Among physicians, there’s tremendous contention as to who represents the “true” voice of doctors.
There are indeed various lobbying groups, but as Stanford’s Abraham Verghese writes in a recent WSJ column, “Our esteemed medical societies and academies aren’t speaking for medicine; they are lobbyists, defending their financial self-interests, lining up for or against the latest bill being proposed,” and that, “our great academic institutions and our esteemed medical schools have historically spoken for the cause of medicine, but these days many medical schools are more like big companies with complex financial interests in large hospitals and clinical practices.”
And that’s true. There is no one representing the doctors “in the trenches,” so to speak, despite plenty who “give their weekends to clinics for the homeless . . . volunteer their services to community nonprofits . . . [and make] home visits to the housebound, poor and elderly.”
We do need to hear their voices, because it is they who will be relied upon now, and in the future, especially if universal coverage is enacted. The current reform proposals do little to change the fact that time spent with patients is undervalued:
Physicians like those should speak up for medicine, and argue in favor of paying doctors to spend time with their patients. They should fight against a payment system that has created perverse incentives that encourage unnecessary treatments. Let’s make it as lucrative to talk to the patient as it is to do to the patient.
Well said.
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That would be me.
Hi Kevin,
I’m no doctor, but this is precisely the point I’ve been making for a very long time on my blog, and in whatever forum I can make it.
We systematically undervalue the time doctors spend with their patients. By doing this, we systematically undervalue the listening, thinking, and deciding aspects of medicine.
It hurts the quality of care, creates higher costs, and leads to unnecessary human suffering.
Unfortunately, reform proposals aren’t addressing this problem, and you’re right, most doctors aren’t speaking up about it.
I’m glad you’re helping spread the word.
Evan
Attorneys charge their clients by the minute to talk. Do you really think this type of system would work in medicine? The slowest (and usually worst) surgeons would get paid the most. Also, a non-productve internist could talk to a single patient for hours and accomplish nothing while a smart, efficient colleague could see multiple patients and solve their problems quickly. If you bring outcomes into the equation, then physicians would only cherry-pick the healthiest patients.
Doctors charging by how much time they spend is commonplace in private-practice psychiatry and psychology. Now so-called “concierge doctors” are taking up the practice in internal medicine and family medicine. From what I’ve heard, well-heeled patients appreciate the ability to spend as much time as they like with their doctors, and those who have gone “concierge” like the ability to respond more holisticially to their patients’ needs and get appropriate financial support for it. I absolutely believe doctors should charge more like lawyers, but the difficulty is finding some way to pay for it.
My family doctor spends quite a bit of time with me. Did so even before he went “concierge”. I am a real person to him unlike the cattle car treatment at my cardiology practice. The UK study on time spent with a patient should be understood in the context of the NHS and its failure to provide timely treatment. Hell, after I waited that long I’d think 5 minutes was terrific!
It is really really sad that our system rewards only procedures, ordering tests, MRIs more than time a doctor can spend to reassure patients when more tests are not needed. Crunched for time, fear of missing something promotes more referrals and tests that could be avoided. The sector that can really bend the curve of costs is doctors. Unless they are incentivised, nothing will change. We need incentives to make patients better with sensible care. If congress has guts to make this hard choice and elevate cognitive care, we probably can bend the curve and save 700 billion a year! We also need to train med students and residents to be aware of what their decisions mean for costs,amazing that the very people who the main cause of costs are mostly clueless about the costs. Has anyone ever asked their doctor what the medication or test would cost and did you get a straight answer?
Has any prominent physician asked President Obama, or the ATLA, or any legislator to outline conditions under which medical providors might be indemnified from civil liability for care given pro bono publico…
or conditions under which the docs and nurses might be allowed to know a quantifiable amount of $$ risk for pain and suffering awards available to potential civil plaintiffs?
Sermo is doing a better job of voicing the opinions of most of the family docs I know than the either the AAFP or the AMA.
http://www.sermo.com/blog/
This is what happnes when medicine and caring become capitalism. You just cannot practice without thinking how to pay your overhead expenses. As an Internist or FP you have to see certainnumber of pts. daily to meet your expenses otherwise you cannot survive.In general,we all try to do out best given current circumstances.Isee 1/3 of my pts in hospital for free and cannot even claim tax break for my time spent with indigent pts.
To change the system will take many yrs and will have to start in residency training program itself.
If doctors start acting like lawyers,it will be the end of medical profession.People still look at us with some dignity and respect and trustworthiness. As for lawyers,all in contraries.
Absolutely physicians should not have to act like lawyers.
They should be protected from any necessity of doing so by those with the power to protect them.
A profession driven by inherent dignity, honor and compassion is such an easy target for exploitation by groups whose charter is otherwise.
I agree with Family Doc. The AMA is actively hostile towards primary care, and the AAFP and other primary care organizations have been unwilling to represent the interests of their memberships.
Sermo’s blog is a good resource.
I am employed as a lobbyist for primary care physicians. I listen to our physician members before supporting any legislation, I seek legislation only when our members request it, and I speak regularly to legislators about how primary care physicians are suffering in the current payment environment. I work at the discretion of my association’s physician members this means I can only work on issues that physicians let me know about. If you want your association to work on an issue- call us! If you don’t call or email I can’t know how to represent you.
I don’t receive any increase in payment when I’m successful and I don’t receive any increase in payment for the number of hours I work, so I’m confused as to how I’m defending my own financial self interest. I believe in the importance of primary care, which is why I work in this field.
Marybeth:
“call us! If you don’t call or email I can’t know how to represent you.”
Who is us? No one gives me a list of lobbyists for primary care docs. As for the AAFP, physicians have been telling them for 15 years that the relative value system is killing primary care, but they refuse to criticize or disassociate themselves from the AMA.
Thanks
This is an excellent point. Who speaks for the practictioner? And not just the one volunteering at a shelter, etc. The practice of medicine is valuable, even if it is not in a ‘free setting,’ but is compensated (however shocking the concept is to the modern mind). Maybe I’m more sensitive to this as an emergency physician. Every day feels a little like practicing in a shelter or free clinic; because so much of the care is free!
Let me make a prediction as someone working in a government mandated setting (which means all of EM). The question for us is not ‘do we get paid for our time’ or ‘do we get paid for doing stuff,’ but ‘do we get paid?’
The EMTALA mandate forces us to see all without any promise of payment from the government that set the rules. They have stiffed us ever since. the mid 80’s. Does anyone really believe the same government will devise ANY just, reasonable system to compensate all doctors fairly? Ask your local ER doctor the question and listen closely.
Edwin
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