I’ve finally figured out why we – physicians – are called “providers.” It’s not merely because we render services. In addition, our role has become a commodity, genericized and stripped of autonomy. We are no longer free to practice as we wish. We have lost the ability to take medical matters into our own hands, to control them, and to resolve them ourselves. Having lost ownership of medical practice to other people – lawyers, lawmakers, politicians, hospitals, insurance companies, licensing boards, and professional societies and organizations – decisions are made without our input or regard and certainly not in our best interest.
I guess I’ve known this for a long time. It’s part of the reason I left practice 25 years ago at age 45 and at the height of my medical prowess and earning potential. Reading about how some physicians have recently been arbitrarily stripped of their credentials only reaffirms my decision to leave practice early rather than let the authorities chip away at it. The doctors I refer to have allegedly misinformed patients about various treatments for COVID, and they now face disciplinary action, including two physicians who have lost their American Board of Internal Medicine (ABIM) certification.
I realize some doctors need to be reined in for their outrageous behavior and remarks – for example, the Ohio physician whose license was suspended for claiming that COVID vaccines could cause people to become magnetized or create an interface with 5G towers. But they are outliers, and that’s not the point I’m making here. What I am saying is that, increasingly, physicians are becoming the unjustified targets of assault on their licensure, livelihood, and constitutional rights. And the medical profession is so fragmented and subspecialized that it cannot mount a cohesive attack to fight these injustices.
One concerning issue is maintenance of certification (MOC), which is required by all specialties. Despite a decade of protest to eliminate MOC requirements, they have become more onerous, costly, and burdensome, without definitive proof that physicians who maintain board certification provide superior care than those without it. You can’t certify caring, dedication, compassion, and integrity. Besides, MOC content is highly redundant with continuing medical education that is a prerequisite for medical licensure in every state.
Nevertheless, ABIM stands behind its MOC program and thinks it makes physicians better doctors. The reality, according to Jay Giri, MD, an interventional cardiologist at the Hospital of the University of Pennsylvania, is that the debate lacks hard evidence and is “mostly people’s opinions.” Why do physicians who were recently certified need to participate in MOC? Aren’t these doctors more up-to-date than physicians who were “grandfathered,” i.e., allowed to retain lifetime certification before MOC existed. In theory, MOC would be more beneficial to grandfathered physicians since they are more distanced from their medical education and training.
Aaron Goodman, MD, a hematology-oncology physician at the University of California-San Diego, initiated a petition to eliminate MOC requirements for internal medicine. Over 15,000 signatures have been collected, yet that represents only a fraction of the number of doctors certified by ABIM (>200,000). One can only surmise that the majority of physicians are unaware of the petition, compliant with MOC and disinterested in its broader implications for the practice of medicine, or are under the impression that attempts to overturn MOC requirements are futile.
Mark Lopatin, MD, a rheumatologist in suburban Philadelphia, postulates “that there have been so many forces exerting detrimental changes to health care that many of us have simply given up.” He likens the situation to “learned helplessness,” a state of apathy and depression described by the psychologist Martin Seligman in experiments with dogs who could not escape electric shocks even when given the opportunity to do so. Our inability to shake off apathy and advocate for ourselves, our patients, and our profession is what sustains the medical-industrial complex, gives corporations the upper hand, and allows them to manipulate the system for their own gain, ignoring the desires of physicians along the way.
Jordan Grumet, MD, an internal medicine physician and host of the Earn & Invest Podcast, is in agreement. He describes a type of demand apathy resulting from “tending to the insurance companies, the government, the hospital, the medical group administrators, and the electronic medical record.” There’s nothing left in the tank at the end of the day for our patients and ourselves, Grumet observes. Protesting is an afterthought even as we grieve the exodus of doctors from medicine and the downfall of our once proud profession.
However, protesting is not a bad idea. Lopatin said he was oblivious to the politics of medicine until he was wrongfully sued 20 years ago. Since then, he has become very active in grassroots movements and organized medicine as a strong advocate for the preservation of the patient-physician relationship. Lopatin has written numerous articles, lectured, done podcasts, and testified on subjects such as the harms of prior authorization, pharmacy benefit managers, scope creep, and, yes: MOC.
I, too, am disaffected by the loss of control over medical practice and the dissolution of our identity as healers. As I said, disillusionment with medical practice drove me away from seeing patients. Ironically, similar circumstances steered me into industry – to work as an “insider” to combat the problems thrust upon physicians by the medical bureaucracy.
Currently, I work for a “local medical entity” that provides mental health insurance and manages services for disabled and disadvantaged children and indigent adults. The company has a strong community presence and mission as well as an altruistic social agenda. I feel as though I can effect positive changes in health care delivery from the perspective of a population health medical director.
I could have taken many other routes to fight moral indignation: join pro-physician organizations, return to practice independently, and even attempt to unionize my colleagues. What matters most, I believe, is doing something about our outrage, including writing and talking about it and protesting against authorities. From Tuskegee to Tiananmen Square, social protests have sparked constructive political and policy changes by influencing the knowledge, attitudes, and behaviors of the public and organizations and institutions.
I don’t consider myself an activist, but I have protested various causes from time to time. I was initiated into the art of protesting as a freshman at Boston University (BU). President John R. Silber invited Marines on campus to recruit students for the Vietnam War. Talk about chutzpah! I joined the picket line to prevent students from gaining access to the building where the Marines were housed. Thirty-three students were arrested that cold spring day (March 27, 1972), infamously becoming known as the “BU 33.”
I was not among those arrested, but I did join many other protests as anger over the Vietnam War intensified. It seemed there was never a shortage of opportunities to join a protest in the years 1965 through 1975, a time when social and civil rights were front and center and marches, boycotts, sit-ins, and freedom summers were common. Because physicians of that era are retiring, it’s up to younger generations to carry the torch. An uprising is long overdue. Perhaps a collective work stoppage would gain the nation’s attention.
In the iconic Eagles song Hotel California, the narrator (sung by Don Henley) calls for a bottle of wine. “We haven’t had that spirit here since 1969,” remarks the Captain. Hotel California has been described as an allegory for the rise and fall of the 1960s, capturing that decades’ revolutionary energy, only to be extinguished by 1975. I’d like to think that the wine was maturing during the past half-century. Now it needs to be uncorked and savored – much like a revolution. We must convince people like Merritt Rook that physicians are not sheep prone to bowing before authority.
What will it take for you to join the protest and speak out against those who seek to destroy us?
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.