"But you'll ALWAYS have a job"

[DrDude]

You hear that all the time. That apparently once you "make it" then you'll have ultimate job security. It's often touted as one of the greatest perks of being a doctor compared to other careers, where even though those other careers make as much or more money than a doctor, they don't have job security.

But I know of many cases of doctors who don't have that fabled job security. From a resident who got dismissed from her residency program and no other program would take her, to an attending who got his license suspended for something that wasn't even really his fault (but ultimate responsibility as we know comes back to the physician no matter who else screws up) and he was out of a job for almost a year until his license got reinstated. These are just a couple cases of many, some where the physician never went back to practicing medicine again.

So do you think this notion of awesome job security is something said by those who don't really know what they're talking about when it comes to the reality of how medicine works? Maybe back in the day when doctors had more clout their job security was second to none. But these days where they're under the microscope it seems that job security is no longer a given.

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[Drogba]

You hear that all the time. That apparently once you "make it" then you'll have ultimate job security. It's often touted as one of the greatest perks of being a doctor compared to other careers, where even though those other careers make as much or more money than a doctor, they don't have job security.

But I know of many cases of doctors who don't have that fabled job security. From a resident who got dismissed from her residency program and no other program would take her, to an attending who got his license suspended for something that wasn't even really his fault (but ultimate responsibility as we know comes back to the physician no matter who else screws up) and he was out of a job for almost a year until his license got reinstated. These are just a couple cases of many, some where the physician never went back to practicing medicine again.

So do you think this notion of awesome job security is something said by those who don't really know what they're talking about when it comes to the reality of how medicine works? Maybe back in the day when doctors had more clout their job security was second to none. But these days where they're under the microscope it seems that job security is no longer a given.

I think there is a pretty significant difference in being censured for a mistake and subsequently becoming unemployable as opposed to risking losing your job and subsequently not being able to find a new one because of economic conditions.

 

[Tired]

I think there is a pretty significant difference in being censured for a mistake and subsequently becoming unemployable as opposed to risking losing your job and subsequently not being able to find a new one because of economic conditions.

Ditto.

Losing your license is a huge deal, and rarely happens for a single incident that "wasn't really [your] fault".

 

[colbgw02]

In other news, we're going to start throwing out all trends and objective data and start basing decisions on anecdotal evidence.

 

[gwen]

doctors lose their jobs for being stupid (be it being stupid/lazy in residency or making stupid mistakes as an attending). my father, a very intelligent physics PhD working for Lucent, was laid off - just because. there is a HUGE difference.

 

[NotAProgDirector]

In other news, we're going to start throwing out all trends and objective data and start basing decisions on anecdotal evidence.

Can I use this for my sig?

 

[Tired]

In other news, we're going to start throwing out all trends and objective data and start basing decisions on anecdotal evidence.

Are you in obstetrics?

 

[McGillGrad]

In the world of medicine, physicians protect each other like union members. If you lose your license and are blackballed, then you made some serious mistakes.

 

[Drogba]

In other news, we're going to start throwing out all trends and objective data and start basing decisions on anecdotal evidence.

The anecdote isn't even relevant

 

[Blade28]

The anecdote isn't even relevant

I think it's a way of alleviating the OP's fears - that the reality is not as bad as those few scenarios.

 

[3dtp]

In the world of medicine, physicians protect each other like union members. If you lose your license and are blackballed, then you made some serious mistakes.

Not necessarily so. There have been numerous cases reported where sham/bad faith peer review by hospitals and medical executives have taken credentialling action based on economic or political considerations.

Doctors/residents do lose their jobs for being stupid/lazy. They also lose them for pointing out hospital regulatory and rules violations in appropriate forums. The former may be warranted. The latter certainly not. There are precious few, if any, protections for economic or politically motivated adverse credentials/contract actions.

This is the reality of todays modern medical world. You do not have to lose your license. You do not have to make serious medical mistakes. You do not need to be sued multiple times. In the matter of Polliner, (TX), Dr. Polliner was awarded a $300M verdict when he lost his job as a result of sham/bad faith peer review when a competing group took over. Poliner is the rare exception in that he actually got to a jury.

This is a real and increasing problem. It has become a large enough problem that Time Magazine did a news article on it the summer before last. There is currently great turmoil in Texas with the Texas Medical Board over just such issues.

DrDude is right. Once a credentialling action, be it for real reasons (ie a truely bad doctor) or political (you pissed off the wrong person or perhaps you questioned the patient care decsions of one of the inner circle), or economic (a new group comes in and promises greater economic rewards for the hospital, if they only find a way to dump you), then you are sandbagged.

And there is a database that tracks all this stuff. Your legal protections are sparse to non-existent. An executive that his terminated because she refused the sexual advances of her boss or blew the whistle on SEC violations in business and is fired has infinitely greater legal protections than the physician that does likewise or blows the whistle on Medicare fraud. The hospital can find a case or two with a bad outcome, "peer" review it, and terminate your credentials. There is no requirement for fairness, due process or the ability to confront witnesses or in many cases even know the reasons.

We spend an enormous amount of time beating ourselves up for accepting pens from drug companies. We should be looking at how to protect ourselves and our practices from these issues.

The job security issue is real and the difference is if you are fired from a hospital, the whole medical community (and the licensing boards) know about it. Justified or not.

 

[mlw03]

healthcare is a profession that every society needs at all times. there are a few others: police, teacher, waste disposal, agriculture. i'm probably missing a few. the point is society needs people to care for the sick, and we have a good system in this country to try and tie supply and demand together (ie, not everyone who wants to gets to become a dermatologist). no individual has perfect job security, but as a whole we have it far better than 99% of the population.

You hear that all the time. That apparently once you "make it" then you'll have ultimate job security. It's often touted as one of the greatest perks of being a doctor compared to other careers, where even though those other careers make as much or more money than a doctor, they don't have job security.

But I know of many cases of doctors who don't have that fabled job security. From a resident who got dismissed from her residency program and no other program would take her, to an attending who got his license suspended for something that wasn't even really his fault (but ultimate responsibility as we know comes back to the physician no matter who else screws up) and he was out of a job for almost a year until his license got reinstated. These are just a couple cases of many, some where the physician never went back to practicing medicine again.

So do you think this notion of awesome job security is something said by those who don't really know what they're talking about when it comes to the reality of how medicine works? Maybe back in the day when doctors had more clout their job security was second to none. But these days where they're under the microscope it seems that job security is no longer a given.

 

[McGillGrad]

Not necessarily so. There have been numerous cases reported where sham/bad faith peer review by hospitals and medical executives have taken credentialling action based on economic or political considerations.

You did not grasp my point. Big mistakes includes pissing off the wrong people and not legally protecting yourself against unsubstantiated allegations.

 

[3dtp]

You did not grasp my point. Big mistakes includes pissing off the wrong people and not legally protecting yourself against unsubstantiated allegations.

I did grasp your point and that is what terrifies me.

When the "wrong people" are in charge, are breaking the rules or committing fraud and one calls them on it, then by definition you are going to piss them off. The philosophy you appear to at least tacitly advocate is to to say nothing, allow abuses to continue unchecked or "go along to get along." When you remove the checks on a system with a high abuse potential (insurance fraud, labor abuse, etc), and you effectively do this by having unchecked power to destroy those who would cry foul, you allow human nature to take the helm.

This is how we got into this mess in the first place.

With the way the laws are written today, you cannot, repeat cannot "legally protect yourself against unsubtantiated allegations." Those in power make all the decisions, there is no due process. The "peer review process" frequently, consists of a closed door discussion among those with power, centering around how to continue business as usual and get rid of the whistleblower, followed by a decision of those same people to execute the decision. Ergo, a specious chart review, a "hearing" and a foregone conclusion.

Carried to its logical conclusion, your assertion is precisely what enables abuse in the first place. This is bad enough in residency, but it carries forward into the attending/hospital relationships as well, which goes to the OPs original assertion: there is precious little job security in this field and the consequences are far more severe than in other industries.

 

[McGillGrad]

It sounds as if you live your life as a perpetual victim who deals with issues reactively instead of proactively.

Living life with that character flaw attracts conflict and usually ends with...surprise... you as a victim.

Take responsibility for your actions, be proactive, know your rights and understand human behavior and you will succeed.

Don't be a victim.


The best example is the current mortgage crisis. People who think like you did not read the contract and did not understand the consequences of certain types of mortgages and then complain and act as if you were victimized when the interest balloons. If you had been proactive, you would have read the contract and known what would happen in the future and made a decision based on the facts.

I did grasp your point and that is what terrifies me.

When the "wrong people" are in charge, are breaking the rules or committing fraud and one calls them on it, then by definition you are going to piss them off. The philosophy you appear to at least tacitly advocate is to to say nothing, allow abuses to continue unchecked or "go along to get along." When you remove the checks on a system with a high abuse potential (insurance fraud, labor abuse, etc), and you effectively do this by having unchecked power to destroy those who would cry foul, you allow human nature to take the helm.

This is how we got into this mess in the first place.

With the way the laws are written today, you cannot, repeat cannot "legally protect yourself against unsubtantiated allegations." Those in power make all the decisions, there is no due process. The "peer review process" frequently, consists of a closed door discussion among those with power, centering around how to continue business as usual and get rid of the whistleblower, followed by a decision of those same people to execute the decision. Ergo, a specious chart review, a "hearing" and a foregone conclusion.

Carried to its logical conclusion, your assertion is precisely what enables abuse in the first place. This is bad enough in residency, but it carries forward into the attending/hospital relationships as well, which goes to the OPs original assertion: there is precious little job security in this field and the consequences are far more severe than in other industries.

 

[3dtp]

It sounds as if you live your life as a perpetual victim who deals with issues reactively instead of proactively.

Rather presumptious aren't we? It is knowing (and of course exercising) those rights that can cause you harm in this field since there is no way to protect them from those who would abuse. Just what data did you use to draw this conclusion?

Take responsibility for your actions, be proactive, know your rights and understand human behavior and you will succeed.

As indeed, I have done and am extremely successful. But this statement is not always true. Throughout 20th century America and Europe, those with power have wielded that power to abuse and prevent others from succeeding. The clearest example of this in the US is the Nixon/McCarthy blacklists of the 50s and the Redlists of the 70s. Robert Oppenheimer, the inventor of the atomic bomb was stripped of his leadership role at Los Alamos in the 60s when he was accused of being a communist sympathizer.

The issue is intrinsic to human behavior and is a direct consequence of it. Succinctly, power corrupts. This is why we have, at least on paper, checks on power and unchecked power is dangerous to those who don't have it. If the checks on power are meaningless or unenforceable, then that is unchecked power. Such is the case in medicine today.

The one redeeming virtue of our system is that I believe that the vast majority are ethical, honest and of good character. But there are enough that are not that cause harm. This is the problem.

The best example is the current mortgage crisis. People who think like you did not read the contract and did not understand the consequences of certain types of mortgages and then complain and act as if you were victimized when the interest balloons. If you had been proactive, you would have read the contract and known what would happen in the future and made a decision based on the facts.

I agree completely with this statement, however it is a non-sequitor. I think your analysis is flawed because the contract and its terms did exist prior to signing, that said, in essence, we're going to screw you if we get the chance, if you agree, sign here. Medicine gives no such a priori disclosure. Those in medicine with ethics and integrity are disgusted by those who abuse.

We gave up feudalism in our society centuries ago, yet, feudalism appears to persist in modern day medical hierarchy in this country, in some cases. Understanding innate human behavior will help you survive, fly under the radar and permit the situation to continue to deteriorate.

Then, if you are lucky, clever or join fully join the system, you will be "successful," but at what price? To yourself? To society?

 

[McGillGrad]

Rather presumptious aren't we?

You must be looking in the mirror while writing this.

 

[Faebinder]

I'll just repeat what the Fatman said in the House of God:

"Rule #8: They can always hurt you more."

Being part of a bigger group is protective.

 

[NotAProgDirector]

I think it's a matter of likelihood.

The chance of being a victim of a sham QA process is very, very rare. You can get "screwed" in any field, although I agree that the legal structure of QA makes it uniquely complex. The chance of losing your job as an MD due to a market downturn is very low, where it is much higher in many other fields.

Still seems like a relatively "safe" career.

 

[swpm]

So do you think this notion of awesome job security is something said by those who don't really know what they're talking about when it comes to the reality of how medicine works?

No. It's extraordinarily uncommon for a competent physician to become unemployable, except by choice or chronic injury/illness.

$300M verdicts, newsworthy fraud, and other illegal shenanigans aside ... physicians really do have awesome job security. But so do Walmart greeters and the fry guys at McDonalds.

 

[McGillGrad]

No. It's extraordinarily uncommon for a competent physician to become unemployable, except by choice or chronic injury/illness.

$300M verdicts, newsworthy fraud, and other illegal shenanigans aside ... physicians really do have awesome job security. But so do Walmart greeters and the fry guys at McDonalds.

How true, but for totally different reasons

 

[3dtp]

There have been a number of comments related to the crux of the OPs original contentions: There is little job security in medicine.

While I think there is a reasonable probability that most will not run into an issue, I have heard anecdotes, both in academic medicine and in private practice to the contrary and have personal knowledge of at least 4 such cases. There have been many others reported in the literature.

There is evidence to suggest that this is not isolated, nor even rare, nor extra-ordinarily uncommon.

Consider:
:Levi, B.H, Ethical Conflicts Between Residents and Attending Physicians, Clin. Pediatrics: 41(9) pp 659-667 (2002)

Dr. Levi states, "Conflicts between residents and attendings oftenoccur and residents must attempt to navigate these perilous waters." and "...evidence suggests there is little systematic effort to insure such professionalism and that those in positions of power and influence downplay the significance of unprofessional conduct when it occurs within their own ranks as well as the distress of those who must endure it."
and "...important to recognize that punitive reprisals are not at all uncommon in medical training." He cites 10 studies supporting this and states that in one large study, (Dougherty, SR, Baldwin, DC Jr, Rowley, BD, Learning, Satisfaction and mistreatment during medical internship, JAMA, 1998:279:1194-1199) 85% of the residents reported having been belittled or humiliated, almost 40% reported having been assigned tasks as punishment, and most alarming, 30% reported having their reputations or careers threatened.

Landrigan et al (JAMA 2006: 296:1063-1070) did a longitudinal survey of interns in a well blinded study of ACGME work hours compliance. That he found substantial non-compliance is not surprising. That he found that official ACGME hours surveys reported a high percentage of compliance with rules, while this blinded study demonstrated a much higher percentage of non-compliance, is alarming. Why do the results differ so dramatically, if not fear of retaliation?

The ACGME's own data report that a majority of residents fear program retaliation.

Landrigan's study surveyed 4400 or so residents which is a substantial number. Others, such as Dougherty surveyed well over a thousand, along the lines of the National Women's Health initiative and other epidemiologic based studies.

And the issue has become more important today, not just from a perspective of career jeopardy, but because it strikes at the very integrity of the profession.

Perhaps one of you rocket scientists who know how to navigate this board could put up a poll to informally see if it is rare, as has been suggested, or much more common as the literature would appear to indicate.

 

[McGillGrad]

Like I said before. Live & think like a victim and you become one.

Then again, you may have never held a real job outside of medicine.

There have been a number of comments related to the crux of the OPs original contentions: There is little job security in medicine.

While I think there is a reasonable probability that most will not run into an issue, I have heard anecdotes, both in academic medicine and in private practice to the contrary and have personal knowledge of at least 4 such cases. There have been many others reported in the literature.

There is evidence to suggest that this is not isolated, nor even rare, nor extra-ordinarily uncommon.

Consider:
:Levi, B.H, Ethical Conflicts Between Residents and Attending Physicians, Clin. Pediatrics: 41(9) pp 659-667 (2002)

Dr. Levi states, "Conflicts between residents and attendings oftenoccur and residents must attempt to navigate these perilous waters." and "...evidence suggests there is little systematic effort to insure such professionalism and that those in positions of power and influence downplay the significance of unprofessional conduct when it occurs within their own ranks as well as the distress of those who must endure it."
and "...important to recognize that punitive reprisals are not at all uncommon in medical training." He cites 10 studies supporting this and states that in one large study, (Dougherty, SR, Baldwin, DC Jr, Rowley, BD, Learning, Satisfaction and mistreatment during medical internship, JAMA, 1998:279:1194-1199) 85% of the residents reported having been belittled or humiliated, almost 40% reported having been assigned tasks as punishment, and most alarming, 30% reported having their reputations or careers threatened.

Landrigan et al (JAMA 2006: 296:1063-1070) did a longitudinal survey of interns in a well blinded study of ACGME work hours compliance. That he found substantial non-compliance is not surprising. That he found that official ACGME hours surveys reported a high percentage of compliance with rules, while this blinded study demonstrated a much higher percentage of non-compliance, is alarming. Why do the results differ so dramatically, if not fear of retaliation?

The ACGME's own data report that a majority of residents fear program retaliation.

Landrigan's study surveyed 4400 or so residents which is a substantial number. Others, such as Dougherty surveyed well over a thousand, along the lines of the National Women's Health initiative and other epidemiologic based studies.

And the issue has become more important today, not just from a perspective of career jeopardy, but because it strikes at the very integrity of the profession.

Perhaps one of you rocket scientists who know how to navigate this board could put up a poll to informally see if it is rare, as has been suggested, or much more common as the literature would appear to indicate.

 

[drtx]

You did not grasp my point. Big mistakes includes pissing off the wrong people and not legally protecting yourself against unsubstantiated allegations.

In a perfect world where you would be able to carry around your crystal ball in the pocket of your lab coat so that you can avoid all unfortunate situations this could be possible---but do you really believe this view or are you just totally blind to all the political BS that affects departments, competing private practices, etc that is being referred to in 3dtps statements....because it can be a big problem...for anyone (good or bad physicians included)

 

[johankriek]

In the world of medicine, physicians protect each other like union members. If you lose your license and are blackballed, then you made some serious mistakes.

what are you stupid?

physicians notorioulsy stab each other in the back ALL THE TIME. there is no loyalty whatsoever...


GO to maryland board of physicians or NY state office of professional misconduct .. there are pages and pages and pages and pages of docs who lost or got their license suspended..

 

[johankriek]

I'll just repeat what the Fatman said in the House of God:

"Rule #8: They can always hurt you more."

Being part of a bigger group is protective.

you aint kiddin.. this is a very truse statement

they can always hurt you more

 

[McGillGrad]

I sense a lot of personal experience being projected here.

The reason people may be stabbing you in the back "ALL THE TIME" is probably due to your inability to control your temper.

You should work on that.

what are you stupid?

physicians notorioulsy stab each other in the back ALL THE TIME. there is no loyalty whatsoever...


GO to maryland board of physicians or NY state office of professional misconduct .. there are pages and pages and pages and pages of docs who lost or got their license suspended..

 

[Blade28]

Hey guys -

Just a general reminder to please keep things civil in here. Let's try to keep the discussion professional and on-track as it pertains to the original issue.

 

[johankriek]

The reason people may be stabbing you in the back "ALL THE TIME" is probably due to your inability to control your temper.

.

not really. I have learned to avoid the knife stabbings but i see it every single day

 

[McGillGrad]

Quick like the tortoise, you are.

not really. I have learned to avoid the knife stabbings but i see it every single day

 

[PeepshowJohnny]

Are you in obstetrics?

Oh man, I almost spit up laughing. *High5*

 

[TRAMD]

In the world of medicine, physicians protect each other like union members. If you lose your license and are blackballed, then you made some serious mistakes.

 

[NonTradMed]

You hear that all the time. That apparently once you "make it" then you'll have ultimate job security. It's often touted as one of the greatest perks of being a doctor compared to other careers, where even though those other careers make as much or more money than a doctor, they don't have job security.

But I know of many cases of doctors who don't have that fabled job security. From a resident who got dismissed from her residency program and no other program would take her, to an attending who got his license suspended for something that wasn't even really his fault (but ultimate responsibility as we know comes back to the physician no matter who else screws up) and he was out of a job for almost a year until his license got reinstated. These are just a couple cases of many, some where the physician never went back to practicing medicine again.

So do you think this notion of awesome job security is something said by those who don't really know what they're talking about when it comes to the reality of how medicine works? Maybe back in the day when doctors had more clout their job security was second to none. But these days where they're under the microscope it seems that job security is no longer a given.

I think when people talk about 'job security' as it pertains to doctors, they are not thinking of doctors who lose their license or fail to get their license. They are referring to the fact that doctors who are legally allowed to practice will always have a job and that doctors won't get laid off during an economic downturn. There are people who get laid off even though they got good performance evaluations, their bosses tell them they are going places, they work their asses off, they play the game right---but then an economic downturn means layoffs. That is the nature of many corporate jobs. Physicians are in relatively high demand that they will not lose their jobs due to the changing of economics---but they can lose their jobs through other means such as incompetence (either perceived or real). That is a trade off. However, I'd wager that the average MD has more job security (and lower unemployment) than the average American.

 

[Mad Dog]

Why would medicine be any more “secure” than any other profession?

You have a skill set that is unique, societally needed, onerous to come by, and specially regulated and licenced-- but your actual job security is similar to any other job. You might be in academics, not thrive in the local politics and out you go. Or you might fail to advance up the professorial ladder, feel slighted and humilated, and out you go. You might join a group practice, get shafted by the partners, and out you go. You might be based out of a particular hospital, and the hospital decides to bring in a hospitalist group and ______. You might decide to open your own practice, which for a variety of reasons fails, and _______. All which neglects of course your losing your hospital privileges for any number of reasons, getting sued and losing your malpractice, getting accused of something by a patient and … etc etc etc, which all also takes its toll on your so-called “security.”

Truth is, people move location in medicine with great frequency, and oftentimes not by choice. Many department chairs in academic centers for instance last just a few years. And most people change practices more than once. Just like with any other job, and similarly not always by choice.

As for the thought though that your skills as a doctor will always be needed, that too is not truly the case. There were a number of old surgeons who never jumped on the laparoscopic bandwagon, and before they knew it, the standard of care was the lap chole and they retired themselves early. This is the same with many other aspects of medicine, where the inability to keep up pressures people to get out. Or they simply can’t practice with the ease that they used to, given rising malpractice, falling reimbursement, etc, and they just take themselves out of the game. Sometimes the rules themselves change, as with the family doc who’s been working the ER for 15 years when the hospital board decides to move to an “all ABEM” model. So long family doc.

My personal impression is that the feeling of “security” in medicine is long gone. Any patient that complains (and they will!), any physicians whose turf you’re treading on, any physicians you depend on for referrals, any hospital board that wants to limit your privileges-- all these things have major effects on you, and require careful attention and harm-avoidance action! Then if you keep up with the current and honest practice of medicine, keep your numbers in the black, and have found a practice environment where you thrive-- I guess then you will have job security!

 

[maxbaner]

bump