It is time for physicians to take back medicine

I remember medical school and residency vividly. How could anyone forget such a sacrifice, such a vital investment in a top-notch education? Hours upon hours of hard work while practical knowledge amassed exponentially every single week. As a lifelong learner committed to excellence, I loved being surrounded by equally dedicated, intelligent high achievers. My classmates in med school and residency were at the top of their class, and we helped each other rise higher, learn more, and thrive in tough environments.

One of many strengths of medical education is the standardization built into the curriculum. To be accepted into medical school, a student must take the toughest science pre-requisites and, once there, every med student throughout the country takes the same courses (anatomy, physiology, pathology, etc.). This solid science foundation is followed by years of supervised hands-on clinical training with an emphasis on ethics and professionalism that is central to medical education. This primary focus is weaved into all instruction — from morning report to hospital rounds to one-on-one teachings.

Most students pursuing medicine still invest hours volunteering in high school and college. They participate in medical missions, shadow physicians and seek experiences that prepare them for a lifetime spent caring for people. For physicians, health care is not something one stumbles upon. It takes years of intentional preparation, discipline, and hard work.

For physicians, shadowing is what happens before medical school — not while in training. Medical training is hands-on pretty much from day one of our clinical years, which amount, conservatively, to 16,000 – 20,000 hours of direct patient care. Medical training has no shortcuts. Rest assured, your physician did not train online; a physician’s education is face-to-face. Our high level of expertise comes not from letters behind our names but from high standards at every stage, no exceptions.

Unfortunately, in recent years, there has been an influx of health care providers whose online education de-emphasizes clinical excellence, ethics, and professionalism in favor of self-advocacy training. Their programs are for-profit, and their education is not standardized. While physicians spend countless hours learning how to care for people by connecting solid science with the art of medicine that takes years to master, providers in these programs learn how to lobby, which has helped them rise through legislation rather than a standardized education.

Nurse practitioners trained in online programs that accept all-comers then become pseudo “doctors,” thanks to the parallel rise of overpaid health care administrators who favor cheaper alternatives to physicians. This perfect storm has caused the level of clinical excellence, professionalism and ethical behavior to dwindle in health care.

Non-clinical administrators now outnumber physicians ten to one.

While the amount of funding for physician residency training has been frozen for decades, we now have ten number crunchers for every one physician. They push us to see more patients in less time, exalting numbers above optimal care, compassion, and the art and heart of medicine. Physicians are pitted against one another, and increasingly isolated at their own workplace. There is no greater disconnect in medicine today than the gulf between highly trained overworked physicians and decision-making non-clinical administrators.

This perfect storm rages on while physicians keep drowning in pre-authorizations, a multitude of useless regulations and charting for two hours from home each night! To top it all off, physicians are now made responsible (and legally liable!) for on-the-job training of mid-level providers from online programs with 100 percent acceptance rates that pump out nurse practitioners who, overnight, become “specialists” in whatever specialty hires them, often with no training in that field, while physicians invest over a decade to become true experts, and would need to complete another residency to switch specialties.

For these practitioners, their new job provides the bulk of their “clinical training,” which physicians are forced to provide with no extra time or pay and no curriculum, often without even protocols in place, and no standardized way to assess progress. It. Is. A. Nightmare. And patients have no idea, as a lack of transparency has crept in as well, likely championed by administrators who would gladly call everyone “doctor” if that means more patients scheduled and more money made, regardless of the quality of care.

Patients are being deceived and shortchanged, while physicians are used to “train” them and then replaced. Everyone deserves to know the level of education, training, and experience of the person in whose hands they’ve placed their lives.

So what can we do?

As physicians, we will continue to rise above. This is who we are. Yet, we must not be complacent while others dismantle our noble profession, snatching professionalism, ethics and the highest standards of care from our core.

The unsettling reality is that non-physicians are, in fact, practicing medicine without a medical license. Legislation has allowed this, and it needs to stop. As physicians, we must educate the public and one another, refusing to participate in schemes that dilute education and deceive the public into believing medicine can be learned appropriately and practiced with excellence through shortcuts.

Challenging times create leaders. They infuse courage and reveal a common cause. I am proud to be one of over 4,000 physicians who represent every medical specialty and state and have united to fight for our patients. We are taking back medicine from big pockets and standing up for every patient to ensure the highest standards of care prevail.

As one voice amidst a rising chorus, I sense a return to greater unity among physicians. Regardless of how we landed where we are, we must set aside what divides us and, with one voice, speak up for our patients. Every one of them deserves our very best.

The tide is changing. And I, for one, will continue to do all I can in my circles of influence, taking risks and fighting for what is right. My colleagues, it is almost too late, yet it is not too late. Join me. Stand up. Speak up. Enough is enough.

Amaryllis Sánchez Wohlever is a family physician and can be reached at her self-titled site, Amaryllis Sánchez Wohlever, MD.  She is the author of Walking with Jesus in Healthcare.

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