原文: No Way Out (Updated)

According to a recent survey nearly half of all primary care physicians don’t like their jobs:

(CNN) — Nearly half the respondents in a survey of U.S. primary care physicians said that they would seriously consider getting out of the medical business within the next three years if they had an alternative.

There is no alternative. No other job offers the combination of income and job security that the practice of medicine does. Additionally, no other job offers the prospect of “doing good while doing well”.

The survey, released this week by the Physicians’ Foundation, which promotes better doctor-patient relationships, sought to find the reasons for an identified exodus among family doctors and internists, widely known as the backbone of the health industry.

A U.S. shortage of 35,000 to 40,000 primary care physicians by 2025 was predicted at last week’s American Medical Association annual meeting.

In the survey, the foundation sent questionnaires to more than 270,000 primary care doctors and more than 50,000 specialists nationwide.

Of the 12,000 respondents, 49 percent said they’d consider leaving medicine. Many said they are overwhelmed with their practices, not because they have too many patients, but because there’s too much red tape generated from insurance companies and government agencies.

If physicians are kidding themselves into believing that a single payer system would result in less paperwork, they’re not as smart as I (or they) think they are.

There are lots of reasons for the shortage of primary care physicians: specialties pay more and have greater prestiage. But make no mistake: this is a problem of the medical profession’s own making. If medical schools and hospitals and were as selective and restrictive in the number specialties other than primary care they admitted and educated, there would be no shortage.

The exchange of autonomy for income was a devil’s bargain the practice of medicine made decades ago. It’s far too late now for buyer’s remorse.

Update

By the way have I mentioned lately that universal coverage will only aggravate the shortage of primary care physicians? Adding 20% more patients will not reduce their problems. My solution both to the problem of not enough primary care physicians and the high cost of health care, which, as I’ve pointed out before, is the cause of the rising number of uninsured rather than its effect, is a dramatic increase in the supply of healthcare.

译文: 没有出路

根据一项最新的调查显示， 有将近一半的内科医生不喜欢他们的工作：

(CNN) — 大约有一半参与调查的内科医生说如果他们有选择的余地，那么在未来三年内他们会很认真地考虑离开医疗事业。

别无选择。没有哪个工作能把收益和职业安全感相结合，只有行医例外。另外，没有其他的工作能带来“在盈利时行善”这样的前途。

这次调查由医学基金会在本周发布，这次活动将促进医患关系变得更好，该调查试图为人尽皆知的健康产业主力军－家庭医生和内科医生的离去找到原因。

经上周举行的美国医学协会年度大会预测，到2025年美国将会缺少3万5千至4万名内科医生。

在这次调查中，该基金会在全国范围内给超过27万名的内科医生和5万名专家发放了问卷。

在1万2千名受调查者中，49%的人说他们曾经考虑过离开医学业。很多人说他们受不了他们的业务，不是因为他们有很多的患者，而是因为来自保险公司和政府机构的繁杂拖沓的官样文章。 

如果医生通过自欺欺人来相信单一保险人制度会导致文书工作减少，那他们就不如我（或他们自己）想象的那么聪明了。

有许多的原因导致内科医师减少：专业会有更高的收入和更好名声。但是别搞错: 这是医疗职业自己造成的一个难题。如果可选择和限定的医学院和医院数量不是像他们接受和学习的初级护理一样，而是和专业一样多，那么医生就不会短缺了。

数十年前行医对收入的自主交换是魔鬼交易。现在买方后悔太迟了。

更新

最后顺便说一句，健康保险全民覆盖只会使内科医生的短缺情况更加恶化吗？增加20%的患者并不能减少他们的难题。我的答案能对主治医师缺乏和高额健康保健都能解决，那就是，我在前面指出的，是未保过险的人数增长的原因而不是未保险的影响增长的原因，这是提供健康保健的一个戏剧性的增长。