I am celebrating my 31st year as a practicing family physician! I love diagnosing and caring for patients– through both everyday and devastating health issues. Medicine has changed a lot since I started practicing.

A new study published in The Permanente Journal found that many doctors are leaving medicine 9 years earlier than doctors did in 2008. The study looked at almost 1,000 doctors from many different specialties. The biggest reasons doctors gave for leaving were the ‘hassle factor’ (44.7%) and ‘too stressful’ (44.5%) as the leading reasons cited by physicians. Think of all of that brain power choosing to NOT practice medicine. What is the cost of that to patient care and our overall health?!

Today, we spend hours dealing with insurance companies as insurance companies tell doctors what medicines they will cover or what tests patients can get. Doctors are increasingly asked to complete “prior authorizations” or “pre-authorizations” for patient to receive their medication or procedure. This means filling out forms, making phone calls for a peer-to-peer call (often this “peer” is not a physician), and waiting for approval.

It can feel soul-crushing.

We went to medical school with the goal of helping patients, not arguing with insurance companies. These extra tasks take away time from patient care and add stress to the workday.

Patients often struggle with medication costs. Some medicines, like asthma inhalers or blood thinners, can cost hundreds of dollars depending on insurance coverage. To help share the burden of dealing with insurance companies, I now give patients a list of medication choices that would all be appropriate for their condition and ask them to message me with the one that costs the least for them. This has worked much better for both of us. The patient understands the cost before starting treatment and I prescribe their chosen medication once.

I am a fan of Mark Cuban CostPlus Pharmacy and GoodRx and SingleCare as they can markedly decrease prescription prices. These three do NOT use insurance and instead the cash-pay price is often LESS than using insurance.

Technology is changing medicine too. I have started using AI scribes during some patient visits. These programs help create chart notes while I talk with patients and review their chart real-time for vaccinations, lab results, imaging, and specialists notes. I am unsure if this saves time as every note still needs careful review before it becomes part of the medical record. AI scribe notes does help me feel less drained after a day in the office. It is as though my mental workload is less.

One of the most freeing experiences I had as a physician was working in the medical tent at Burning Man. Documentation there was brief and simple. There was no insurance billing. I could focus on caring for people. It reminded me why I became a doctor in the first place. It was definitely a highlight of my doctoring career.

Even with all the challenges, I continue to practice medicine with no timeline for retirement. But the changing landscape of healthcare can feel daunting at times. Thank your physician for continuing to practice medicine. Feeling gratitude from patients may lengthen your physician’s career length.