My daughter said, “Daddy, I want to be a doctor when I grow up.” I immediately scolded her, washed her mouth out with soap, grounded her and took away her iPad for a month.

Well, not really.

Because I don’t have a daughter. If I did, I wouldn’t spank her, but I’d passionately dissuade her. Medicine is taking a real fanny whooping these days.

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What doctor practicing today doesn’t feel the stinging blows coming from third parties — the government, insurers, pharmacy benefit management (PBM) companies and even patients?

One doctor I knew said that practicing medicine is the razor’s edge between two slippery slopes.I would amend that statement to say the power morcellator between two unclimbable slippery slopes.

Today’s physicians, male and female alike, need thicker skin to traverse the mayhem and madness awaiting them each day. All joking aside, the medical landscape is certainly fraught with more challenges and complexity than in years gone by.

The $64,000 question: What can physicians do about it? (Actually, make that the $3.2 trillion question because that’s what we spend on health care each year).

The answer is, unfortunately, not very much.

Each year it seems there are new models of care and reimbursements being proposed by pundits, policy makers and ‘stakeholders’ in ivory towers somewhere. We’ve all heard acronyms like ACA (Affordable Care Act), ACO (Accountable Care Organization) and MACRA (The Medicare Access and CHIP Reauthorization Act) bandied about like tennis balls at Wimbledon.

Whether it’s Hillarycare, Obamacare or “somebody-else-entirely”-care, these provide solutions to some problems, but the creation of new problems that go along with it. And no one seems to be satisfied. Certainly not patients or doctors.

Take the recent outrageous premium increases affecting millions of so-called ‘Obamacare’ subscribers. These patients, many already hard-pressed to pay their existing bills, must now make some very hard decisions about where to get their health insurance coverage — or to go bare once again.

Still, more will be forced to find new doctors as many markets are left like ghost towns after health insurance companies pull up stakes and suddenly leave. Doctors just see patient volumes and administrative burdens increasing dramatically in an ever more complex, fragmented, disjointed and, I daresay, dysfunctional system.

Even the insurance companies are unhappy — although their profits continue to soar, largely because of very lucrative contracts with — guess who? That’s right — the federal government! They’re going to make their profits one way or another — either through premium hikes or taxpayers’ money.

The pharmaceutical industry is under increasing pressure from legislators to lower its costs. Not even the DEA is happy, as its personnel struggle to abate the tsunami of opioid abuse and diversion devastating our nation.

So no, make-believe daughter, don’t become a doctor. If you do, it won’t be daddy spanking you, believe me.

Instead, be a health insurance company CEO like UnitedHealthcare’s Stephen Hemsley, who cleared a cool $66 million in 2014. Or be a wonder geek, like Facebook‘s Mark Zuckerberg, who has a net worth of $55.3 billion.

Or just be Beyoncé. What the hell.

But never, ever in your wildest dreams (or nightmares), be a doctor.


This is Dr. Joel Cooper’s opening salvo for The Medical Bag.  Cooper, who has many years of medical writing and reporting experience as well as being a practicing family physician, plans to write many more blogs and articles for us in the days and months ahead. We welcome him.