Here's why 9 out of 10 doctors wouldn't recommend medicine as a profession

Now, some doctors are trying to tackle physician burnout with innovative new programs of their own

July 9, 2014 12:00PM ET

by David Martin @Stories_Live

Dr. Don Rice needs to move fast to stay in business. He owns Urgent Care Clinic in Lincoln, Nebraska, where he and his staff see some 18,000 patients a year – about 50 a day.

“Sometimes I feel like those Chinese acrobats spinning all the plates, and you’re just frantically going around trying to see if you can keep them all up before they come crashing down,” Rice says.

With shrinking reimbursements, growing bureaucracy and increasing competition from both nurse practitioners and specialists, Rice sees primary care medicine as a dying field.

“What we do in primary care is not valued. It’s devalued,” Rice said. “I think family practice will be a dead specialty in about 10 years.”

Dr. Don Rice and his staff see around 50 patients a day at his clinic in Lincoln, Nebraska.

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Rice said he wouldn’t recommend primary care for medical school graduates, and he’s not alone. A 2012 survey of 5,000 physicians by the nation’s largest insurer of physician and surgeon medical liability found that 9 in 10 wouldn't recommend medicine as a profession. For those already in the profession, the stress can be unbearable. On average, the U.S. loses as many as 400 physicians to suicide every year.

According to Dr. Brian Forrest, who practices family medicine in Apex, North Carolina, physician burnout is one of the major issues in medicine today.

Forrest has pioneered what he calls a direct care model, which makes seeing your doctor like a health club membership. He doesn't take insurance, but for about $50 a month, patients have unlimited access to his clinic, plus free blood work and other basic diagnostic tests.

In return, Forrest says he no longer needs the large staff handling the insurance and billing paperwork. That means Forrest does not need to generate as much income to cover his costs, which gives him the ability to spend more time with fewer patients and still remain profitable. He’s no longer rushing from patient to patient just to make ends meet, no longer fighting with insurance companies and no longer chasing patients who don’t pay.

“When you can just be the doctor and take care of the patient and you can spend 45 minutes with that patient, that’s just pure joy in medicine,” Forrest explained.

Now, it’s 10 to 15 minutes and I hand you a prescription for an anti-depressant and I hope to God they’ve got a social support system that helps them understand there is light at the end of the tunnel.

Don Rice

Urgent care doctor

Dr. Pamela Wible, a primary care doctor in Eugene, Oregon, said she was so disheartened by what she calls "assembly line medicine" that she became suicidal, lying in bed for six weeks, not caring if she woke up in the morning.

There, Wible had a vision how she could regain the joy of being a doctor. She held a series of town meetings and let patients design her practice, an experience that left her with a whole new understanding of what her patients really want.

“I was just amazed at how simple people’s needs really are,” Wible says. “When you’re sick, you want a cozy small space with someone like your mom who loves you and you don’t want to park in a three-story parking garage and you don’t want to sit when you’re sick in a cafeteria style waiting room, and you don’t want to be asked for your credit card and your insurance card and all the things that people are hassled to do when you’re not feeling well.”

Pamela Wible, a primary care doctor in Eugene, Oregon, said she was so disheartened by what she calls "assembly line medicine" that she held a series of town meetings and let patients design her practice. She said the experience that left her with a whole new understanding of what her patients really want.

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Wible now is a solo practitioner in the true sense of the word. She has no receptionist and no billing department. She doesn't even a have nurse. Like Forrest, she spends much more time with her patients, and says she's much happier as a physician as a result.

Both doctors agree that the extra time they get with patients means they're able to offer more comprehensive care. At his urgent care clinic, Rice says he knows there are limits to what he can do as a doctor.

“I miss out on the opportunities to say, ‘Hey, look you’re having trouble sleeping. You’re relationship is on the rocks with your spouse. Let’s talk about what got you here.’ Now, it’s 10 to 15 minutes and I hand you a prescription for an anti-depressant and I hope to God they’ve got a social support system that helps them understand there is light at the end of the tunnel,” Rice says.

“I have to take a deep breath and just say, ‘What can I do to help you today?’ – just see what we can accomplish in the time we have together,” he added.

Wible and Forrest have each attracted followers to their models.

Dr. Lara Knudsen went to one of Wible’s training seminars and opened a clinic modeled on Wible’s a little more than a year ago in Salem, Oregon.

“The younger generation is focused on free time and not totally consumed by medicine,” Knudsen said. “We want to have a life outside medicine.”

Wible now says she has sleepless nights worried about doctors who have not seen a way out of assembly line medicine.

“I feel, of course, very happy now about my life," she said. "But it also feels like a tremendous weight knowing most of my colleagues feel depressed and burned out. And many of them are in the same place I was 10 years ago."