time ones, were not compatible with family life and a satisfying economic future.

Doctors leaving the field before the age of 50 is a huge red flag for any field. I hope the field of pediatrics recognizes that and seriously takes a look at not just the training but the practice of pediatrics and the current economic models being offered in all aspects of the field.

As for me, I don't regret the decisions I made. I've always enjoyed the more academic pursuits and I was going to end up in a more academic, nonclinical field regardless of any practice issue at play--the writing for that was on the wall for a very long while. I've always found volunteering at a free clinic an amazing way to "practice" pediatrics and give back to society. So, that's how I stay fresh and keep my skills up--and help people in society who otherwise wouldn't have access to a pediatrician. But, when I was a younger pediatrician and toying with options, it would have been nice had there been more that worked and I hope for future pediatricians who want to practice clinical pediatrics that the future is brighter for them in that sector. Right now, it's way too challenging and frustrating!

Are you a doc not using your stethoscope any more or using your training in a way you never predicted? Tell us about it in the comments. You are very much not alone!

This post originally appeared on Better Health , a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.

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2 Comments:

Anonymous MS4 said...

Makes me (sort of) wish I'd chosen to go into Peds instead. Working part-time would at least give me a fighting chance of keeping up with most of the new developments in my field. (I'm a 4th year med student nearly done with residency interviews)

I like the idea of working in medicine, I love learning about the underlying mechanisms of health & disease, and I adore working with patients. But when I consider the realities of practicing medicine in a managed care setting (and always under threat of litigation) somehow it all falls short. Will this really be my career for the rest of my life? Will I gain the same joy from working with my patients even 10 years from now?

I don't feel free to admit these questions to just anyone, but the few people in whom I've confided tell me their thoughts and feelings mirror my own. For everyone's sake, I wish it were just me.

January 17, 2010 at 8:03 PM  
Anonymous Anonymous said...

I am an Ob/Gyn that practiced for 12+ years. I left 2 years ago to work in pharmacovigilance with a contract research organization and have never looked back. I feel like I am using my brains instead of just braun. Also feel well compensated for my work!

January 20, 2010 at 10:03 PM  

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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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