Will physicians go extinct? Artificial intelligence, legislation, profit motives in the health care industry, and clever lobbying by non-physician providers may all contribute to our demise. However, I believe the existential threat to our profession stems from the ranks of physicians themselves.
1. Unwillingness to embrace activism
Pathologist and writer Rudolph Virchow once said: “The physician is the natural attorney of the poor.” Like most physicians, my goal is to provide evidence-based and compassionate care to my patients and be their chief advocate. As a hospitalist, I consider it my duty to fight to ensure that whatever is medically necessary gets done for my patients while they are hospitalized. Sometimes I argue against insurance companies, and sometimes with my own hospital administration.
Once the patient is discharged, however, it, unfortunately, has been a different story. I must admit (and I’m a bit ashamed) that I haven’t written to Congress expressing outrage at the dismantling of patient protections. I haven’t organized protests about exorbitant medication prices. I haven’t joined my local medical society to combat the coordinated assault on physician-led care and haven’t walked out on strike protesting the profit-above-patient ethos pervasive in health care today. I have many excuses why I don’t do more: I’m overworked, I have student debt to repay (so I work more), and I have young children. I suspect that the majority of my colleagues may be in the same position — focusing on the patient in front of them but not actively engaged in shaping the health care landscape that will impact all patients. If we continue to stand silently on the sidelines, our patients may not trust that we truly wish to remain their health care champions.
The continued well-being of our patients depends on physicians rising up and continuing to be leaders in health care. It seems that right now patients are being deceived by restricted health care insurance plans, the industry-wide promotion of non-physician providers, misinformation campaigns aimed at physician reputations, and the forced metamorphosis of health care from vital professional services to retail industry. In my view, none of these efforts seem to be truly focused on patient well-being, but instead, they are an attempt to minimize the standing of physicians and maximize industry profits.
2. Indifference to our reputation
Physicians may be well versed in the science of medicine and undergo incomparable clinical training, but we seem to lack the skills to defend our reputations effectively. Profit-fueled insurance companies, health care systems and sometimes even our own government all act to weaken the sacred patient-physician relationship. As if wasn’t bad enough that we have quackery and internet marketing to contend with — there also seems to be a focused effort by some health care professionals fundamentally calling into question the compassion of physicians. Does this sound familiar to anyone? “Heart of a [blank], brain of a doctor.”
You may have seen it on a poster, a cup or on your Facebook feed. Or how about the nationwide efforts by some professions to equate an academic professional degree (“doctorate”) to a residency trained physician with three to seven years of closely supervised and intensive clinical on-the-job training.
How can it be that professionals with degrees with 500 clinical hours (sometimes only observational) are considered equally qualified to diagnose, prescribe and treat patients as physicians with 12000-20000 clinical hours (intensely scrutinized 80-hour work weeks)? We have sat on our hands too long and allowed anyone with a white coat to proudly declare they are equal in training and skill to physicians.
By ignoring such attacks, being indifferent to the incursions on our autonomy and not fervently speaking the truth about differences between the training between physicians and other “providers” we are allowing our society to be left with eroded patient care. We or our loved ones will one day face the consequences of this when the majority of physicians have been replaced.
3. Lack of unity
Throughout health care, it seems that every group except physicians are effectively organizing to achieve their aims: Nurses work together to protest unsafe patient-to-staff ratios and ensure quality, PAs push for greater autonomy and NPs stick together to advocate for independent practice rights across the United States.
What do physicians do? After completing our arduous residency training, we seemingly jockey for our interests. Super-specialists seemingly care little for the plight of primary care physicians because their challenges seem alien to them. Is ours a single profession in name only? Our professional organizations are mostly centered around specialty and the few that aren’t charge exorbitant yearly dues for what seems to be some very expensive hand-wringing. We need to devise strategies to bridge the gap between specialties and to create an effective collaborative organization for the entire profession.
4. Neglecting our trainees
Does it make any sense that our patients desperately need more physicians, and yet the number of U.S. residency positions has remained virtually unchanged in decades? We aren’t doing anything to address the physician shortage because we believe the bureaucratic lie that there is no physician shortage, or we choose to ignore the fact that non-physician providers with significantly less training are willing (no, absolutely delighted) to fill the gaps.
Perhaps we need to reimagine the way we train physicians completely. Undoubtedly, we can modify the format of education so that individuals with children or other real-life responsibilities can attend. The premedical college years seem ripe for disruption. Additionally, if we’re brutally honest, medical school could also be shortened without sacrificing the intensely supervised apprenticeship that follows (residency training).
Finally, we need to nurture the health of our trainees better. Clearly, there is something wrong when hundreds of physicians each year just leave the field entirely (or worse yet, they end their own lives). Archaic work hour regulations, a dog-eat-dog culture and a shortage of mental health and support programs are areas that need immediate attention. Being a physician has been the greatest honor of my life; to be able to take care of patients as a member of a profession that values science, service, compassion and lifelong learning. To ensure the safety of our patients, all physicians need to do more to ensure that our profession takes immediate and coordinated steps to rectify the havoc in our health care system.
Varun Verma is an internal medicine physician and CEO, Medofi. He blogs at his self-titled site, Varun Verma, M.D., and can be reached on Twitter @VarunVermaMD.
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