There has been a disturbing shift in how medical professionals feel about their career. I almost cringe every time I’m at a party or social gathering now and tell people I retired early from my medical practice. I try not to bring it up.
I don’t cringe out of fear for how they will perceive me or whether they will look down upon me with condescending scorn about how I left a profession I trained so long for. Instead, I am finding that more and more physicians are looking for their own way out. This is disheartening, to say the least and I wish it wasn’t the case.
I thought at first this was more a problem of “front line” physicians, those in primary care, obstetrics, and emergency medicine. However, more recently, the grumblings have progressed into the fields of anesthesia and radiology. How could this be? They are in the sought-after category of the panacea of excellent pay and lifestyle that is often found in “ROAD” specialties: radiology, ophthalmology, anesthesiology, and dermatology. Is no one safe?
It seems the reach of insurance companies and health care administrators (who are not clinicians) has stealthily worked its way throughout the health care system in the united states and is strangling the lifeblood of physicians. The joy of medicine is being sucked out slowly by increased burdens of pressure to see more, do more, without regard for patient outcome — of course with the caveat of earning more money for the bottom line of the organization, not to the benefit of the patient or physician.
What seems to be the common ground amongst specialties is the loss of autonomy and the stripping away of control from physicians. The percentage of employed physicians continues to grow while the self-employed shrinks. Although, there has recently been a small surge in the idea of “direct primary care” as a way to bypass insurance companies altogether and reestablish the doctor-patient relationship without a non-medical middleman deciding what is appropriate medical care. While in theory, this model makes sense, I worry that it will become a solution for health care for the rich but glaringly ignores the poor who cannot afford to pay out of pocket for medical expenses.
So, are doctors to blame for “selling out” and joining an organization and becoming employed? In many specialties, it has become almost a necessity to obtain an employed position out of residency. Medical student loans have crippled physicians who could not bear the thought of taking out more loans to cover the expenses of starting a practice. Instead, the lure of an employed position offers coverage for malpractice (an extreme expense that often prohibits self-employment in specialties like obstetrics), an immediate salary that will help make a dent in the student loan burden, and the allure of promised perks such as a more predictable schedule. It becomes a matter of survival from the start as a newly minted attending physician. For many, the prudent choice is indeed to become an employed physician.
It’s not all bad to be employed. Good care is given to patients. Fantastic, compassionate, and intelligent physicians are employed. I’m not blaming these organizations for the early career exodus of physicians. It is an all-encompassing problem with health care in the United States that reaches all corners of our country and all patients. The problem occurs when health care becomes a business run by people who are not clinicians. Physicians begin to feel like they are running up against a brick wall. A wall of denials for patient care, refusals of requests for adequate visit time with patients, and a blocking of advocacy for patients by the professionals who can help them the most.
Without question, we cannot ignore health care costs which are exorbitant, and strategies must be present to reign in this runaway train. However, for improvement to exist in our health care system, physicians must be involved in the decisions about how money is allocated, what conditions and treatments are covered under insurance, and the appropriate time needed to evaluate and diagnose conditions in real office/hospital settings. These decisions simply cannot and should not be made by MBAs or politicians who know nothing about the medical implications of their business decisions.
Looking forward, we have the chance to save health care in our country. It starts with physicians (and our organizations such as the AMA, ACOG, AMWA, etc.) speaking up in Washington DC, hospitals and surgical centers being run by physicians instead of business people, and health care organizations being led by doctors first, who will advocate for patients while also being mindful of fiscal responsibility. This is the only way the brick wall, which is putting a barrier between physicians and the highest quality of care they want to provide for patients, will begin to crumble.
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