Physicians’ Seven Year Gap

This past weekend, while jogging through my community, I had the pleasure of bumping into a former colleague and his brother who were out for their daily five mile walk. Dr. G. had attended a local medical school, finished near the top of his class, and had gone on to do his internship and residency at the premier private hospital in Miami Beach, Florida. After completing his residency in internal medicine, and achieving Board Certification, he moved to Palm Beach County, Florida to practice.

He became the medical director of almost every skilled nursing home in the area.  No one wanted the job. The patients were elderly and in the last years of their life.

The bureaucratic rules meant he received hundreds of phone calls from the nursing staff at all hours of the day, every day. If a patient had indigestion and needed over the counter medication, they were required to page him. If a patient scraped themselves and needed a band aid and peroxide they were required to call him, all day and all night. The calls were so frequent most physicians would not cover his practice so that he could get a day off or take a few days vacation.  I met him for the first time while we were waiting to meet the Board of Directors of the local hospital on our first day of becoming staff members of the only hospital in the area at that time.

Over the years, my associate and I would take pity on the poor dedicated soul and agree to cover his practice so that he could take a break. It took at least two physicians to cover the practice and, frankly, by the second day the phone calls for minor ailments drove me crazy.

He practiced for 25 years then, due to some inherited money and good investments and savings, retired seven years ago. My only contact with him these days is meeting him and his brother on their walk. The conversation is always directed by him to the state of the practice of medicine. “How can you earn a living these days with all the cutbacks and regulations“, he would ask.  He would also inquire about health care reform and the sale of physician practices to the hospital and the health of colleagues he had practiced with.

On today’s walk he talked about a blog (website) he had discovered on line where physicians and patients discussed health care issues. He had read several articles about non physicians complaining about doctors earning money and charging a fee for the products and services they provide.  “What makes people think that doctors don’t have to earn a living to pay their bills as well as the next guy?”

Today’s walk was additionally special because it was the weekend of the NFL Divisional Playoff games. Dr. G. was a devout football fan. He bled Orange and Aqua for the Dolphins and Orange and Green for his Miami Hurricanes. As we walked he said,” I entered medical school in 1972 and completed my residency in 1979. It’s like there is this gap of seven years when I saw nothing and did nothing but study and learn medicine. I don’t remember who played in the Super Bowls let alone who won it. I don’t know who won the World Series.  I couldn’t tell you which movies won the Best Picture of the Year Award at the Oscars or who won the Tony for Best Musicals on Broadway?”

As we walked I thought about it too. Then I realized, that seven year period of time seemed as if someone had put a hold on my life as well. During that period, my friends from high school and college went on with their lives. They started businesses and other jobs. They married and started families. They travelled. They socialized.

I devoted seven years of my life to become the best doctor I could be. I studied and slept in-between 36 hour shifts on call with only seven or eight hours off at a time.  I had always considered my seven year gap a personal aberration but here was a colleague who experienced the same thing. I wondered about those physicians who had a ten or fifteen year post graduate experience before they got out in the world and re-joined the living. How did they survive?

Then Dr. G. said to me, “Imagine giving up seven or more years to learn and perfect your profession, helping others, and here we are in 2011 with patients complaining if you charge them a $25 co-pay or make a $2 profit by selling them a generic antibiotic they needed anyway”.

He has a valid point.  Our society doesn’t think twice about paying other professionals (I.e., attorneys, accountants, plumbers, electricians, etc.) a wage commensurate with their experience and expertise.  So, why then does our society, in general, have a negative perception of doctors earning a reasonable living commensurate with their education, experience and expertise?

Guidelines for When to Call 911 First and When to Call Your Doctor

We are very fortunate to have a fine and well trained paramedic squad to respond to medical emergencies in Palm Beach County and the City of Boca Raton around the clock.  Additionally, patients of my concierge medical practice have direct have access to me 24 hours a day.

I educate my patients how to use the services so that they get the most appropriate attention for the medical condition they are experiencing.  Thus, it is important to have basic guidelines of when it’s appropriate to call 911 in a life threatening emergency.  All too often, 911 is called for non life threatening emergencies which can delay emergency response time to other families’ life threatening crises by diverting attention to their non critical situation.

I suggest my patients call 911 immediately if they, or someone they are with, experience any of the following:

  1. Breathing Difficulty
  2. Chest Pain suspicious of a heart attack or pulmonary embolus
  3. Loss of consciousness or change in mental status
  4. Uncontrolled Bleeding
  5. Severe Trauma creating the possibility of life threatening internal injuries.
  6. New and uncontrolled pain suggesting a major and severe injury or illness

In these situations, I ask patients to call 911 immediately and then call me if they are free and not attending to or providing resuscitation for the patient. When the paramedics arrive on the scene they will take the steps necessary to save the patient’s life. They will attempt to stabilize the patient and bring them to the nearest emergency room even if it is not the hospital of choice or the hospital where the patient’s physician has staff and admitting privileges.

In situations other than those mentioned above, when 911 is called, the paramedic unit is responding to a non critical situation. When doing so, they are unavailable to respond to some other individual’s life threatening situation.

In most cases, irrespective of their findings, the paramedic’s protocol will direct them to recommend that the patient be taken to the emergency department for additional evaluation. They often choose to take the patient to the closest medical facility not the one the patient would prefer to go to.  This often results in long and lengthy time spent in the ER waiting to be seen by the ER staff and undergoing numerous laboratory and imaging tests because the ER staff does not know the patient’s medical history.

I remind my patients to call me first in non life threatening situations so that I may intervene and direct the evaluation. I speak to the paramedic team at the site to judge the severity of the situation and to make suggestions to the patient and family.

When I meet the patient at the ER, I know my patient well enough to judge, without many tests, if they are sick enough to stay and be admitted. The process is facilitated by knowing the patient’s medical history and knowing what the patient looks and acts like when they are well.

Very often, instead of going to the ER, the patient can safely be treated in my office, their home, or the office of a colleague who specializes in the type of medical condition  they are experiencing. This saves the patient time and gets them the attention they need for their non life threatening situation without overloading an acute care hospital’s emergency department.