The Vanishing Oath is a film patients must see

I recently watched The Vanishing Oath, a physician-directed documentary detailing the challenges impeding doctors to best care for their patients.


It follows the travels of Ryan Flesher, MD, an emergency physician who took time off and traveled the country talking to university economists, an Emergency Medicine trailblazer, a malpractice attorney, medical academics, a divinity professor, current physicians, former physicians about what ails our health system.


Here’s a video excerpt:


The Vanishing Oath is a film patients must seeThis is an important film. Physicians are burnt out, a phenomenon that starts early in training, and doesn’t improve after doctors leave residency.

With the effects of health reform approaching, already scarce primary care doctors are bracing for an influx of over 30 million newly insured patients.

But regular readers of already know that. Dr. Flesher illustrates the problems already well known among the medical community.

It’s more important that our patients see this film. There’s little public understanding of the obstacles that impede a physician’s professional life. Aside from reading physician blogs, this documentary realistically looks at the odds stacked against doctors today. At the time when they’re needed most, they’re instead being driven from the profession.

Doctors strive to best care for their patients. After watching The Vanishing Oath, it’s clear why that is becoming increasingly difficult to do.

The Vanishing Oath is available for sale on May 10, 2010 on its website. Highly recommended.

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  • Dr. Wes

    I agree Kevin. My review here:

    I’m trying to secure a theatre on the North side of Chicago for the public to view it either for free or for a nominal charge. There is a Chicago-based premier showing in Palos Heights, IL on 25 May 2010 but seating is limited. The public needs to see this.

    Also, although it deflates the optimistic mood of completing medical school or a residency program, just about every medical student and resident should see this film before graduation.

  • jsmith

    At bottom, the problems in medicine are two. 1. Aging. Old people are a lot of work for docs, and there are a lot more of them than there used to be, in part because of doctors. 2. Technology. The more things we can do for people, the more work we have.

  • gerridoc

    Thank you for making this film! What is ironic is that today I mailed in my resignation from the hospital medical staff where I had been affiliated for over 25 years. I can hardly wait to see the full documentary.

    • Nancy Pando

      I am the producer of The Vanishing Oath. The film is clearly gaining momentum. Please help us to achieve our goal of selling our supply of films by the end of July so that we can fund this grassroots project. Or if you would like to host a screening in your area, please notify me.
      Thank you for your years of hard work, only now can I appreciate what you have given.
      Nancy Pando, LICSW
      The Vanishing Oath

  • Gregg Masters

    The clip offers a glimpse into what appears to be a valuable piece of documentary journalism! Timely, yet granular insights into our imploding house of cards financing and delivery system. Imagine, post residency x 6 years, and this doc pulls a shift at Blockbuster for health benefits eligibility. Might this be seen as the medical version of a ‘Starbucks effect’, aka the self employed or yuppie conduit to health insurance coverage?

  • DrV

    Nice review, Kevin. Thanks for bringing this to my attention. I’m working on getting a copy now. So much to discuss in revealing the flaws in our profession.

  • debra

    Thanks to Dr. Malm for speaking out. She expresses what I think a lot of docs have been unable to admit. It was courageous to go on camera.

  • Alexey

    any link to watch full movie online? It must be in open access

  • Not Savvy

    Just to point out: Dr. Malm wouldn’t have the billing/coding problems and the need to work at Blockbuster for health insurance if there was universal health care.

    Also, Obamacare provision that creates exchanges for those on the independent market my help Dr. Malm secure health insurance without the extra job.

    Didn’t someone in a previous post indicate that the AMA makes a lot of money from the codes?

    And if the cash only model is the way to go, why doesn’t Dr. Malm just pay cash instead of buying insurance.

  • ninguem

    The Oath is literally vanishing. They are rewording it to get rid of pesky things like loyalty to the patient. At the risk of invoking Godwin’s Law, it reminds me of the Germans changing their oath for soldiers and civil servants, from loyalty to the Constitution, to loyalty to Hitler.

  • jonnyhippee

    Simple solution:
    1) patients must pay by the hour, cash only, in 6 minute increments (just like lawyers) and the patient then submits the claim to their insurance for reimbursement.

  • Anony-mouse, MD

    DVDs are very “20th century.”

    Charging $23.99 + $2.98 shipping is a bit steep for an independent documentary. I only point this out because I believe that this film has something important to say, and it should be seen by as many people (especially patients) as possible.

    Ryan and Nancy, if you’re reading this, I hope that you strongly consider making your movie available (in its entirety) through more affordable means via online distribution, especially bittorrent.

    I understand that this concept might be pretty counterintuitive to someone who likely funded the making of this movie with personal assets, so I’ll simply point you toward the links below and wish you the best of luck; I’ve already spent about 40 minutes searching for the info below and I should really be studying for Step 3 :)

    Link to
    “More Independent Film Makers Embrace News Of Their Film Being Pirated.”

    Link to
    “Star Wreck owes its Success to BitTorrent.”

  • Dr. Mary Johnson

    I seem to remember talking to the producers of this film a few years back.

    O well. The way things are going, I know there will be a sequel;)

    And yes, the Oath doesn’t mean anything if it only means something to doctors.

  • andymc

    She says she doesn’t like the assembly line aspect to medicine yet she wants to work for Kaiser??

  • Payne Hertz

    I’m sure patients will be very surprised to learn that they pay nothing for their medical care, as claimed in this documentary.

    Massachusetts law requires any business with over 11 employees to provide health insurance. Am I to believe a doctor can’t find a job in the medical field that pays health insurance? Has she tried a hospital or clinic? Does Blockbuster even provide health insurance to part-time employees? This doctor claims she is too exhausted to properly care for her patients, but apparently loses her exhaustion the minute she shows up for her Blockbuster job, which she seems quite enthused about despite the crap pay. Wouldn’t she be less exhausted and earn more money just working an extra hour every day and paying for her own insurance? Sorry, but this segment seemed contrived to me.

    The figures on what a doctor makes are also rather disingenuous, as it claims that a doctor makes $146,000 on average in salary but then deducts the cost of overhead and malpractice from this total. But doctors in private practice do not earn a “salary” they earn “profit.” Doctors who work in hospitals earn a salary and typically do not pay their own malpractice costs, and it is highly unlikely any of the hospital’s overhead gets charged to them. Overhead costs are also not a percentage of gross pay, they are a percentage of gross receipts of a private practice.

    Here’s a breakdown on what doctor’s salaries really look like, based on physician surveys. Note that these salaries are net after expenses:

    Isn’t it rather disingenuous to keep quoting this $146,000 figure, and not make it clear that it does not reflect what doctors in private practice make nor is it even a particularly accurate picture of what salaried doctors earn?


      “Earnings of physicians and surgeons are among the highest of any occupation. According to the Medical Group Management Association’s Physician Compensation and Production Survey, median total compensation for physicians varied by their type of practice. In 2008, physicians practicing primary care had total median annual compensation of $186,044, and physicians practicing in medical specialties earned total median annual compensation of $339,738.

      Self-employed physicians—those who own or are part owners of their medical practice—generally have higher median incomes than salaried physicians. Earnings vary according to number of years in practice, geographic region, hours worked, skill, personality, and professional reputation. Self-employed physicians and surgeons must provide for their own health insurance and retirement.”

      As for Blockbuster, it seems to provide health insurance for it’s part-time employees. In four hours working as a MD in California, the median income would be about $280, more than enough to pay the monthly premiums on a basic health plan on the individual market-and more than enough to pay cash for routine care.

      A customer service representative makes $8 an hour. The customer service representative at Blockbuster working 40 hours a week makes about $320 per week.

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