Most physicians wouldn't recommend a career in medicine. Here's why

More physicians are regretting choosing to pursue medicine, according to a 2023 survey from the Physicians Foundation, and 21 physicians joined Becker's to discuss why this is and what's needed to change it. 

From increased control over day-to-day operations to reimbursement bumps, here's what physicians think needs to change about healthcare to encourage the younger generation to pursue a career in medicine. 

Question: Only 40% of physicians would recommend a career in medicine. What reforms are needed to abate this?

Editor's note: These responses were edited lightly for clarity and length. 

Mohammad Agha, MD. Assistant Professor of Clinical Physical Medicine & Rehabilitation for University of Missouri Healthcare (St. Louis): Health systems should provide opportunities for physicians to bring their expertise to nontraditional areas (for them) like operations, lobbying, strategy and contracting. Initial exposure to these areas will create engagement by bringing physician perspectives to the table. The indirect impact is these physician leaders will bring this information back to their colleagues who can provide additional input, which will amplify physician engagement throughout an organization.

Taizoon Baxamusa, MD. Orthopedic Hand and Upper Extremity Surgeon at Illinois Bone & Joint Institute  (Morton Grove): The security of medicine as a career was shown to be upended during the COVID-19 pandemic, as well as the ability for other fields to maintain hybrid or remote work, which was not as feasible in many medical subspecialties. Burnout has been on the rise especially in healthcare, with the loss of autonomy, with physicians fighting administrative hassles such as prior authorization as well as handling hurdles such as malpractice costs and student debt which can erode into compensation. I think offering financial support for medical education and simplifying administrative hurdles will bring back enjoyment which will in turn improve the work-life balance.

Robert Bray Jr., MD. Founder of DISC Sports & Spine Center (Newport Beach, Calif.): There is no one answer to reforms needed. It’s a loss of control and respect that has diminished the field. Legal pressures have eroded confidence and patient relationships and have forced practicing in a defensive manner. Major reform of personal injury and malpractice is an ongoing battle that has been fought against by a much more powerful lobby. In a similar fashion, hospitals and systems believed that doctors were better off as employees, but this has rarely led to increased satisfaction, especially amongst the specialty providers. The doctors need, as a whole, to regain some control. I have never been more fulfilled with my ability to practice the way I wanted, old fashioned. I spend time with patients and try to emphasize quality since I started my vertical ASC structure from the first clinic through delivery of the episode of care. It has improved our relationship with the payers and delivered a more cost-efficient, quality-driven product. In short, the physicians need to regain and be given control.

Kenneth Candido, MD, CEO and president of Chicago Anesthesia Associates: This is based upon the recent trend of a total lack of autonomy as physicians become employed at an exponential rate. In the past, physicians had the ability to select their optimal work environment and the parameters upon which they saw patients. In the employment model, their schedules are determined by forces outside of their control and their referrals are made at the behest of an institution without regard to their preferences. Income is also not contingent upon effort but is predetermined by the corporation. Sanctions are made against independent thinking, including referring their patients to trusted outside consultants, which are punitive and demeaning. The corporation has its ultimate goal of maintaining control over all professional functions; the physician has lost decision making abilities. The corporation feeds itself from monopolizing the local markets. Even where superior outside consultants would better serve patients, the corporation prohibits it. The corporation does not care about patients besides what type of health insurance they may have. There is no attempt to maximize the best options for patients, rather the goal is to maintain exclusive control of the patient's entire health universe. The so-called "population health" model does not serve patients, it serves institutions and corporations. Physicians sit by and watch all this unfold and are helpless and impotent to address the fundamental flaws in this system, since in the end they have become fearful and have been forced into a dependent role. This dependent role is not what medicine was intended to be, and is not the medicine of our forefathers in any capacity.

Brian Gantwerker, MD. Neurosurgeon at the Craniospinal Center of Los Angeles: I think payer reform and the unwinding of capriciously manufactured benchmarks, both of which were a major blindspot of the Affordable Care Act. While well-intentioned, it has led to a windfall for insurers, leading to more bad behavior to protect those ducats at all costs — and to MACRA/MIPS which instituted performance benchmarks that have not been shown by any entity to have benefitted our patients. You have to unwind the graft and bad behavior and bring the insurers to heel. There is a very real possibility that the politicians may want to use this to push single payer, which will undoubtedly be run by one of these bad actors. Until then, nothing will improve. Furthermore, clinical decision making should always be done by a physician, and kept between patients and their physicians.  

Scott Glaser, MD. CEO and President of Pain Specialists of Greater Chicago: I am one of the 40% who do not recommend a career in medicine and have actively encouraged my children to go into other fields. The only hope for medicine is insurance reform. The current medical insurance companies truly operate like a monopoly or cartel. It is not a level playing field as the sole purpose of their existence is to maximize profit and they do that by reducing access to care. It has created an untenable position for physicians by creating so many obstacles to delay or deny care.

Steven Goldberg, MD. Orthopedic Surgeon at Physicians Regional Healthcare System (Naples, Fla.): That statistic is unfortunate. Medicine is, and for the foreseeable future, a profession that is both personally and financially rewarding. That is why medical school spots are as competitive as ever. Although the influence of the "business of medicine" is pervasive, doctors still have value and are needed almost everywhere. I'd like to see reforms on the ownership of practices by large hospital organizations, financial institutions, insurance companies and pharmacies, where the doctor-patient relationship is almost always influenced, at least in some way or another, by that association.

Nariman Heshmati, MD. Executive Medical Director of Optum Washington (Mukilteo): It really has to be a wake-up call for us that so many physicians would not recommend a career in medicine. Physicians enter healthcare because they want to make a positive impact on others. When barriers arise to them providing care, then we start to see burnout, early retirement and frustration. We need to re-examine clinical care delivery from every angle. Regardless of what company sign is on the door, what payer is contracted, or what EMR is present, we must design a system where physicians can practice high-value medicine without barriers and patients can easily access that care. When we accomplish this, physicians will once again embrace their chosen profession and recommend it to others.

Sam Joseph, MD. Orthopedic Surgeon at Joseph Spine Institute (Tampa, Fla.): Multiple reforms are needed, including reduction in educational costs that leave most doctors with over $250,000 of debt. With the margins continuing to get smaller, the ability to pay off this debt becomes more taxing on their overall lifestyle. As physicians, we are the only group that have seen a 30% cut in reimbursement over the years with no adjustment for inflation. With reduced reimbursement and higher overhead, it results in losing propositions. Currently practicing doctors feel that conditions get worse every year.

Roneet Lev, MD. Emergency physician at Scripps Mercy Hospital (San Diego):  Pride in medicine. I am very proud to be a physician of 35 years raising two daughters who also chose to become physicians. There is nothing else I would rather do. There is no other profession where every day you make an important difference in someone’s life. If we focus on what inspired us to become doctors, it helps manage the many business and bureaucratic frustrations of healthcare. As executive director of the Independent Emergency Physicians Consortium, we discuss unfair regulations and difficulties in reimbursement on a regular basis. If you are in it just for the money, you should choose a different profession. The problems are not in being a doctor, they are external.

Corey Hunter, MD. Executive Director of Ainsworth Institute of Pain Management (New York City): I would not recommend anyone going into primary care or psychiatry, not because the fields are not interesting or valuable, but because doctors practicing those specialities are not valued by payers and are not appropriately compensated for their time. As far as the rest of medicine....would I recommend it to someone else?  The way it's heading, only certain specialties will be able to survive what's happening with hospitals, private equity and insurance companies buying everyone up. Unless the government steps in and starts pushing back against payers, our healthcare system will fail. The Medicare Administrative Contractors are supposed to manage Medicare on a regional level, but they aren't even obligated to follow Medicare guidelines when it comes to coverage. If that kind of change happens, then I would encourage medicine as a field… If it doesn't I won't be telling my kids to follow in my footsteps. 

Bert Mandelbaum, MD. Sports Medicine Surgeon in Santa Monica, Calif.: As one of the 40%, who would recommend their children to go into medicine — I have two daughters in medicine, a wife who is a family physician, and a son-in-law as an orthopedic surgeon. There are five of us contrary to my colleagues. I still think that medicine offers all of us an opportunity to care for people, have a great lifestyle and be paid fairly well. It clearly is not for everybody and only those who really want to commit to taking care of people and patients should make this career choice.

Thomas Miller, MD. Professor, Department of Orthopaedic Surgery at Virginia Tech Carilion School of Medicine (Roanoke):

  • Reduction in nonclinical demands to allow improved "face to face" interaction with patients. Too much time is spent on mandated documentation. While accurate and thorough documentation is appropriate, it is poor use of the physician skills and training.
  • Return of autonomy in decision making.
  • Early education on how to become part of the institutional decision-making process. Learn to work from within - not against.
  • Realistic discussions early in (or before) medical education about expectations regarding career demands and work-life balance. There is a cost to everything; quit pretending there isn't  

John Prunskis, MD. CEO and Medical Director of the Illinois Pain & Spine Institute (Elgin): Changes need to be made to the Affordable Care Act to reign in the high reimbursements to hospitals, compared to the reimbursements of physicians in private practice . This irrational difference in reimbursement between hospitals and ASCs and private practices is needed to increase physician satisfaction. Also, eliminating the mandate for hospitals to use the electronic health record would go a long way and improve physician satisfaction. Boosting physicians pay that has been cut every year for a long time is necessary, and addressing tort reform claims is necessary

Deepak Reddy, MD. Spine Surgeon at South Bend (La.) Orthopedics: This could turn into a long multifocal essay on this topic. I’m going to make it simple. Pay physicians more. Medicare has been steadily cutting physician reimbursement under the guise of “budget neutrality” for years. The American Medical Association suggests that since 2001, accounting for inflation and increasing practice costs, physicians are getting paid 26% less by Medicare for the same work. This has forced many physicians to make up the income gap by doing more. More calls, more documentation, more phone calls, more procedures, more hours. This has led to significant physical burnout and dissatisfaction. Coming to our senses and realizing that Medicare cannot continue to expect a total knee replacement to cost less to do in 2019 than in 2000 (37.1% reduction) is essential to the future of healthcare. Unless we design policy changes that address the critically misguided reimbursement strategy, the historical norm will further dissuade us from sending our brightest pupils to walk our path. 

Kristopher Schroeder, MD. Anesthesiologist and Professor at University of Wisconsin School of Medicine and Public Health (Madison): The results of this survey are substantially notable and worthy of thoughtful consideration. My worry is that much of the impetus for this reluctance to recommend a career in medicine may only worsen as clinical volume demands increase and barriers to the unfettered care of patients continues to amplify.  Realizing career fulfillment and an enhanced ability to recruit and retain physicians requires a thoughtful restructuring that focuses on a variety of key elements. First, physicians need to reclaim their collective purpose and be allowed to focus on the care and clinical improvement of patients while untethering their practice from the whims of administration and insurance company executives. The wellness of these physicians needs to become a priority and they need to be valued as more than spreadsheet satisfying cogs or widgets. Instead, physicians need to be afforded the opportunity to practice with some degree of autonomy over practice composition and location. The wellness of our next generation of healers requires immediate action or we collectively risk losing the ability to maintain our current level of healthcare delivery or drive the discovery and implementation of novel therapeutics.  

Tom Schuler, MD. Spine Surgeon and Founder of Virginia Spine Institute (Reston): A career in spine surgery is amazing. The ability to restore and improve our patients's lives is transformative in 2024. The biggest challenge in recruiting new doctors to the field is the immense time and financial commitment to achieve the right to be able to help so many. The biggest challenge once a physician has arrived is the insurance bureaucracy that controls patients' access to receiving these life changing treatments. The areas that need to be reformed involve these factors, especially financial investment, and inappropriate burden of access to care.

Vladimir Sinkov, MD. Founder and CEO of Sinkov Spine Center (Las Vegas): The main reason the physicians are increasingly dissatisfied with their career in medicine is the feeling of lack of control over their work and ability to take care of their patients. Due to declining reimbursements and increasing regulatory and non-clinical burdens, more and more physicians decide to become employees of large organizations (hospitals, insurance company affiliates like Optum or Kaiser or mega-groups controlled by venture capital firms). Once they become employees, a significant amount of clinical and career autonomy is lost. The initial increases in salary eventually become diluted by ever-increasing "production" requirements, and physicians then feel trapped in a job they do not like but can no longer leave (don't forget the non-compete clause).  

Physicians continue practicing medicine with the constant concern for being named in a frivolous medical malpractice lawsuit. Such lawsuits take a significant toll on physicians in terms of their finances, time away from clinical practice and life, and stress. Physicians also feel that their concerns are not being heard by elected officials — every law that is attempted to improve their situation is being diluted and changed by the hospital and insurance companies lobbyists.  Physicians feel that there is an increased lack of appreciation by their patients and the public in general for the sacrifices that they made and continue to make to become a physician and continue staying in practice.   

The reforms that could potentially abate this should include medical malpractice reforms, increase of reimbursements for medical services back to reasonable levels dictated by current market forces, and reforms that would decrease regulatory burdens so that physicians can regain their independence in clinical practice.

Zeeshan Tayeb, MD, Owner of Pain Specialists of Cincinnati (Ohio): In order to enjoy what you are doing as a physician; you must avoid burnout. This is the most crucial item when considering why physicians do not recommend others to join the field. Building a talented and efficient staff is the key factor to avoid burnout. Surrounding yourself with those who have a shared interest in your success, will help alleviate your personal burden in day-to-day operations. This will also allow you time to diversify into other ventures outside of medicine, should you have hobbies or interests.

Christopher Yeung, MD. Spine Surgeon at Desert Institute for Spine Care (Phoenix): Medicare needs to fix the budget neutrality provision. Medicare payments are not keeping up with inflation and have in fact declined the last two years. Commercial payers typically follow Medicare‘s lead. These declining reimbursement rates in the face of increased operational cost and inflationary pressures are not sustainable. This financial stress is eroding the enjoyment of being a physician. It’s already stressful caring for your patient’s health and wellness. These additional financial worries make being a physician a less enjoyable profession. It is also driving the majority of new physicians to seek hospital employment, which diminishes physician autonomy and enjoyment.

Christian Zimmerman, MD. Spinal Neurosurgeon at Saint Alphonsus Health System (Boise, Idaho): For this practitioner, the answer is multiplex and collective in extremes to collate and answer. Blaming the COVID-19 pandemic with its mismanagement or population expansion is obviously effortless, yet the truisms lie in what practicing physicians have experienced over the past many decades. Increased work demands of the underinsured, inflexible care models of population health emphasis with marginal results, and payer aversion and denials for rendered care. Couple that with dubious EMR changeovers and system inefficiencies, and the antagonistic recipe for opposition is complete. The noble legacy of being a medical practitioner is weighted with undue and unnecessary regulations that burden even the most stalwart of constitutions. 

The fix lies in regaining the respect and cherished public sentiment of physicians and adjuncts for those who administer care. Return the highest of standards for health education and a merit-based system whereby the wanton best performers enter this field and maintain that level of excellence. This will only become an issue again when politics and need meld alike attitude about healthcare and its delivery needs. The current outlook is quite dim, and may slip even further as care withholds and insurance scrutiny continue to plague the system.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Featured Podcast