It is time for American physicians to rise up

It is time for American physicians to rise up

It’s time for the American physician to stand up.

We will no longer bend to the tyranny of bureaucracy, the venom of litigation, or the naivete of legislation.  For we have spent many a night sweating on the phone as our dear administrators slept comfortably in their beds stuffed with hundred dollar bills.  Our experience standing in the line of fire dwarfs that of any attorney questioned by his client’s peers.  And we have tended to more constituents personally than any verbose and hyperbolic politician.

Yet the doom and gloom of our current health care system is being flung belligerently at our feet.  The American physician is beaten, battered, and toiling in a cocoon of self hatred.  Caught in a tangled web that binds, our detractors count on our sacred healing oath to imprison us in a system that becomes more constrictive by the day.  We are too proud to stand down.  We are too dedicated to our patients to bow as the chains are pulled tighter.

We have been judged by the outlying ice that melts at our extremes, and denied the strength of our inner core.  We are solid.  We are dependable.

You will legislate, you will regulate, you will under compensate.  And we will nod our heads willingly.

But when you attack our pride, our character, you cross the line.

We have spent every waking moment since childhood planning for this.  We have studied more hours than most can conceive, We have worked while others rested and than worked some more.

We have been placed in the most difficult of situations.  We have had to question God regularly.  We question ourselves.

We stand tall and proud as American physicians.

We will not let you cast us as villains.

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.

Image credit: Shutterstock.com

Comments are moderated before they are published. Please read the comment policy.

  • QQQ

    “We will no longer bend to the tyranny of bureaucracy, the venom of
    litigation, or the naivete of legislation. For we have spent many a
    night sweating on the phone as our dear administrators slept comfortably
    in their beds stuffed with hundred dollar bills.”
    ————————————————————————————————-
    When you have skyrocketing cost in education, and you have to jump
    through all these hoops to become a doctor (it is not an easy
    accomplishment) you are going to want to be well compensated. ACA is cutting into doctors paychecks making incentive to become a doctor less attractive, which equals less doctors. No, we won’t see this shortage in the next year or two. We probably won’t feel it for another decade. The average age of doctors in this country is about 50 (reports vary from 49 – 51). 10 years from now, the average doctor is reaching retirement age and there are fewer med students filling their shoes. Also, there is an
    aging baby boomer generation who will need more health care than they
    require now.

    So you have a more limited supply of doctors and an
    increased demand for health care. Unless we kick our politicians out of
    our health care, we are never going to drive costs down.

    The pattern I see in this country is 1) Government identifies a
    hardship; 2) Government intervenes in private industry to try to fix the
    hardship; 3) The problem grows, as rules of economics react to the
    government intervention; 4) Government intervenes again, creating more problems (back to step 1).

    • Dr. Drake Ramoray

      You left out the shortage of residency slots. I hear what you are saying but I predict five years.

      https://www.aamc.org/advocacy/campaigns_and_coalitions/fixdocshortage/

      • DeceasedMD1

        OK. How does a disorganized group of physicians find a way to unionize?

        • Dr. Drake Ramoray

          Well the med students and residents are too brainswashed and the academic types see patients once or twice a week and are the ones doing the brainwashing.

          Endo doesn’t have enough docs (we are about 6K in the whole country and a lot less who actually see patients everyday). The other societies are of no help as I have pointed out elsewhere.

          I would think the most likely would be the hospitalists type but so many of them move around the country (at least in my area) that they aren’t in one system long enough to protest. Pay for performance is especially bad for them as they typically don’t have a pre-existing relationship with a patient, and are closest to the hospital beuracracy.

          I suppose it would have to be a within hospital system type uprising (why it hasn’t happened in say Kaiser etc is a very good question). We get lots of puff pieces about how great their system is but then none of the docs I have ever talked to have talked it up. Our local corp med employed hospitalists type just leave (seems every month of consults is from a different doc).

          I used to think it would be taking Medicare/Medicaid becoming a requirement of licensure (being talked about in VA and Mass.) but as more docs work for hospitals that becomes less and less of an issue. The outpatient offices owned by our local hospital here are running 60-70% Medicare/Medicaid so any sort of mandate on a hospital system is irrelevant and for the first time ever a majority of new docs are joining big groups or hospital systems (who likely already take Medicare/Medaid).

          I’d have to agree with Dr. O’brien. We are one of the least rebellious groups in society. I don’t think docs will unionize in my lifetime (I used to, and have posted as such on these boards, but I cite the Medicare/Medicaid part above). I think more will retire, move to direct pay (maybe even part time), and the NP/PA will have an expanded roll in healthcare. It is also possible the FMG rolls will expand (it is already fairly heavy in some non-procedural specialist fields). As Dr. G says if you are an american medical student better work on some irreplaceable skills.

          • DeceasedMD1

            thank you for your thoughtful reply. But it is striking that docs in general all have irreplaceable skills. Yes I know it can be dumbed down and devalued by CorpMed. But if as a group, as Dr. G points out, we all went on strike, we would start getting attention. All the admins in the world could not handle that. Even if we had some decent PR expressing our concern for HC to the public it would draw attention. I know previously the reason we never went on strike had to do with ethics and issues of pt abandonment. But at this point, if we can’t practice in the way we feel is safe to take care for our pts it is not ethical to continue following gov’t/insurance regulations and obstacles that are harming pts. what more can we do? We need to own medicine again. Not sure it is possible but being complacent will get us nowhere.

        • doc99

          Collective Action is essentially precluded by the US Supreme Court’s decision inGoldfarb v Virginia State Bar.

          • DeceasedMD1

            amazing. Doesn’t that law specifically just apply for lawyers or does that include all professions?

  • Dr. Drake Ramoray

    I hang my head when reading this. I feel like this is the rallying speech before we charge across the field to be mowed down by our enemies.

    You are rallying the troops but the die had been cast. Short of direct pay care, which isn’t feasible for the population a large, the regulatory burden alone will keep the independent physician from surviving. Add the fact that the majority of new docs completing residency start working for hospitals or mega corporate practices and its over. CMS using the government cudgel for meaningful use an PQRS without allowing oh shocks. To collectively bargain is the last straw that breaks the camels back.

    Truth is outside of specialty procedures, or specialties others don’t understand or want to do (see Endocrinology, neurology, ID) the physician is about to be replaced by the PA/NP. The medicine societies support it. Sure older generations of docs (I’m not even that old) are with you you but younger docs post about their new PCMH/ACO specific training as a way to improve their prestige.

    Corp med has won. You think the AMA, ABIM (see certification maintenance of), the AAFP, or the ACP will save us? Patients will either get Walmart Care at Nordstrom prices or Nordstrom Care at Nordstrom prices. After this month of prior auths, letters, red tape, patients yelling at me, and another tellin me to kiss their a$&, my new plan is to do whatever I can to retire as soon as I can.

    • Arby

      After the game, the king and pawn go into the same box. – Italian Proverb.

      To ignore this is to their own detriment.

    • buzzkillerjsmith

      Precisely. It’s all in Mansur Olson’s 1965 book, the Logic of Collective Action. Actually it comes much before that, but Olson elaborated and discussed the issue at length.

      Upshot: Groups that are organized and focused, even if they are small, win, and groups that are unorganized lose. There was actually a recent study from some academics at the U of Pa and some other place that documented home the rich, a small minority, get what they want from the government, whereas the rest of us get the rind.

      Dr. G. has yet to embrace the despair. Perhaps he was coffeed up when he wrote this. Perhaps he simply lacks wisdom.

      He really needs to talk to me–during my regular office hours, those rare times when I am available to students.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      A certain Tennyson poem comes to mind…. :-(

      • southerndoc1

        “Theirs is not to make reply,
        Theirs is not to reason why,
        Theirs is but to do and die.”

        • DeceasedMD1

          sort of compares doctors to Iraq war veterans or Navy Seals. One nAvy seal was interviewed on Charlie Rose and he had no opinion or awareness of our involvemnent, just said it was up to the president. are MD’s becoming almost of that mindset?

      • doc99

        I’d prefer Dylan Thomas “Do Not Go Gentle Into That Good Night.”

    • SteveCaley

      Yes, I was scolded for not being a Spartacus – a brave fellow, and an honest one. Lost bad in the ninth inning, that fellow did.

  • Thomas D Guastavino

    12:01 AM, Sept 1, 2014, 2014. Every doc walks out of their offices, hospitals and ERs, especially the ERs. Who’s with me! Anyone?

    • DeceasedMD1

      It’s you and me Dr. G. But seriously wonder why there has been no talk of strikes. Pts are being poorly cared for as it is now by CorpMed. So what is the worst thing that can happen? They fire docs? Their being replaced anyway!

      • Thomas D Guastavino

        As I have said in previous posts, there is only one remaining option. Develop irreplaceable skills then as you are forced out the door write on the walls: “Who is John Galt”?

        • DeceasedMD1

          Well you have an irreplaceable skill, but it does not seem to prevent admins from thinking they’re in charge. It’s crazy.

      • Patient Kit

        Strikes don’t just happen instantly or easily. They require organization, leadership, commitment, sacrifice and a willingness to take big risks. I really think that people who have never personally been involved in a strike themselves have no idea how hard they are. They are always an action of last resort after everything else has been tried and failed. Strikes have consequences that can involve hardship and loss in the hope of a longer term win. That said, there is good reason for them sometimes. But once you commit as a group to strike and announce a strike publicly, you better be prepared to follow through and actually do it or you’ll end up in an even weaker position. Still want to go on strike? ;-)

        Personally, I think that all the exploitation that is currently taking place in workplaces across America, now including the exploitation of doctors, is a direct result of the decline of organized labor in this country. Previously, the credible threat of unionization kept employers wanting to keep employees happy to keep unions out. Now with very little threat of unionization anywhere, employers literally have all the power over their employees. And that only got worse and more exploitive in an economic downturn. The demise of strong unions is also a major reason for the ever widening economic class gap in the US..

        We went through a time during which many people drank the koolaid and bought into the idea that each of us, as individuals, could get better individudealers for ourselves from our employers and that being lumped together as a group of employees would only cramp our individual style and bring us down to some mediocre salary and benefit package. We were all so convinced that we could negotiate with a powerful employer one by one instead of collectively. And here we are. Just where they want us.

        But take heart, docs. Although we are all living through a time of major change, I do not believe the situation is hopeless. The controversy of whether you are greedy or working for free aside, I do not believe that the American public believes we can do without doctors. Harness that and rebuild the trust between doctors and patients and we could have a powerful and really big group. But somebody has to do something. From where I sit, it seems like doctors are waiting for someone else to do it for them. If you want to organize a strike, you need to get the general public (aka patients) on your side to support you when you strike. Then you’ll have something. But you don’t just tweet a strike date and just go. You need to prepare and strategize.

        In a side note, I was called a thug here yesterday by a doc when I used the word “threat” in a sentence about mounting a credible threat of moving to a single payer system as a way of creating more leverage with insurance companies by threatening (!) to eliminate their industry. I hope I won’t be called a thug again today by using the word threat again in a sentence with union and strike. If you really can’t be confrontational, you cannot go on strike. Just strike that off your list of things to do if that is the case.

        • Arby

          Union managment sold out to greed too, and to keeping people around that should have been fired. It wasn’t all the memberships fault for the deminse of unions, except that they kept voting the corrupt in.

          • Patient Kit

            Believe me, Arby, I know all too well the dark side of unions. People are corruptible by power wherever they attain that power. I was a union member on my last job. Things got brutal in my workplace. And I worked in the nonprofit sector focused on social justice and corporate responsibility issues. Government, business, nonprofits, healthcare, unions all have one thing in common — people, with all our flaws and weaknesses. When it comes down to it, both democracy and socialism look good on paper. Then you add the ingredient of human nature and poof! Corruption and greed at the top of both.

            That said, in the workplace arena, as imperfect as unions are, they did help to balance the power between employers and employees. Unions accomplished much that we all took for granted and they could do good things again. Any given union is only as good as it’s members and leadership. Now employers have all the power.

            I know you think I’m naive — a harsh word to call me, btw. You call me naive and yesterday a doc here called me a thug. LOL! Perspective is a funny thing. I haven’t had the easy life you think I’ve had and, believe me, I don’t think I can change the world or eliminate poverty.

            I do think I — and all of U’s — can make a difference though. I think we can make things better. At the very least, I believe that even if we’re pushing back against a giant, that things could get much worse if nobody ever pushed back at all. So, I push back. And sometimes I know it has mattered. I don’t need to change the whole world. Making things better for even one person at a time is worth doing to me. But I do believe there is some collective power in working together against giant powers. Does that make me naive or a thug?

          • Arby

            I don’t think naive is a harsh word; it implies innocence. But if that is the way you take it, I am sorry to have insulted you so much.

            You may not have figured it out yet, but I am a very grass-roots type of person. This is because all large organizations even if they started out well, draw the wrong crowd to them and become something along the way that only works for themselves. So, yes, I will draw a clarifcation out of anyone who comments here who thinks the current state of .gov or unions can solve the things we the people should look to ourselves to solve.

            Btw, someone once implied I hated the homeless, another that I was a Marxist and still another I that pillor the anti-vaxxers. I figure it is because comments are not really conversations, and such they are open to vast misinterpreation.

          • Patient Kit

            I was actually a little insulted when you called me naive. To me, it sounds akin to being called an idiot for trying to do anything good in this world. But, as you may have noticed, your “naive” insult didn’t stop me from continuing to say what I have to say or do what I have to do. And within 24 hours, I was called a thug here. I’m sure enough of who I am though to know that I am not a naive thug. ;-)

            I’m pretty grassroots myself. I think we do need good leadership but that should come from the base and not stay forever. When it comes to big mainstream politics like, for example, the 2016 presidential election, I will participate. Even if you don’t like your choices, they are not all the same. Some are worse than others. It’s the system we have. Part of the problem is how many people opt out of using their voices and their votes. Whole blocks of people get ignored because they don’t vote.

            Feel free to draw clarification from me all you want. I’m always happy to clarify what I mean. I do think we have real conversation and discussions here — and good ones. They just aren’t in real time or face to face.

          • Arby

            It wasn’t meant to stop discussion; it was meant to share the perspective of one of those whom you say you fight for.

            Worldlness is relative in perspective. However, I know the worldly are not easily offended, particulary by words from strangers on the web. Why should they be? And, for the poor, they have enough of those insulting them in real life to be concerned about the internet “insults”.

            Btw, I think it is a better thing to not be worldly. Whatever happens to get you there, it is usually not good.

          • Patient Kit

            It’s really no big deal, Arby. It did roll right off my back and I let go of it quickly. I just thought I’d let you know how I reacted to the word since something sparked my memory of it and I realized that I never got around to responding to you in that other thread. I was mildly amused at being called naive and a thug within such a short time. I’ve been called worse.

            I don’t pretend to be dirt poor. I grew up basic working class and I was on my own by age 18. I’ve had my share of struggles but I’m very aware that many have it far worse. It sounds like you’ve had a hard life and I’m sorry for that. I’m well aware of how the powers that be keep poor people in their place and beat them down and make them feel worthless and powerless so they stay there. I’m not going to apologize for spending a good chunk of my life helping where I can. I know that I have helped some and the fact that I can’t save the whole world and change everything does not negate the small amount of good I have been able to do. A person could do worse than having me in their corner advocating for them. I’m pretty stubborn. ;-)

            We may be strangers on the Internet, but I wouldn’t be wasting my time participating in discussions here at KMD if I thought it was totally meaningless. I’ve cared deeply about healthcare reform for a long time and after my recent experience of being diagnosed with ovarian cancer while uninsured, I thought my story was worth telling here. So I shared it even though I knew I would catch some attitude because I am on Medicaid. I can only imagine what it’s like to be on Medicaid for a whole lifetime. My experience on Medicaid has been good, partly because I knew how to advocate for myself and go after the best care I could get. And I got it.

            Maybe I reacted badly to being called naive because I don’t believe that ignorance is bliss. I’ve been living in the real world for many years. I’m in my fifties. I guess I feel like I’d have to be pretty clueless to be naive at this point.

            No hard feelings. Just communicating how I feel.

        • LeoHolmMD

          Good points. You are not a thug.

        • DeceasedMD1

          i am well aware that it requires an organization and planning. But it is interesting at one point when I mentioned a union here my post was deleted. You make an excellent point about unions being weakened and now here we are again. Although i undersatand some unions now are corrupt themselves. what a mess.

          • Patient Kit

            I didn’t mean to imply that you, in particular, don’t understand what it takes to organize a union, DeceasedMD. I’m sorry if it sounded that way. But I think doctors in general, as a group, might not really know. It’s definitely worth trying to figure out WHY doctors haven’t taken more action, union or otherwise, to exercise more power in our healthcare system. We can’t hope to change things until we figure out that WHY. it’s never too late to find your inner rebel. ;-). I wonder why your post got deleted just because you mentioned the word “union”. That seems odd. Are you sure it wasn’t something else you said?

          • DeceasedMD1

            No offense taken. u are probably right we don’t know as it has not happened. so u have some good ideas. My only thought is MD’s are fragmented groups. Sort of feels as formidable as getting the various factions in Iraq to unite. A joke but i think it is difficult. We have a good idea of how people feel on here, but I don’t have a feel for how other specialties feel about the problem issues in medicine. I also think to some degree there is a huge lack of empathy. And specialists are now taking over what PCP did, so there is less incentive perhaps to help. Everyone has their own turf and protects it to the fullest. So I could be wrong but it is odd that with PC being undermined, that all MD’s would be concerned because in the end it will affect them as well perhaps indirectly. And it does not help having the AMA or any of these orgs cowering or working in a business model corrupting medicine IMHO.
            And yes the post I had written several about unions which they took and then the last one
            was deleted with some flag. not much else I said on the last post so I assumed. But in any case I wish there was a way to form a group. And u no doubt would be a great asset! i keep dreaming…

        • Suzi Q 38

          I agree with everything that you said and want to add more.
          I remember the teachers in our area striking.
          When teachers strike, they do so in great numbers.
          They tell everyone that they are going to strike.
          They involve the parents as well as the students.
          I remember seeing students and parents standing in a strike line on behalf of their teachers, not allowing cars to pass through a
          “wall” of people. Teachers begged students not to go to school, and to support them.

          I remember ads for substitute teachers, who would be paid 3 times the normal wage just because they “crossed the line” and taught a class.
          The school districts want to avoid strikes because they lose ADA money. That is the money the government pays for each child each hay h/she attends school.
          If the students don’t go to school, there is no money for the school.

          If the patients strike with the doctors, this would send a strong message. I would support any doctor of mine by supporting their stand for themselves and their patients.

          It would be hard, but at least doctors should be aware that teachers have done it successfully for decades. Why not doctors?

    • LeoHolmMD

      I think there are only a few ways a strike would be successful in medicine. Care would have to continue, perhaps for free, in the streets…or similar. I think the only way to really sock it to the “system” is to hold a more general strike involving the patients: stop utilization for a few days or get patients to stop paying premiums. Light up HHS phone system with complaints…or something like that. Patients will have to be involved or it will not seem like it is about them…even though it is. It would be far more effective to target smaller entities like hospitals or the Boards. In fact, I suspect the ABMS could be shut down immediately if everyone stopped paying for dues/MOC etc.

      • DeceasedMD1

        If we could only stop being so d@mned compliant!

      • Suzi Q 38

        Believe it or not, you have got something there.

    • Suzi Q 38

      Great idea.
      I hope the “masses” of doctors join you.

    • Sarah

      Here’s one courageous oncologist who did just this thing!

      http://www.oregonlive.com/portland/index.ssf/2014/04/former_oncologist_claims_kaise.html

  • Arby

    A large part of the public has been rewarded for doing what we are told with another large part doing nothing at all.

    So who do you want to hang out with on the playground?

    • James O’Brien, M.D.

      AAPS is the only group that gets it. With their suit against ABME, they are isolating one of the bullies and basically smacking them in the nose in front of the whole class.

      APA, on the other hand, was told to shut and and listen in 2009 during ACA negotiotiations, and they complied.

      I am completely serious about this classroom/playground metaphor. We want life to be like the classroom, but it really is the playground especially when it comes to the Macchiavellian politics and finance of medicine.

      If doctors think they are going to win by being good students and citizens and working hard to impress the teacher, they are in for a world of hurt.

      • Patient Kit

        Is this classroom-like world you speak of anywhere near the Ivory Tower? I really think you’re onto something here. I’ve asked before how doctors can go through such a lengthy education process and, after investing so much time , money, effort and youth in becoming a doc, start their career clueless about the politics and economics of the healthcare system they worked so hard to become a part of. I can understand being all starry-eyed and innocent in med school. But once you’re out working in the system during the residency years, you’d think the real world would be hard to ignore.

        • Mike Henderson

          Your statements are exactly what I explain to others. I have no intentions of investing so much effort and time to just let it go to waste in the current system. How other physicians tolerate this, I have yet to understand.

          • Patient Kit

            Direct pay may be the answer for you and your patients and, if so, that’s great for your little group. But it’s not the answer systemwide for many patients or even many doctors. And so, we continue to search for solutions that will work for the rest of us. Even though I consider DPC a niche that will never be a widespread model, I am happy for you that you’ve found a way to be happy practicing medicine.

        • James O’Brien, M.D.

          It is the ivory tower indeed. Many medical organizations are led be a subgroup of tenured physicians who don’t have the same skin in the game and who see far fewer patients. Many of these people are ideologically in favor of ACA unlike the rank and file. AAPS is the exception.

          If you post on the board to complain about the state of medicine, and you still belong to the AMA, I submit you are a turkey paying dues to The Thanksgiving Appreciation Society.

      • DeceasedMD1

        Is AAPS involved in other bullying such as how medicine is being overtaken by medical industrial complex? How they could become employees fo hospitals soon without independent practices?
        Know why APA rolled over dead? I get the idea they are cowards -like many of these med org. but not sure what they are afraid of.

      • Suzi Q 38

        I personally think that they should strike or sue their own corporate employers.
        They are going to have to band together and fight, but most of them are truly tired at the end of their workday to make plans and execute those plans.

  • DeceasedMD1

    That is the first time i have heard any of us say that, least about ourselves. I am afraid there is truth. we can complain all we want but unless someone finds a way to organize, They are out to undermine us.

  • Patient Kit

    My admittedly rebellious self has been mystified at how uninvolved doctors have been in the healthcare reform process in this country because, to me, it seems like doctors should have some power in this process.. It’s been explained to me in numerous ways like doctors don’t have time, doctors hate politics, all the other parties involved are too powerful to go up against. Yeah, because you let that happen. But characterizing docs as generally non-confrontational, unrebellious and afraid to rock the boat explains to me a lot better how we got to the point we are today. Maybe some docs thought they were above politics, untouchable, indispensable and there was no good reason to get involved in that side of medicine. Maybe some docs thought they had too much to lose to risk rocking that boat. Well, welcome to the world of nothing left to lose — it’s fertile soil for rebellion and confrontation.

    On my last job, we went through a series of mergers, restructurings, reorganizations and the nastiest work situation of all — a demerger when a merger didn’t work out. That was like a bad divorce and trying to unscramble eggs. We had two presidents during that phase. And let me tell you, the two presidents thing did not work at all. During that time, we started to go through a series of layoffs. The first group of employees to get axed were those who tried to stay under the radar and stay uninvolved in the politics of the power struggle. Those of us who picked a side lasted much longer. Lots of people got caught in the crossfire of that power struggle, but the first ones to get axed were those who tried to fly under the radar.

    • RuralEMdoc

      “If you’re not at the table, then you are on the menu”

      • Patient Kit

        Care for some doc chops or a piece of patient pastry? Or perhaps you’d like to try the house specialty that combines the two into a tasty meat pie. ;-)

      • doc99

        If you’re only goal is a “seat at the table,” you’ll most likely get stuck with the check.

    • SteveCaley

      Consider the ministers in Germany in the 1930′s. A silent lot, they were.

      • Patient Kit

        Silence isn’t always golden. Sometimes it’s cowardice. Sometimes it’s even evil.

        • SteveCaley

          “First they came for the Socialists, and I did not speak out–because I was not a Socialist.
          Then they came for the Trade Unionists, and I did not speak out– because I was not a Trade Unionist.
          Then they came for the Jews, and I did not speak out– because I was not a Jew.
          Then they came for me–and there was no one left to speak for me.”
          Pastor Martin Niemöller (1892-1984)
          Divide and rule..” Joseph Stalin

  • Dr. Drake Ramoray

    IF this doc thing doesn’t work out for you, you might have a career in literature. Not that I don’t hope your right, I just don’t think docs or patients will win this one.

  • Doug

    I think you left out the “cross of gold” bit, but otherwise bravo on the hyperbole fest.

    Not buying into the self-pity, not buying into lying down either. How many of us take an active role in our profession’s representation? A vast minority. Our voice isn’t silenced, it’s non-existent. We are a minority voice in politics. The groups that represent us are only populated by, at best, a percentage in the teens.

    So many of us feel so comfortable in getting on a site like this and “letting loose,” which is the most passive-aggressive strategy we could ever take. We know we’re among more like-minded folks here. Until the majority of docs start bringing well-articulated points to people who matter, I won’t hear this whining. I just won’t.

    • Suzi Q 38

      So true.

  • Patient Kit

    Great response, Dr Grumet.. As a patient, I’m awed when I think about what it takes to become and be a doctor. You all have to stop believing that we patients have all been turned against you because that’s what you read in a few articles in the NY Times. That is what they want you to think. My mind boggles at the many ways that our enemies have been able to divide and conquer — doctor v patient, primary care v specialists, independents v employed, young docs v old guard docs. Anything to deflect off of who and what our real enemies are. Anything to weaken how powerful we could be if we actually stuck together.

    In the words of Bob Marley from his wonderful “Redemption Song”:

    “Emancipate yourself from mental slavery;
    None but ourselves can free our minds…
    …Won’t you help to sing these songs of freedom?…”

    This country was born of revolution, not all that long ago. Why has the idea of rebelling against anything powerful and exploitive become so impossible for so many Americans to even imagine?

    • Dr. Drake Ramoray

      If a you talk of revolution now you are a domestic terrorist and are put on an NSA watch list.

      • Patient Kit

        As a longtime activist who loves my country, I choose to exercise my precious First Amendment rights of free speech and the freedom to criticize my government. Use it or lose it! [see raised fist photo at the top of this thread]

        • Dr. Drake Ramoray

          I am not saying I disagree with you. I’m just pointing out the modern reality

          • Patient Kit

            And I agree with you that it has gotten more complicated since 9/11. But as someone who stood here in NYC that day and personally watched those towers fall, as someone who will never forget the sound of inconsolable wailing in the middle of the night coming from my neighbor firefighters’ homes (we lost 81 that day in my Brooklyn neighborhood, several on my block), I consider exercising free speech and criticizing my government as important as ever. Our First Amendment rights will always trump NSA for me.

          • James O’Brien, M.D.

            Speaking of NSA, do you think that a government that cannot keep the names of Iranian double agents out of the hands of Wikileaks is capable of keeping your ob/gyn or psych history out of the hands of hackers?

          • Patient Kit

            Maybe not. But I don’t think Blue Cross or Aetna are necessarily any more capable than government of protecting our personal health history information from hackers. Or hospitals. Or doctors. Or anyone who has a lot of confidential patient info in an electronic file.

          • James O’Brien, M.D.

            In which case you can sue them. Try suing the Federal Government.

            Look, I get it, you like OCare because it’s a good deal for you or you think it is (revisit that idea in a year). Well if you are paying less into than you think you’ll draw, that’s no surprise. But someone has to make up the difference. It’s not for most Americans who are paying more and having fewer choices. National policy shouldn’t be based on what you like but what is good for the country as a whole.

          • Patient Kit

            LOL! I can guarantee that national policy is not based on what I, PatientKit, like or want. And, while I do believe that many doctors are struggling for a variety of reasons, including lack of emotional support from their colleagues, I don’t believe that the ACA is driving doctors to suicide.

            If you read a few of my posts here you’d know that I actually have plenty of issues with the ACA. But the ACA came into existence because what we had pre-ACA wasn’t working. We’re not there yet on where the US healthcare system needs to go. Do you really believe that all of our healthcare system’s complex problems started with President Obama?

            What I want is good, affordable, accessible healthcare for all Americans. And I’m open to any reforms that will achieve that.

          • James O’Brien, M.D.

            That’s what Medicare patients say who use more than three times what they pay into the system .

            Meanwhile, we are approaching 100 trillion in unfunded health care costs by 2035.

            The math doesn’t work. That debt can never be repaid. Bankruptcy and Weimar type hyperinflation are the only options. You can argue, but history and math says I’m right.

            The problems with health care could have been fixed by far less than a government takeover.

      • James O’Brien, M.D.

        Dr. Ramorary,

        I was at a medical meeting this past weekend.

        I looked forward, I looked left and then looked right and asked my self an honest question.

        Do I sincerely think this group can or will stand up and rise against the hospitals, politicians, and lawyers?

        They are all fine, bright, dedicated people, but soldiers or even punks/playground fighters they are not. The Martin Prince comparison is apt.

        The answer left me even more comfortable with my decision to go off the grid. Which I did in 1991 because I saw this coming.

        • Dr. Drake Ramoray

          I just began my pre-liminary application for emmigration to New Zealand yesterday. My wife has finally seen the light and said it can’t hurt to have options. This has begun in part because of the pushback I’m getting from patients who are mad at me about the insurance they have. In the last two weeks, I have been cursed at, told to kiss a patient’s a$$, called a quack, and accused of getting kickbacks from the hospital (I’m in a small private practice) for radiology imaging. Mos of this is the result of very high deductibles. But lord knows if I’m off my A-game for one visit, I’ll get some flamingly bad online review, or bad patient satisfaction survey if I worked in a hospital.

          My goal is still a low cost direct pay practice (although I have posted elsewhere there is already some discussion in VA and Mass about taking medicare/medicaid as a contingency for licesnure. I’m a first generation American immigrant, and this is not the country my parents moved to. It’s always good to have options and your right docs aren’t gonna win this fight.

          • James O’Brien, M.D.

            Smart move. I visited NZ in 2001 and fell in love with the place. I get frequent very good job offers from NZ but I haven’t jumped on any yet because my situation here off the grid is still uniquely good. But I always like having that idea chambered in case things go bad quickly in a way that directly affects me.

            Docs there have all the advantages of practice here with few disadvantages, except they make a bit less. But it’s probably worth it for the stress reduction and lifestyle.

            If you need information about NZ recruiters, feel free to ask me for contacts.

          • Arby

            i wasn’t going to be back commenting for some time, yet I followed a hop from Disqus and saw one of Dr. O’Brien’s replies. I read his comments on other blogs with interest so started I reading. When I came across this comment of yours…holy cow! Although, I really mean another word.

            It makes me sad. Don’t get me wrong; I am happy for you wherever you end up happy, but it is the idea of it I find distressing. About the country being different, I understand. A relative of mine worked with a couple from Russia that emigrated here and they once told her that over the years it just began to feel more and more like they never left there. That they lived in that environment and see the parallels in our country today, I think bears listening to.

            However, I still hope it doesn’t get so bad that you think your only good option is to expatriate. The country can’t afford to lose you and I mean that sincerely. It is individuals that make this work not the powers that be.

          • Dr. Drake Ramoray

            It’s not quite as dramatic as it sounds. It’s a multi-stage process to move to New Zealand especially credentialing as a physician. I actually looked into doing so following fellowship. It’s more of a long term contingency plan say should I have no other option to work for a corporate hospital. My short to medium term plan remains to stay and start a direct pay practice. The new driving force to look into it has resulted from the behavior of patients as healthcare changes have occurred.

          • Arby

            That’s cool. I did misunderstand. It just really bothers me to see physicians feeling like they have to flee because our country is in what amounts to a three-year’s old temper tantrum, by the populace and the government alike, and not just in healthcare.

            I wish you well in your practice wherever, but if you stick it out here please keep in mind that not every area of the country is the same; what may not work in one place may very well work in another. There are still some adults left in the country. And, on that note, I hope you enjoy your Independence Day, brought to us once upon a time by some adults.

          • Dr. Drake Ramoray

            Happy Independence day to you as well.

            http://firedoglake.com/2014/07/01/america-ranks-36th-in-feeling-free-to-choose-what-to-do-with-your-life/#

            We have some work to do in this country, but are we really grown up enough to do it?

          • Arby

            Apparently not.

            The Russians weren’t Republicans nor am I, but if I ever run across them, I’ll be sure let them know they should have moved to Uzbekistan. Although the first comment on the article you linked to, does call into question the validity of that survey.

            If you wish to have single payer, stick around it will come soon enough. They are talking of raising premiums up to 20% in my state. That will only go so far with the populace before single payer will be here.

            For that matter you don’t need to wait, you can work for government now or in academia. You still have choices left for the time being. But, if your real problem is getting yelled at by patients, don’t expect single payer to solve for that or even academia; I’ve seen some student meltdowns too.

            Unfortunately, I worked retail and there is no end of things people will yell at you for and it goes beyond class or political party. Which is what I meant when I said there are still some adults in this country. Adults don’t yell at their doctor over their deductibles.

          • Dr. Drake Ramoray

            I could have picked many a website that discussed this study. Many of the “conservstive” ones attributed their meaning to the survey as well.

            I am not waiting for single payer (That should be pretty clear from my desire to go direct pay) but I do believe it was thrust upon us so that the populace will demand it.

  • Dr. Drake Ramoray

    History is not on your side. Walmart systematically destroying destroying mom and pop shops. Lowes and Home Depot killing independent hardware stores. A handful of grocery chains in any given region of the US. Big box stores galore. I call it the Walmartification of medicine for a reason. It will be like walmart, except for the prices.

    Medicine is being coporatized with the backing of the government and Medicare. I appreciate your optimism and agree with your most recent statement, but the answer is going to be a low cost direct pay practice.

    • Arby

      It is the only thing that provides some level of choice over own bodies. That or just don’t go to doctors for any disease that is isn’t quantifiable.

    • Suzi Q 38

      This is nothing new. You are citing businesses who are big, gobbling up the little businesses.
      We have a free market economy, which is legal and allowed to proliferate and grow.
      The “drivers” of this phenomenon are the consumers who “vote” with their hard-earned money. We are responsible for Levi Strauss changing their manufacturing locations from the U.S. to an outside country. There goes all of those jobs….all because I don’t want to pay more than $50.00 for a pair of jeans…although my daughter seems to think that I need to wear Paige jeans with a $100.00 price tag.
      As far as the grocery stores….Albertson’s prices were kind of high in my area. Then over a decade ago, they had a major strike. They had employees telling us that we had to go shop at another store.
      it was then that I realized that for many years prior to the strike, I was paying way too much for my groceries. They taught me to go elsewhere…
      Now I shop at Winco in California, which is huge.

      My point is that the big corporations aren’t the only problem. It is price and service.

      • Dr. Drake Ramoray

        Yes I’m all for free markets and competition, and there is certainly something to be said about economies of scale.

        Perhaps a better example is the banks. There used to e mom and pop banks wig personalized service, and owners/employees who served their community and were well respected individuals in their community.

        Then the government comes along (in concert with the big banks) and adds all these rules and regulations that the small banks can’t handle and as such they either go out of business or merge with the big banks.

        Government, hospitals, an insurance companies are targeting the independent physician. What medicine is under going is just about anything other than a free market change.

        My point with the other examples is that soon there will only be big players in healthcare and people won’t have options because the rules are being made in such a way that only the big institutions can follow them. An individual or small group of doctors has no hope of meeting all the GOVERNMENT requirements that have a dubious connection to patient care. The hospitals and insurance companies love the changes. We don’t use EMRs because they are high quality and improve patient care (they could be but they aren’t). We use them because we are mandated to do so. And again, the small independt practice struggles to be able I afford them. It’s just another line item expense (albeit a big one) for a hospital corporation.

        In the not to distant future seeking healthcare will involve a regional monopoly, who has you seen by a random PA/NP (note the random part and because they are cheaper) and you will be a managed population not an individual patient. Your medical care will be closer to calling your cable company than going to the doctor.

        The American people are being weaned off the individual relationship with a personal physician through crony capitalism and intimidation to “manage” populations. We aren’t talkin about freedom Steve Jobs and Apple here.

  • DeceasedMD1

    How so other than direct pay? and that helps one control their practice but does not solve the crisis in medicine and still affects one indirectly. sort of like your piece about — was it allergist consult that would not take your referral because he worked for CorpMed and u didn’t.

  • SteveCaley

    Revolutions, to work, must be practical. The most necessary thing is they should take place in a society with a conscience. Otherwise, they are demonstrations, insurrections and similar nuisances, which can be suppressed with very little work.
    The viability of conscience in society is a symptoms of its own homeostasis – wellness, as we are used to it. A society that is not well often does not have much of a conscience or immune system. Energetic gesticulation in such places is little more than a curiosity that quickly evolves into a nuisance.
    All Americans are taught of the brave New England farmers who stood on the chilly Concord hillside, in 1775, to show the British that revolution was in the air. Very few American remember that eight years afterwards, many of the same veterans stood on the same hillside, in 1781, to oppose the new Government – the free and independent Massachusetts Government – by force of Arms. The Governor marched the Massachusetts Militia to Concord, break up these same veterans, by gunfire and death if necessary, for standing up against the New Boss. But look it up, and Daniel Shays, too.
    The same fellows who represented the sweep of righteousness in 1775, were merely a nuisance and an obstacle in 1781. And yes, some of them were shot down. Their call for relief from oppression and financial ruin, was simply bothersome to the new Leadership; and was ignored.
    Our society seems not to be aware of, or suffering much, from the decline of the American civilization. It does not seem to be seeking relief. It is not oppressed by conscience, as it was during the time of Civil Rights Movement. It is possible that neither analgesia nor stimulation has much benefit to the comatose patient.
    Consciousness-raising and organizing a revolution to restore humanity in the here-and-now, must be respectful of the state of the civitas and society, culture and civilization in which the here-and-now rests. I fear that perhaps, as a society, we merit the DNR.

    • DeceasedMD1

      If you ever decide to retire, you should write a book. This is very insightful and something I have been searching to articulate for awhile. There seems to be no conscience in our society. All these admins and Press Ganey are just ways to placate the masses. It is clear they just wish to pacify and keep the status quo.

      Often the few people left who still have a conscience, write logical articles here on ways to fix the system. But it does often seem like they miss the fact that there is no investment by the powers that be, in doing so. You are spot on that they are likely considered minor nuisances to be pacified. In a nut shell, you have explained why it has been so frustrating and well, sort of hopeless to complain as it is met with deaf ears.

      The recent mass shootings expose what you are saying to be true about society. There seems to be little regard for public safety, even small children’s. It does seem that addressing gun laws, and helping a fractured mental health system would address some of those. great example was the recent Seattle shooter who had a psychotic disorder and h/o multiple psychiatric hospitalizations. He c/o hearing voices of the Columbine shooter telling him-what else-to shoot and kill masses of people. He was able not only to get a gun, he actually had worked in a shooting range a few years back. Does not take a genius to figure out policies that would prevent this. But Americans after Sandy Hook have given up. Like you said it is screaming to deaf ears, to those that want to show their might through their guns and it is of course quite a lucrative business.

      It is also striking that when society is declining and fearful, they want more police intervention. In fact they sort of change their role: Police are becoming the new psychiatrists if you will. They are expected to do full crisis evaluations such as the Elliott Rodgers case. The NY Times reported today a sheriff in Texas is complaining that he is housing the mentally ill for petty crimes related to their mental illness in his jail and it is costing a fortune. And he feels the mental hospitals should be taking care of this. Imagine. Now the police are being asked to treat the mentally ill like criminals. It is pretty bad for a sheriff in Texas to have to say, that’s not my job. Clearly it is engineered this way. Almost seems like the society has a need to punish the most vulnerable.

      • SteveCaley

        Thanks for the compliment. I actually had a “sabbatical” a little while ago, when I was fired for unprofitability at a clinical position. They were pleased with my medical performance, but walked me off-premises just the same.
        I’d used the time to read a bit – and I enjoyed Jared Diamond’s Collapse: How Societies Choose to Fail or Succeed Ours is not racking up the “succeed” points.
        We ignore problems such as the outbursts of gun violence, under the haughty assumption that “I don’t have time for liberalism,” to be bothered to help people with this-or-that problem. “Let them pull themselves up, I’m busy!”The concept that such things are symptoms of a sinking society does not occur to us.
        In our society, we often note that those who are struggling to keep up, and who are humiliated for poor performance often tied to their mental illness, seem to organize themselves around a violent and powerful “fictive personality” that seeks revenge. Cho in Virginia Tech seemed to fit the bill. And it’s usually high schools, occasionally colleges – never bowling alleys or ice-cream stands.
        Following that line of analysis, I’m waiting for the first shooter to take on a clinic or a hospital. I fear that’s next.

        • DeceasedMD1

          gee I’ve been thinking the same thing for awhile about hospitals or clinic shooters. Not sure if it would be an angry pt or a doc tired of the latest EHR though.
          Sounds like a good book I may have to read. Clearly it is no wonder ethics is on the brain. How demoralizing to get escorted out for accurate diagnosis. The only time I hear that is when some Silicon Valley start up is threatened you will give away secrets so off you go with security. Sounds well just a wee bit paranoid. Wow you must be good if you are unprofitable. That is quite a compliment.

        • DeceasedMD1

          yes I have been thinking the same thing about shooters in hospitals. Just not sure if it would be a disgruntled pt or a doc frustrated with the latest EHR. Congrats on getting escorted out. That is quite a compliment to be unprofiatable. Shows what a good diagnostician you are and how they are just a wee bit paranoid. Do you think? LOL. Have had my share of these nut job admins as well. This is where mental illness starts.

        • Patient Kit

          There already have been multiple shooting in hospitals. There was one in Johns Hopkins ED a few years ago that precipitated a report by Gabe Kelen,MD, Director of Emergency Medicine at Hopkins (Annals of Emergency Medicine, 9/12/12).

          He found that between 2000 and 2011, there were 154 hospital-based shootings resulting in 235 dead or injured, with 30% of the shootings happening in EDs, 50% with police or security weapons Most shooters had a personal association with the victims. Dr Kelen concluded though that we have about as much chance of being shot in a hospital as we have of being struck by lightening.

          • DeceasedMD1

            yes you are so right. There was doc shot at JHU. Thank goodness he is OK. I met him briefly. A disgruntled family member whose mother was pretty ill and I assume communication was lacking-just a hunch. But yes the gunman shot the doc and then kllled himself and his mother. very tragic. Is that the one your thinking of? But I am forgetting how often it happens. just does not make the same kind of sensationalized news usually and does not involve masses of people.

          • Suzi Q 38

            I don’t know about that case, but in general, a person’s of family member’s health is pretty important. What is an everyday thing to many physicians and other heath care professionals may be deeply troubling to the average patient(s). If you add into the population people who are borderline schizophrenics, severely depressed, or mentally unstable, you as a clinician may have a bigger problem on your hands than you initially thought.

          • DeceasedMD1

            I didn’t want to say that, but that was my hunch as well. And this was a busy surgeon who I have a hunch was out of tune with how unstable and stressed this fellow was. Again just a hunch but I think you are on to something there.

          • Patient Kit

            Yes. The Johns Hopkins case was a distraught son shooting his mother’s oncologist surgeon and then killing his mother and himself. I have no idea what the details of the situation were that precipitated the son taking such extreme action.

          • DeceasedMD1

            It was an JHU orthopedic surgeon and I think the son was taking care of his ill mom who was the pt. and well.. lost it. The orthopod survived at least as you likely read. Sad situation. Thanks for pointing out it’s already happened as I forgot about that one. In internship, I am now remembering one of the ER attendings was shot by a pt. Not a good outcome. How did I forget that one? Seriously it was bad. They were thinking of getting extra security and metal detectors but nothing much happened. Lots of training occurs in bad neighborhoods. Stay away from charm city. Great place to get mugged between U of Md and JHU. Surprising it does not happen more with the increasing number of disgruntled pts and well docs too. If it was in the financial sector they would have payed for armed guards. Anyway enough of my banter. hope u had a nice swim.

          • Patient Kit

            You’re right. The doctor was an orthopedic surgeon who had done spine surgery on the mother and the son got upset when there were complications. I’m glad the doc survived and that this doesn’t happen more often. I don’t know where I got oncologist from — either another shooting or I just have oncology on my mind for obvious reasons.

            I don’t know why you forgot the shooting of the ER doc while you were an intern. It must have been terrifying. My sister who works as a psychotherapist (MSW) for HHC, which is NYC’s public hospital system, would probably say that it was too scary and traumatic for you to remember if you were going to go on working in hospitals.

            I really think there is only so much that can be done, securitywise, in hospitals with so many people coming and going, especially against determined shooters. I was here in NYC on 9/11 and I get in the subway everyday knowing that there is no way that it could be secured. It’s just not possible. And freedom isn’t worth giving up for the illusion of security.

      • Patient Kit

        “Almost seems like the society has a need to punish the most vulnerable.”
        **********

        No doubt about it, there is a lot of utter contempt — the opposite of empathy — for the poor, weak, vulnerable, elderly, sick (especially the mentally ill) and the plain unlucky. Many people seem to believe self-righteously in survival of the fittest while some of us — including many docs, I hope — believe that those of us who can should help those less fortunate than us. Pick your side in that particular battle between good and evil.

        • DeceasedMD1

          Thanks Kit. not trying to get too philosophical here but it ties in with this blog and IMHO is just getting worse, which makes the practice of medicine more challenging.

    • Arby

      Thanks for the history lesson; I have always loved history as there is nothing new under the sun.

      Ever ponder the idea of the false help of those that think they know best how to care for the downtrodden, yet make things much worse. They can always take the moral high ground by what they have said, but their actions are incredibly harmful and coercive and usual allow their wards very little choice in the matter of their own care.

      • SteveCaley

        Ah – try Chairman Mao’s Great Leap Forward – the reorganization of Chinese agriculture into modern techniques and practices, and communes rather than private farms. The peasants had to be pushed hard to undertake the change – sometimes it takes a firm hand to mobilize the backward-thinking members of society!
        Alas, the reason that the peasants were moving so slowly wasn’t due to lack of revolutionary fervor. They were moving slow because they were dead from starvation. 45million died from the Great Leap Forward, almost all from starvation. Oopsy, Mao! Take a Mulligan on that plan.

        • Arby

          Ok. I mentioned history; I guess I asked for that. I wasn’t thinking of such an extreme example by a ruthless dictator. More along the lines of the destruction of neighborhoods to move urban poor into public housing by well-meaning individuals without the ability to see the outcome.

          However, for your example, wasn’t the reason given that it was a matter of starvation either way because the peasants couldn’t support themselves?

          • Patient Kit

            If you haven’t already watched it, I recommend watching HBO’s “The Wire”. It’s a great show that really nails institutional dysfunction, including intentional dysfunction to keep people down and how those institutions effect people, especially the poor. It takes place in housing projects in Baltimore. The show lasted 5 seasons and covered a lot in that time but I wish it had lasted another season to cover the healthcare system the way it covered other systems so well. That show had so much resonance. I reference it constantly.

          • SteveCaley

            Naw. The peasants were doing fine being Chinese peasants – a skill that they’d perfected a couple dozen centuries before the Western peasants. The Chinese peasantry died from Bright New Ideas. Had they been left alone, they could have been going on the old ways just fine. The Great Leap Forward was a case of fixing something that wasn’t broken.

        • James O’Brien, M.D.

          It doesn’t matter to the central planner. They meant well. Results be damned.

  • QQQ

    A large percentage of doctors will find that they will be unable to
    survive financially…so many have huge loans to repay from their time
    in school, and with the 6-digit cost of malpractice insurance thrown in,
    they won’t be able to pay their bills, let alone make an income…it’s
    simply an extension of what’s going on now with the way
    medicare/medicaid programs limit what they can charge, making it
    necessary for them to depend on other patients’ ability to pay and the
    insurance they carry…which in turn becomes problematic because
    ObamaCare
    or any national healthcare program will severely limit those insurance
    payments, making it then necessary to charge even more to the patients
    who pay on their own…and there won’t be many, if any, of those
    anymore…in short, or severe doctor shortage in this country today will
    become even more of a problem, and a lot of the treatment now available
    simply won’t be available from truly qualified personnel anymore, and
    thus will become rationed, and of course that will make it even more
    difficult for doctors…Because they’ll be stretched so thin…

    In
    effect, what ObamaCare does is create a situation in which there will
    be many fewer highly qualified physicians and a tremendous amount of
    your medical care will be administered/prescribed by minimally
    trained/educated/experienced people making, for all intents and
    purposes, minimum wage…think of it this way…when you go to have
    something fixed on your car, you want someone working on it who has a
    bit more idea about your car than where to put the gas in.

    • Suzi Q 38

      I agree with you, but why did so many physicians vote for Obama and his healthcare plan?

      • QQQ

        They wanted hope and change! Instead they got a bait and switch!

        • Suzi Q 38

          I agree.

          I could see this, and I am not as knowledgable as most physicians. I could see “the writing on the wall,” which is so clear now.

          I advised my daughter, who was a nurse, to consider an NP degree. I could see that the NP’s and the PA’s are going to be needed with the president’s new health care reform.

          What does this mean for GP’s and patients?

          It makes for very resentful doctors who, rather than take out their frustrations on their employers or the healthcare system, take it out on their patients.
          This is sad for us, who are used to good treatment by our physicians. It is hard to accept this and we are at times getting angry.

        • James O’Brien, M.D.

          I question the maturity and character of anyone who liked the slogan “hope and change”. Hope is buying a scratcher to win a million dollars that you didn’t earn. It’s not a commitment to work hard to advance one’s skills to improve one’s lot in life. It’s not a plan to solve a problem, it’s just magical thinking. As far as change, all of the changes have been bad, especially in medicine. A change I would have liked in 2008, the end of “too big to fail” was not endorsed by either candidate. Instead banking was “changed” by the Dodd-Frank reform, which is basically the white collar equivalent of the Lansky-Luciano crime bill.

          A smart, self-aware society doesn’t behave like this.

      • James O’Brien, M.D.

        I hope every zombie who supported ACA and entered medicine in the last five years does go broke.

        It’s not a good thing to walk around as childlike adult.

  • DeceasedMD1

    Well that about sums it up. LOL. I agree FP/IM and anyone in PC are pretty much at the DNR stage. I think our profession is so divided. The AMA is the new mafia to me-thanks for the link BTW on their role in ACA. Did not realize back then how lame they even come across to politicians.
    I can see that most of us that blog here are pretty much of the same mind set, but if we were in Derm we may have a whole new outlook on life and would never come to look for KMD. Might not be so bad: a little botox here and there.
    We are too divided and it is not clear that all docs are unhappy. You are probably right about the hubris and likely plain old fashion denial of many physicians. I think many don’t want to see the big picture. It also does seem quite dependent on specialty and where you live. But how happy can it be to be in onc where generic meds are scarce for your cancer pts? Maybe a good salary but like u said money ain’t everything. And it seems like instead of concern for other docs, it is so very adversarial. Look no further than the RUC meetings. That meeting sounds like PC is left fighting for the crumbs. I guess greed is at play here and they have so much hubris, they don’t realize they are destroying medicine by killing off PCP’s through torture and financial starvation. Water boarding sounds more pleasant. In that regard we are surrounded by enemies.It is especially bad the AMA is high up on the list.
    Strange you had your posts censored here. You always have intelligent points to get across. I mentioned the word union more than once and was censored.

    If we did have a voice, we would need an ear to listen. I am beginning to wonder if in our society that values sports, yelping, and tweeting if there is a conscience here. We live in a society that has been unable to change even after Sandy Hook to make children safe. Not to digress but this is a bad sign. I think Steve Caley has a good point above that society has in part responsibility here too. Without a conscience, our concerns fall to deaf ears. I am not sure we should give up, but this thread shows all of us are struggling where to go with this. It seems futile to many.
    And I do agree with you about the younger generation coming in. I would prefer death before I have to rely on one of them if I get to old age-at least from what I read on here I have been appalled. The other group that are frightening here are the tech gurus that have wonderful solutions in not only curing all diseases but creating devices that will make our lives so ever more efficient.

    • James O’Brien, M.D.

      Creative destruction does not occur in centrally planned economies. So that won’t happen.

  • DeceasedMD1

    She resigned in April 2013, because of her oath to do no harm and her belief that Kaiser policies were “making patients suffer,” her suit states.”

    That was refreshing. But how does this help the hospital get sued by more than a disgruntled doc or any change to occur. Sounds like a disgruntled doc being paid off a few million for her pain and suffering dealing with her employer. A few million is nothing to Kaiser. What about charges against the hospital for the ways they practice oncology? sounds like onc pts will continue to be treated poorly butnow thye can read about it.

    • Suzi Q 38

      I don’t think that Kaiser will change its practices just because of one little lawsuit. On the other hand, I had a series of bad experiences with my health care, and my insurance was a very expensive PPO. In other words, I could choose whatever physician or hospital (non Kaiser) that I desired.
      After all of those mistakes and a “near miss,” I am presently wondering if the high premiums for my PPO care is better than the low premiums at Kaiser.

      • DeceasedMD1

        My disqus is not working Suzi Q so I am glad I found your post. I very much agree with you. Most academic and CorpMed type hospitals goal is to extract as much money as they can. That is their goal. Seriously. But that phrase you get what you pay for is no longer true. I am sorry you had so much trouble but i find that anyone needing a thoughtful diagnosis who has something unusual gets lost in most systems these days. i think most of us feel like you do. There are no end to costs that end up having little or no value. The bad thing about Kaiser is you are stuck in their system as you well know. At least with a PPO you can have choice-if you call it that.

        • Suzi Q 38

          Thank you, doctor.

  • DeceasedMD1

    i think you misunderstood me. I am in agreement their system is corrupt and the doc is right. And it is nice to see. but it is limited sadly. I am just saying that the system will not change with one lawsuit by one doc making a small amount for a law suit forkaiser standards. but it’s a start.

  • buzzkillerjsmith

    Thanks but no thanks.

    I talk only about the San Francisco Giants and the WSU Cougs, but then I do talk at some length.

  • Patient Kit

    I believe a woman named Rosa Parks would agree with you. And so do I.

  • DeceasedMD1

    it is a good start. I just wish some regulatory board would get after Kaiser. After all, they are still practicing this way. But good for her for speaking up and challenging this pretty horrible system of care. And most of all, thanks for your post.

    • Suzi Q 38

      What I don’t understand is the people that I know who have Kaiser as their insurance plan.
      They are happy with Kaiser, and praise their practices.

  • jordan

    Oh Buzz,

    So predictable. Look, physicians are like cattle. And you, along with them, are quietly being herded toward the slaughter house.

    Some of us have found a pasteur which is empty. We graze as much as we like. We lay in the sun. The land is abundant and could support the whole herd. So we call out to you.

    “Hey fellas, come over here, don’t go to the slaughter house!”

    That’s what this post is. I’m trying to get your attention.

    But you, along with the many, shake your head and complain how it is useless. Meanwhile, your days and minutes grow even shorter.

    Like most Docs, the herd is quiet and docile. Mostly they say nothing. You are slightly more annoying.

    You whine and whine, yet you follow them none the less.

    • buzzkillerjsmith

      Pasture, not pasteur. Lie in the sun, not lay.

      You got my attention. Now I’ve gotten yours. Not that your silly ideas will change.

      If you have read many of my comments, you know I am doing fine. This is about the field as a whole, not about me.

      Annoying? Annoying, at least to this doc, is empty rhetoric that does not correspond to reality. Herd, calling out, grazing. You’re in a dream world, doc.

      As you know from the other comments here, most of the docs know this. They too shake their heads.

  • James O’Brien, M.D.

    There is a reason that Moses wandered for 40 years in the desert. It wasn’t because he had a bad map.

    The slaves had developed a submissive mentality despite their deliverance. He knew that it would take two generations to turn them into the fighters who could take Jericho and the Canaan.

    Now don’t give me grief about historical accuracy. The important lesson is the allegorical not the literal truth of the story.

    Physicians are like the Martin Prince character on the Simpsons, they don’t understand why the bullies don’t appreciate his making the honor roll and his service as a hall monitor.

    As I have pointed out, physicians excel in the classroom, but the big mistake is thinking that life is like the classroom. But it is like the playground where alpha dogs rule. And where the Martin Princes of the world get wedgies and black eyes.

    Frankly, I have no hope that physicians can change their stripes. Many medical students and young physicians have bought into the idealism of ACA. The middle aged have a very hard time changing the way they deal with conflict.

    So now we are in a fight, flight, adapt or die situation. I do not believe we are fighters, at least collectively. The AMA rolled over for ACA. The American Psychiatric Association (which I do not belong to as they are, in my opinion, wrong on just about every issue) is a big fan of ACA and is still optimistic about the prospects for parity, even though those of us who really understand human nature know that means everybody gets equally bad treatment, except those who buy their way out. Kind of like education in the US.

    Because of debt, overspending, bad investments, divorces, whatever, many doctors are not in a position to choose flight. Adaptation isn’t working out so well as this board reveals. 300 doctors a year are choosing the worst possible option.

    Bottom line: I don’t see a revolution. I don’t think we are psychologically capable of it. Maybe two generations will have to pass before we can cross the Jordan.

  • http://www.mightycasey.com/ MightyCasey

    You and your colleagues are most certainly not the villain(s) of the piece. Nor are patients, often decried as being un-engaged, un-interested, entitled, and/or too dumb to understand science.

    Here’s an idea – how about DOCTORS and PATIENTS form an alliance to end the medical-industrial complex’s successful (so far) campaign to set docs and patients in opposition? Think about it – who holds the purse strings on this thing? It’s not patients, and in most cases it’s not docs, either.

    Oh, sure, many C-suites in large health systems are occupied by folks with MD after their name, but the great majority of MDs are looking patients in the eye every day, working to help those patients get/stay healthy.

    Let’s start a revolution. Doctors and patients working together to break/fix our very crazy, out-of-alignment system. I’m in. You?

    • James O’Brien, M.D.

      It’s not going to happen. Doctors are not rebels and punks. They will continue to work hard under increasingly abusive conditions or retire. A tiger cannot change its stripes.

      • http://www.mightycasey.com/ MightyCasey

        Would love to know where in my comments anyone got called “punk” – if you think that MDs are abused under the current regime, try taking a cancer or Parkinson’s journey as a patient.

        • James O’Brien, M.D.

          You’re not getting my drift. In this context, punk is a compliment. In a situation where one is well paid and happy, being a punk indicates ingratitude and possibly a personality disorder. In a situation where people are miserable and captive to malicious and abusive authority, being a punk is a perfectly acceptable response.

          So that oncologist went punk on that Kaiser administrator, like Johnny Rotten did on Malcolm McLaren, that’s something I can admire. When the AAPS makes like Chuck D and fights the power of the MOC mafia, that’s punk. In a good way.

          No one is comparing mistreatment of M.D.s to having cancer, I have no idea where that bizarre and irrelevant comment came from.

          • http://www.mightycasey.com/ MightyCasey

            Totally clear on your position now, and all I have to say is we are in complete agreement. Someone seriously has to build a snark emoji, or font.

            I mentioned cancer because that is a journey that I am personally very familiar with, and said mention was driven by my mis-read of your snark font.

  • James O’Brien, M.D.

    Go along to get along types, you may want to see this:

    http://www.breitbart.com/Breitbart-TV/2014/06/26/PA-Family-Physician-Facing-ObamaCare-Fines-Despite-Following-the-Law

    You’re running up a down escalator that’s moving faster than you can comprehend. This FP tried to comply.

    He’s right. In a decade FP will be a cattle car of PAs and NPs dispensing generic statins, ace inhibitors and antidiabetic medication. And given the lifestyles of the American public, it won’t make a difference.

  • Sara Stein MD

    Great blog, Jordan. You have captured perfectly how many an individual doctor feels these days. That said, every day, a patient appears who reminds me why I have worked this hard (and continue to do so). The gratification of really helping someone in that moment is priceless, and addicting. It’s why I come back the next day, even though there’s no profit in what I do. Without those moments, I’d be long gone.

Most Popular