Medicine needs a social revolution led by America’s doctors

Enjoy year-round sunshine with a month paid vacation. Earn 300k plus production bonus. No state tax! No call! Daily I’m bombarded with glossy postcards promising the good life.

With so many options, why are physicians fleeing medicine? Some leave for teaching, waitressing, even homemaking. Others escape into administration, insurance or pharmaceutical positions. Many simply retire in despair.

Robert Centor, MD, writes about our quiet rebellion: “This rebellion has no Glenn Beck or Sarah Palin; no Abbie Hoffman or Che Guevara. This rebellion occurs one physician at a time, as that physician finds continuing their practice undesirable.”

And the truth behind the exodus?

There can never be year-round sunshine for physicians working in an unjust health-care system. And $300,000 can never be enough to numb the pain of dedicating one’s life to a profession that has lost it’s soul. A month’s vacation can only distract us from our suffering for approximately thirty days.

Now is not the time for doctors to give up call, but to accept a call to action. Ours is a sacred obligation, a covenant with patients. America’s greatest dreams can never be delivered by politician-saviors. We are the saviors we’ve been waiting for.

Years ago, I stopped pursuing the elusive production bonus; I stepped off the treadmill to follow my heart. And I discovered to heal my patients, I had to first heal my profession. So I held town hall meetings where I invited citizens to create their ideal clinic. Celebrated since 2005, our model has sparked a populist movement: Americans are creating ideal clinics and hospitals nationwide. One hospital CEO now affectionately calls me “his MLK.”

More than a quiet rebellion, we need a non-violent social revolution led by America’s doctors. Medicine needs a Dr. Martin Luther King Jr. I think I’ll apply for the job.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care.

 

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  • http://www.blogspot.tenthousandvirtues.com Rick Loftus

    Hear, hear! There’s so much deeply wrong in our fracture health non-system. It is up to the physicians to help our patients and communities navigate through an increasingly-baffling and needlessly-expensive “health” system. And I think we doctors can at the same time give up servitude to a non-system we all know is broken.

  • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

    Thanks Rick!

    A favorite quote:

    “(S)He is the best physician who is the most ingenious inspirer of hope.”
    - Samuel Coleridge

    We must innovate and inspire. The ideal health system is best built from the bottom-up. Patients and docs do not want one-size-fits-all medicine. When physicians lead, leaders will follow.

  • Kathleen

    I’ve been reading about Dr. Wible’s work for quite some time. Healthcare has deviated from its mission of taking care of people. Dr. Wible focuses on putting the patient’s needs at the center of medicine. What a delightfully ‘disruptive’ concept.

  • Beth

    Graduating residency and starting my own practice in a large urban area seemed crazy to many people and…a little scary to me too. But I was inspired by Dr Wible to believe that patients want meaningful interaction with their doctors and so I took that leap. Now I have a difficult time imagining practicing medicine any other way. Thanks Pamela for encouraging me to follow my heart.

  • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

    Yes! Delightfully disruptive. We have entered an era of disintermediation (removing the middleman) and renewed transparency that will allow the sacred patient/physician relationship to blossom with minimal third party interference.

    • pcp

      “We have entered an era of disintermediation (removing the middleman) and renewed transparency”

      Would be interested to hear more about this. Seems like we’re going in exactly the opposite direction.

      • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

        “Seems” like we’re going in the opposite direction. Emphasis on seems. Fear-based stakeholders and their rules & regs seem to be pushing us in one direction (which gets more media attention) while positive disruptors–working quietly seeding innovative, streamlined and more ideal health-care models–are moving us in the other.

        What we see on the surface is often very different from what’s happening on the ground. When Americans are invited to dream ideal health care they design economically viable clinics and hospitals that inspire more citizens to do the same. When physicians break free of cynicism and despair they liberate themselves to do the same.

        Often the general populace is moving in a very different (more enlightened and progressive) direction than their leaders. True leaders will ultimately follow the people.

      • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

        Regarding disintermediation:

        We live in an era of transparency. Disintermediation or “cutting out the middleman” allows modern businessess such as eBay and Amazon to build direct relationships with clients. Even in medicine removing intermediaries saves money and renews patient-physician relationships.

        Gandhi advises: “You must be the change you wish to see in the world.” Now is the time for innovation.

        Excerpt from Advice for a Frustrated Gastroenterologist:
        http://www.idealmedicalcare.org/blog/advice-for-a-frustrated-gastroenterologist-2/

  • Jan

    As a nurse and professional in the system for nearly 40 years, I have oft wondered why “we” have let insurance and big business dictate what medicine, treatment course and diagnostics patients will receive… it has come to the point of a dictatorship and the Us/Them is not good for patients or anyone else trying to “navigate” a less than patient centered system!

  • http://www.StressReductionResources.com Greg Schweitzer

    I am inspired by Dr. Wible’s pioneering efforts to heal the profession and meet the growing demands of patients for a higher quality care. It is so exciting because in the process the physician is being healed, and isn’t that key?

  • http://fertilityfile.com IVF-MD

    Ask yourselves this question. Which statement is closer to the truth?

    A: Healing the sick intrinsically makes for an unfulfilling career and politicians and the corporations that influence them have not yet done enough to make it better. Therefore, we need more corporate and government involvement.

    B: Healing the sick intrinsically makes for a fulfilling career, but politicians and the corporations that influence them have done much to make things worse. Therefore, we need less corporate and government involvement.

    I’m on board for a peaceful revolution and it begins with peacefully encouraging people to think for themselves. We believe what we believe partially based on evidence of the senses, things that we can see, hear and experience in real life, aided by logical and critical thinking. We also partially believe what we believe because others have told them to us over and over. What happens if you teach an impressionable young child a lie and then reward him with smiley faces and straight A’s based on how well he/she can regurgitate that lie? Add to this some social punishment if he/she speaks up and intelligently questions the conforming view?

    The power balance between physicians and patients on one side and politicians and corporations on the other side has grown over the years due to the power disparity of unequal force (the common man can not effectively tell a politician what to do. the politician can tell the common man to do anything at the threat of sending him to jail). How can we regain the balance? Interesting food for thought. :)

  • http://ENT4MyKids.com James Ochi MD

    Our son is considering going into medicine and I don’t know if I should encourage him or tell him he’s crazy.

    Many doctors right now would say it isn’t worthwhile to put in all the years to become trained in medicine. I am concerned not only for us doctors but for everyone as patients—what kind of care can we expect to receive as we get older if we continue to make doctors miserable?

    Dr. Wible is leading physicians and patients back to what medicine should always have remained: one person who is under the care of another person!

  • http://www.consentcare.net Martin Young

    Pamela, I agree with you 100%.

    The ‘non-benefit-to-patient’ costs of providing medical care have escalated so much that doctors are forced into working high volumes for low markups. This economic necessity is the rust that has corrupted medical practice.

    Anything that breaks this trend must be welcomed.

    Great post!

  • Dr Erika

    Dr Wible’s message is a huge inspiration to me! And gives me hope that it’s possible to practice medicine and be happy and not be burned out. Am implementing some of her tenets in my practice.
    I’d love to find a way to have town hall meetings in my town like she did. However my practice is not primary care but very specialized (bio-identical hormones for men as well as women). So not sure how I’d do that.

  • DRJEBJ

    We just need more doctors to opt out of insurances and Medicare/Medicaid. Let the patient feel the pain by paying and filing their own claims. Thumb your noses at “regulators” who tell you how to practice, document and code. Make your care more affordable and your practice more profitable at the same time.

  • http://www.synergyfamilymedicine.com Dr. H Yang

    Pamela,

    Great post-right on the target.

    You would be an excellent MLK for the medical society.
    This huge task can not be done by one person or just the people on the listserv.
    A lot more medical professionals and policy makers need to hear your/our voices in order to generate enough energy to make revolutionary changes.

  • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

    Thanks for all the wonderful comments! The time is ripe for innovation. Embracing our patients will indeed lead to healing ourselves as physicians (very perceptive Greg!).

    @IVF-MD: I agree wholeheartedly and choose B! I’d like to see physicians break out of “survival mode” and lead a peaceful revolution. It’s actually quite simple to pull off.

    Rather than wait for election day just invite your community to a town hall meeting this week. You, the physician, are here to serve them. You want to know how to do this. Invite townspeople to share their ideal, their dream clinic, hospital, health care system. What people really want is very basic and inexpensive. And it starts with being human with one another. If you are not a public speaker then network with charismatic leaders in town or established infrastructure such as churches or schools and host a meeting there.

    Erika, where are the patients you would like to serve? Fitness clubs? Community colleges? Start there. Call me and I’ll help you strategize. It’s a real eye-opener to listen to people. And it beats slogging through thousand-page health-care reform bills.

    Time to break the economic stranglehold on physicians. We are here to support our patients not third-party intermediaries who add no value to the patient-physician relationship.

    I’m with Gandhi on this one: “You must be the change you want to see in the world.”

    Inspired? Pass it on.

    Pamela Wible MD

  • http://www.ibsnspa.com Kevin Teal MD

    Dr. Wibble,
    I have arrived at your destination and am hoping to lure other Physicians out of the matrix. I have launched the Arlington Physician Independence Forum in Arlington Texas to create a haven for dostors who long for something more from their practice. Thanks for the insight.

    • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

      Great Kevin! I grew up in Dallas. Lots of “out-of-the-matrix” physician activity in the region. IMP doc below is one of them. Map of “ideal” practices here (many formed with community engagement): http://maps.yourgmap.com/v/c_ne_Ideal_Medical_Practices.html

  • Steve Shapiro

    I was a participant in the town hall meetings in Eugene about 5 or so years ago.

    I’m one of those self-empowered people who sees himself as a client, not a patient, and think it’s a great idea to ask clients what they want.

    That’s why I choose my foods based on my blood type and self-treated my self for an auto-immune condition called Pemphigus.

  • http://greenbabyguide.com Joy

    Dr. Wible has found truly healing solutions for both patients and doctors. We need to hear more from her!

  • Kathleen

    Many are stuck on the hamster wheel of practicing medicine in an increasingly toxic environment where it seems to be all about the mountain of administrative minutiae rather than our patients. We did not swear an oath to insurance companies.
    I have found the Ideal Medical Practice site and list serve to be life saving. This is a group physicians and nurses dedicated to helping each other practice more humane and sane medicine. Dr. Wible is a member of this group. Many of the ~1000 members are primary care, however the principles can be applied to most medical practices.
    For those of us who have been walking around in the ‘deep weeds’ or stuck on the hamster wheel, this is an excellent step in the right direction.
    http://impcenter.org/about/

  • Narmandi Zaurice Parker

    I think what Dr. Pamela Wilbe is doing is the reform we need for health care.

    If other physicians would follow what Dr. Wible is doing and tweak it to where it works for them, they’d feel new-found gratification in their practice.

  • jill

    So, after 15 years of working in health care and seeing how HMO’s evolved and how powerful the insurance industry became I was afraid for the future of health care.
    I was also a victim of a system run by bureaucrats instead of doctors. Doctors so burnt out and dependent on a failing system that they could not manage their managed care practices.
    Then, I met and became patient of Dr. Wible who is truly a visionary with great common sense. Keep healthy people healthy and invested in being so, avoid costly and unnecessary testing and limit the number of patients and overhead. Wow!!
    We can revolutionize medicine one doctor and 400 patients at a time. Rock on Dr. Wible!!!!!!

  • Lisa

    30 years ago, as a newly graduated R.N. all I wanted from my new profession was to make a difference in the lives of my patients. But before long I realized that for that to happen we cannot be bogged down with unsafe pt/staff ratio’s, ridiculous charting systems that use up 40-50 % of your time, physical layouts designed by architects who do not have a clue, and a lousy system which seems dead set on treating the disease and not the patient. Nurses generally are motivated by the relationships we develop with patients and their families, not by their illnesses. We don’t want or need monetary compensation, just an working environment that allows us to nurse and nurture our patients. Thanks Pam for opening up this discussion!

  • http://www.LoveAndDiversity.org Love Unlimited Organizers

    Hello.

    I am speaking on behalf of the team members of the Love Unlimited Film Festival & Art Exhibition, an annual international event that takes place in several cities as we enter our fourth year. We had the honor of screening the world premiere of Dr. Wible’s amazing film “One Doctor’s Dream: Eight Questions to Change the World” to a very delighted audience recently. Dr. Wible’s film presented an amazing night covering everything from Breakthrough cures for pain (laughter as a cure), free cancer screening and much more. The best thing about her is that she turns no one away for lack of funds. She is inspiring.

    Love and peace flows freely,
    -On behalf of all of us on the Love Unlimited Organizing Team

  • Lisa Kay

    I welcome a future where we embrace the simple acts of Kindness, Compassion, Grace and Love as part of our daily interaction with our families, our neighbors, and our friends.

    Thank you Dr. Wible for visioning and supporting these simple acts in the field of medicine and creating a virtual forum for others to participate and feel that they too can be a part of this beautiful new growth in the way we care for each other. How sweet it is for me to read about people breaking away from fear and finding their way into a brighter future.
    Hugs…

  • http://www.maitreyaecovillage.org Robert Bolman

    Pamela (Dr Wible) once met me at the DMV and diagnosed a medical problem while we both waited in line. I mean like, you can’t not LOVE this doctor! The US health care system is so broken and morally bankrupt that any doctor rebelling against this system to the extent of Dr Pamela Wible is a hero.

  • http://www.linqmusic.com Linq

    When I first received my pharmacy degree and went into the profession as an independent pharmacist, I had the opportunity to make a positive difference in the lives of my customers. I loved what I did, and my regular customers became friends.

    Things began to shift in my area in the 1980′s when HMOs here received the green light to become for-profit entities. I remember telling my customers that it was the beginning of the end of the “care” in healthcare. Boy was I right!

    I became more and more frustrated over time as I was forced into the games going on within both the health insurance industry and big pharma. I found myself spending much more time weaving my way through the obstacles being thrown by the industry at the expense of my customers than I was able to spend counseling and helping them myself.

    I finally decided that I could no longer be a pawn in the game, so I sold my pharmacy, gave up my license and left the profession.

    The “up” side of this decision is that because I’m also a singer-songwriter, I was able to use my personal experiences to write and record an entire CD of rather scathing songs about our current healthcare situation in 2009 under my stage name Linq. It rocketed into the Top 50 Folk category of the Roots Music Report the first week out and remained there for five weeks. It sparked radio interviews and many wonderful conversations.

    I still play the songs, and I invariably receive wonderful feedback from audience members, most of whom have their own stories to share.

    Pamela Wible, MD has sparked the beginning of an alternative path that has the potential to be THE change needed to move us toward a healthier, patient-focused single-payer system.

  • gus3

    I’ve known Dr. Wible for over half our lives. I met her when she was pre-med, and I wondered at the time how someone with her nature could survive the soul-sucking grind that her future likely held. To see her now, is to see the best of the American entrepreneurial spirit that says, “There is a better way, and I can do it!” She is re-claiming not just the practice of medicine, but the art of healing.

    Thank you, Dr. Wible. May you be a blessing to all who come in contact with you.

  • ninguem

    And on top of that, referring to the top of the thread, the headhunters are usually lying about the three hundred grand.

  • http://www.CoachForHealthCareLeaders.com Deborah Munhoz

    Reading the flood of affirmation and appreciation for Dr. Wible’s message gives me great hope for a better future in healthcare- for physicians and consumers. What can we learn from MLK? He had a vision, he had faith and he was courageous. Yes, to the idea that it is our responsibility to create the future we envision- irrelevant of the evidence all around us. Yes, to having faith in what we cannot yet see. What does it take to boost our collective courage in what individually can feel like a Sampson and Goliath fight? Personally I plan to follow up on any links that help build grass roots, critical mass for health care change that works for physicians and their patients. Thanks for the added inspiration!

  • IMP doc

    I’ve known Dr. Wible for nearly 30 years. She has always been way ahead of the curve. If you want your dream practice, simply write down everything she says, and memorize it. It works.

  • http://www.drbetherickson.com Dr. Beth Erickson

    As a marriage and family therapist who has practiced for 36 years, I am in sympathy with the physicians who, before they stepped off the treadmill, were dispirted by the way they were expected to practice medicine. I myself have not taken insurance or allowed patients to use it for 7 or 8 years. And I charge top dollar which my patients must be willing/able to pay, or they must see someone I refer them to. This allows me to concentrate on my work with them, rather than on prior authorizations, insurance forms, and the like. What a relief!

  • http://www.peoplespharmacy.com Joe Graedon

    A true visionary…Pamela is one of our health heroes. Time for this movement to gather more momentum! At some point this quiet revolution will become the dominant paradigm. Help make it happen.

  • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

    I’ve received private emails asking, “Who will lead this revolution?” Honestly I feel it’s more of a decentralized al-Qaeda method. Seeding cells of joy in doctors, empowering patients across the country.

    The revolution is not top-down. The evolution we seek is inside-out. There is no hierarchy. There is no need to march through the Washington DC streets begging politician saviors for help. The next movement is a pilgrimage to our souls. It’s a journey that we can only make on our own–one by one. The ripple effect when we all take this step inside is magnificent.

    I do not have the roadmap, but feel confident this is a major thoroughfare.

    Thoughts?

  • http://www.peoplespharmacy.com Terry

    The vision of patients and providers (physicians and others) partnering together for better health is inspiring. Thanks to Dr. Wible for her heart-felt leadership!

  • Dyeanne

    This is so inspirational.
    I’ve been a general surgeon practicing since ’91. I became a general surgeon because I was able to treat patients at many different points in their life – often life altering events. My current partner and I left extremely busy practices, because of what I called corporate medicine.We now practice in a rural area thinking there would be less promoting service lines, marketing unnecessary services and more about compassionate care and treating the individual. My observation of the human body is the ability for it to heal.
    Compassion,caring,listening to the patients as an individual and helping them with those tough decisions about when to intervene is the part of medicine I enjoy. Just because you can do something doesn’t mean you should. Every single operation,procedure,and medication has the potential to harm. As I’ve tried to become involved in healthcare reform I realize how many layers there are. I can’t find anything that makes any sense except that Big Business will make a lot of money on meaningful use of meaningless data. I agree the only solution is grassroots,we have to empower the true stakeholders, the patients, the many caregivers, and physicians and providers who want to be partners with their patients. There is so much pain all around us, and it becomes so much harder to give patients the help and simple things they really need because so much money is wasted. I can’t believe how much most patients pay out of pocket.
    I will research the website for help with learning effective ways to enact change locally. My brother just quoted Gandhi’s “Be the change you want to see ” when I was feeling so much despair for my profession and especially the people we care for.
    Thank You

    • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

      Dyeanne and all ~ I am available if you need me. There are many resources on my website. Please call or email me if I can be of further assistance.

      Pamela Wible, MD
      3575 Donald St. #220
      Eugene, OR 97405
      (541) 345-2437
      http://www.idealmedicalcare.org

  • http://www.RadioPublicity.com Alex Carroll

    Keep up the good work Pamela!

  • Caroline Cummings (happy patient of Dr. Wible)

    Pamela – this is fantastic and I’m so glad you’re stepping up to lead this (much needed) revolution of medicine.
    My favorite line is that it’s not “time for doctors to give up call, but to accept a call to action.”

    I know you are inspiring docs all over to take the leap and follow in your footsteps. I’m VERY lucky to have you as my family doc. :)

  • http://freelancemd.com Freelance MD

    Ah.. I’m in complete agreement with all of the above… and, I’m glad to say, that Pam is also writing for us at http://FreelanceMD.com around nonclinical careers and lifestyle design for physicians.

  • Rodney

    I enjoyed reading your article, Pamela. As always, your words are incisive, witty, moving, and heart-felt. All doctors should be as compassionate and as generous as you. Keep up the excellent work!

  • Leroy

    Great article Pamela…you are definitely a pioneer! As some one that has worked in healthcare, I can honestly say that you’re right on target. It’s unfortunate how the cost and quality of health care is dictated by pharmaceutical companies. However, I beleive if medical professionals bonded together for the same cause, I think the health care system will change as we know it. I have and will always have faith in the medical professionals that ensure our well being. Faith in the system…yeah…not so much. Revolutions are necessary. So I say to you Pamela…are you ready for a revolution???

    “The greatest revolution of our generation is the discovery that human beings, by changing the inner attitudes of their minds, can change the outer aspects of their lives.” – William James

  • jackie

    Not only is Dr. Wible an inspiration in medicine, but her message needs to extend to other fields as well – such as clinical social work. As Dr. Erickson notes above, this approach to practice is possible and do-able in in marriage & family therapy – and I think more of us need to know that and hear this message! And I’ll be the first to take it to other therapists and social workers!

    THANK YOU, Dr. Wible, for doing what you do!!!

  • http://www.drcarole.com Carole Lieberman, M.D.

    As a psychiatrist, I am extremely saddened by the increasing depression and demoralization of doctors. This is not what they/we signed up for. Doctors go into medicine to help patients, not to be increasingly burdened by administrative bureaucracies and insurance cutbacks. I am especially disheartened at the large number of psychiatrists who have dealt with these issues by seeing patients for monthly ‘medication visits’ instead of providing them with psychotherapy – not just drugs. I refuse to do this. Whether or not a patient needs medication, he needs psychotherapy to get at the root of the problem. We need to stand up to Obamacare and the prospect of socialized medicine. This is an impending disaster for doctors and patients.

    • http://fertilityfile.com IVF-MD

      Agreed. We need to stand strong. So if the premise is that doctors who once practiced in a career that provided a fulfilling, interesting, exhilarating way of life are now despondent and suffering because it has been replaced by a political, bureaucratic garbage pile of administrative chores, there are two commonly advised approaches. The first is to suck it up and try to be happy in spite of it. I don’t like that way. The second is to do something about it. I like that approach. Doing something about it can consist on a small personal scale of choosing a field that is more sheltered and safe from the bureaucratic destruction or tailoring your practice to be more resistant to such destruction. I can attest that this is definitely doable and can work very well. “Doing something” can also consist on a larger scale of being an activist and advocate to help educate others to the truth about the harm that is happening to or is about to happen to healthcare if we just idly stand by and do nothing to stop it. Will we unite as physicians and taxpayers to stop the destruction or will we be uncaring and just turn a blind eye to the aggressive takeover being perpetrated by the bureaucrat-corporatist gangs? The answer to this question will make all the difference.

      As a physician who is apparently in the minority in that I still really love my work (for now that is), I feel that it’s not too late.

      • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

        The best way to revolutionize health care is for physicians and patients to band together and create something better than what will be handed to us by politicians. Patients tend to be clueless about the plight (and flight) of physicians.

        Next month will do a public showing of the film “The Vanishing Oath” (see snippet here: http://vimeo.com/7610236). Educating patients is key.
        Change happens together. Demonizing each other is a sure way to weaken any movement.

        Pamela Wible MD

  • Gael Wheeler, D.O.

    Thank you, Pamela, for illuminating what is possible!

  • http://www.shamanicvibrations.com Jon Reinschreiber

    Physician, heal thyself. Reclaim your art.

    The energetic aspects of healing are as equally important as the technical aspects of medical science. Today’s physicians, working within the present healthcare system, have lost the art of being healers and have joined the ranks of the technicians with production line tests and procedures. Modern medicine can fix us, but it can no longer heal us. The responsibility for healing now belongs to the patient.

  • http://www.RadioRounds.org John Corker

    Keep up the great, compassionate work, Dr. Wible!

  • Michelle D’Amico

    It’s about time that doctors are standing up for their patients and communities! Congrats to all of you wise and brave pioneers!! I can attest to the amazing care I received from Dr. Wible when I was her patient in Oregon. Now that I’ve moved out of state, I will only seek a replacement doctor who follows the ideal medical practice model.
    ~Michelle

  • Andrea Kowalski

    I’m currently reading Mountains Beyond Mountains by Tracy Kidder and am so inspired by the work of Dr. Paul Farmer in Haiti. Dr. Pamela Wible reminds me of Dr. Farmer, except that she is leading a domestic medical revolution (which, arguably, may be more challenging than Haiti). I respect and applaud her!