The top issues residents will face in 2015

Robert M. Wah, MD
Past President
American Medical Association
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It’s been many years since I was a medical resident, but as an educator, I have the opportunity to see residents from the other side. In the new year, three issues will rise to the top of residents’ minds.

Medical school debt

The most recent data from the Association of American Medical Colleges shows that medical school graduates this year face an average education debt of more than $176,000, and 40 percent are planning to enter a loan forgiveness or repayment program. Most residents spend at least a decade of their post-residency years—if not more—repaying their educational debt.

This debt load is oppressive. The AMA continues to press legislatively to lower this burden. In addition, AMA Wire® offers informative articles with practical pointers for managing debt. I also advise my residents to keep their debt in perspective. There aren’t many people who go into any profession without any debt. We aren’t the only ones with these burdens.

Future practice environment

There was a time when a resident’s decision about where to practice was all about geography—but that’s changed dramatically. Today, there are so many ways that health care is delivered, and doors are open that didn’t even exist before. I always recommend seeing change as opportunity.

Residents can use resources from the AMA to explore the broader world of health care. I encourage my residents to take advantage of any opportunities to learn about different health delivery systems. Decisions about future practice also can consider underserved areas and the existing health care workforce in specific areas. Our new Health Workforce Mapper makes doing so simple.

Physician wellness

Finally, an important issue for residents—and really, for all physicians—heading into the new year is that of physician wellness. This topic is especially close to me, as I serve as chair of the World Medical Association (WMA) committee that is focusing on the well-being of doctors. In fact, a group of “junior doctors” (the WMA’s equivalent to residents) were the catalysts for creating this physician wellness committee at the WMA.

Those junior doctors cited many good examples of how important wellness is to residents. This is a time in which you’ll be working and learning more than ever, honing your clinical skills. When you finish, you’ll be focused on how to give the best possible care to your patients. Be sure to make it a priority to take the best possible care of yourself, too. It’s a good habit to start in residency.

Residents: Are these issues you’ll be watching in 2015? What topics are most important to you? Tell me on Twitter, at the AMA’s Facebook page or in a comment below.

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Comments

Thank you for this insightful essay. In response to your final point about wellness:<br/> For internal medicine physicians in primary care, the changes in practice have contributed to a crisis in physician health, and subsequent delivery of health care. Factors that multiply the increase in work hours and stress on the internal medicine doctor in office practice the urban northeast include: <br/> 1)Medical practice ownership is now by corporate or corporate-behaving-not-for- profit groups, where earnings and institutional continuity trump all other goals; corporate culture breeds loss of control over ethics, office flow, time with patients, staffing, productivity, etc. <br/> 2) Business administrators are the supervisors of primary care physicians; medical care is a commodity; emphasis on billing strategy and customer satisfaction trumps care of the sick <br/> 3) Primary care physicians are forbidden to care for their hospitalized patients – a system where sick patients are abandoned at the door of the hospital and treated by hospitalists, who are "too busy" to talk to primary care physicians. This facilitates timely ordering of tests and shaves hours of a hospital discharge times, yet it interrupts continuity of patient care <br/> 4) Government mandated electronic medical records ( EMR) are ill conceived, hide critical patient information, are expensive to run, have intrinsic inefficiencies that add hours onto the physician's day. <br/> 5) Increased EMR documentation standards for billing, and emphasis on pay for performance documentation, move focus off the reason for the patients' visits and add to time a physician must invest in documentation. <br/> 6) Physicians are now required to both diagnose and treat the sick, and navigate complex health insurance system for confused patients – who experience increased out of pocket costs, deductibles, increased copays, prior authorizations, etc. <br/> 7) Sheer extreme work hour demands on physicians in primary care practice exceed all ACGME work hour restrictions for residents; these work hour demands trap internists and other primary care physicians in twelve to fourteen hour days, and six to seven days per week of work.<br/> 8) Physicians are at liability risk from increased expectations of patients who resent increased insurance costs yet see their doctor both the face of medicine and the gate keeper. With increased patient expectations comes increase in "failure to diagnose" malpractice lawsuits. <br/> Physicians who are overburdened and exhausted experience mental and physical consequences of unrelenting intense work; this is not a risk to affect health care, it is reality now. As a teacher of medical students, I know the idealistic faces of caring optimistic future doctors - none of whom will choose to practice in the conflict zone of a corporate primary care outpatient office. Sadly, a proud tradition of physician practice in primary care internal medicine is on a collision course with extinction; physicians drop out from illness or retire as soon as possible. There is no army of physicians choosing to take our places.
Dr. Wah, its great to hear your perspective on the top issues facing trainees and even better to see them directly aligning with the top issues as labeled by the largest resident representative body, the AMA-resident and fellow section. To this end, and to respond also to mashumd's comments, we are addressing concerns over future practice environment and physician wellness as part of our strategic aims this year. <br/> <br/> Building off of the AMA-RAND 2013 study on physician wellness which did not sample doctors in training, we have developed and will launch a survey in June 2015 to address what drives physician satisfaction for doctors in training. Subjects include questions about practice environment, and as the AMA-RAND study excluded hospital based physicians, this will be a pivotal study in also looking at the emerging cohort of doctors who will likely pursue hospital based careers.<br/> <br/> Second, we believe that physician wellness is timely and concerning and are theming the next RFS meeting, June 5-7 in Chicago on wellness in training. Coinciding with a summary report of the literature on this subject by our section, we will be holding sessions with key speakers to start the debate on how to address this complicated issue, and will be bringing forward issues and potential solutions with the aim to increase physician wellness in training with sustainable effects. We are collaborating closely with our world counterpart in the World Medical Association's, the Junior Doctors Network on this subject.<br/> <br/> Readers, please also check out our FB page and leave us your issues and suggestions so that we may better address physician wellness [<a href="https://www.facebook.com/amaresidentsandfellows]." rel='nofollow'>https://www.facebook.com/amaresidentsandfellows].</a><br/> <br/> Thank you,<br/> <br/> Tina Shah<br/> National Chair of the AMA-RFS
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