Significant Challenges Facing MDs'

They include the increasing costs of medical malpractice coverage, higher practice costs, lower insurance reimbursement rates and insurance-company restrictions resulting in less autonomy over how patients are cared for.

The Association of American Medical Colleges projects that America needs a 30% annual increase in medical-school enrollment in order to keep up with need for doctors. In 2012, compared with 2002, medical-school enrollment will be up 21%.

But for potential physicians, there is a future of looming medical-school debt, which is higher than ever. Students who graduate from a public medical school have a median debt of $100,000; private-school students graduate with a median debt of $135,000, according to a 2003 study by the Association of American Medical Colleges. Compare that with 1984, when median debt for public-school graduates was $22,000 and private-school students was $27,000.

Monthly payment on a debt of $150,000 at the end of residency at an interest rate of 2.8% is $1,761, according to the study.

No one ever said being a doctor was easy. School and training go on seemingly forever; once graduation arrives, doctors work long hours and are faced with life-and-death decisions daily.

But there were rewards. For decades, doctors earned hefty paychecks, had autonomy and respect. But those benefits are fading, and as a result, so is the number of doctors. Within the next 15 years, the United States will experience a shortage of between 90,000 to 200,000 physicians, according to the recently published Will the Last Physician in America Please Turn Off the Lights: A Look at America's Looming Doctor Shortage.

The American Medical Association recognizes there are shortages in certain geographic areas and in certain specialties. Part of that is due to the aging population and a stagnant number of medical-school applicants.

But there are other significant reasons. They include the increasing costs of medical malpractice coverage, higher practice costs, lower insurance reimbursement rates and insurance-company restrictions resulting in less autonomy over how patients are cared for.

This is not just a question of career choice--consumers will be affected greatly by this shortage. If you think there's a long wait for an appointment now, it could be nothing compared with 15 years down the road. The three co-authors of Will the Last Physician in America Please Turn Off the Lights, all from the physician-staffing firm Merritt, Hawkins and Associates, say the wait will jump to three to four months or more to see a doctor for a non-emergency, and a routine doctor's visit will cost two to three times what it does now--whether you are insured or not, they say.

Insurance has become a loaded word. One-third of the country is insured by Medicare, and over the next nine years, the government program plans to cut payments to physicians by about 40%, while practice costs are projected to increase 20%, according to the American Medical Association. The first of those cuts will take place in July, when the reimbursement rate to doctors will drop by 10.6%. The next cut, of 5%, will occur in January.

It's expected to have a trickle-down effect. "If Medicare makes a change to their reimbursement, other insurance companies follow their lead, since Medicare drives the marketplace," says Lawrence Smarr, president of the Physician Insurers Association of America, a trade association for medical malpractice insurance companies.

But as costs continue to rise, many doctors say they need to see more patients in order to maintain their salaries and cover basic practice costs.

Are you a practicing physician? What's your experience of the workplace today? Would you encourage your children to follow in your footsteps? Let us know in the comments section below.

"We used to have a lot of respect for doctors, but now they seem like easy targets," says Phillip Miller, an author of Will the Last Physician in America Please Turn off the Lights. "There's a perception among patients that, 'I went to a doctor's appointment and he was 45 minutes late. He's probably on the golf course or driving his Mercedes.' The truth is, they're probably busy with patients."

The amount of time it takes to pay off debt depends on the specialty. The average physician's net income, adjusted for inflation, declined 7% between 1995 and 2003, according to the Center for Studying Health System Change. In order to enter the most lucrative specialties, like radiology, ophthalmology, anesthesiology and dermatology, doctors must continue with their training into their 30s. That means they can't start chipping away at their debt--let alone make money--until a time by which their counterparts in law or business are usually prospering.

Meanwhile, getting sued by a patient is a major concern. Of course, doctors who make fatal mistakes and who are unqualified should be held responsible. But there's evidence that the bulk of lawsuits brought are frivolous. Of all malpractice lawsuits brought to jury trial in 2004, the defendant won 91% of the time. Only 6% of all lawsuits go to trial; those that aren't thrown out are settled. Only 27% of all claims made against doctors result in money awarded to the plaintiff, according to Smarr, president of the trade association for medical malpractice companies.

Regardless, doctors need to defend themselves against the possibility of damages--and that's an extremely expensive proposition. It takes about four-and-a-half years from the start of a lawsuit to the end, and the average cost to the defense in legal fees was $94,284 in 2004, according to the American Medical Association.

To support that assertion, a 2007 survey by Merritt, Hawkins indicated that 57% of 1,175 doctors questioned would not recommend the field to their children.

http://www.forbes.com/2008/05/05/physicians-training-prospects-lead-careers-cx_tw_0505doctors.html