MORE ON HOW MEDICAL BUREAUCRACY is driving practitioners away. Plus this email from reader Madhu Dahiya:

Glenn,

I’ve thought about quitting medicine plenty of times in the past few years. I am a full-time dermatopathologist (a laboratory based physician who looks at skin biopsies, skin excisions, sentinel nodes for skin cancer, and the like, under the microscope). I’ve always practiced in teaching hospitals and the work load has exploded over the past few years. Part of this is our fault – we under train in pathology, especially dermatopathology, for a complex of reasons. I’ve decided, instead of quitting, to try and stick it out basically because teaching hospitals need doctors with some experience – they can’t rely solely on newly minted docs fresh out of training who stay a few years in academia and then leave for private practice where, even if things are equally bad, at least the pay is better.

Hospitals, especially teaching hospitals, are little bureaucracy factories and the layers of government and state regulation certainly don’t help. I don’t know the answer, I mean, I don’t know how you slay that Goliath. I honestly don’t know. I think that’s the most troubling part. Some of us just don’t know what the next step should be. We don’t even know where to most concentrate our energies. I guess, for me, that’s the residents although they’d be hard pressed to know it given how grumpy I’ve become in the past few years under this work load. When I first started out, I spent a lot more time teaching. A lot more.

Sadly, medicine isn’t the only profession that’s been ruined this way. Law isn’t what it used to be, and the problems of engineers are well-known. I think, though, that medicine and related fields have gone downhill faster in recent years.