All my life, I’ve been told that I will have job security. No matter what, as a doctor, I will always have a job despite whatever may come. I have chosen one of the most stable and secure jobs that exist. But did I?
Coming from a family of clinicians — seven physicians, two nurses, and one LPN — one would assume that we are safe and secure, for medicine is the safe house from the economy; however, as the coronavirus pandemic spreads, we see that that assumption is no longer true.
Let us start with the vast majority of the medical world: the outpatient offices and clinics. These settings include cardiologists, gastroenterologists, primary care providers, rheumatologists, dermatologists, surgeons, and many more; and as of a few weeks ago, all of the latter were effectively shut down. Those that have been able to transition to telemedicine have, but our fee-for-service system — which rewards based on procedural volume– has left many of these physicians unable to perform the highest-yield cases. Effectively, gastroenterologists are not able to do colonoscopies, cardiologists stress tests and catheterizations, and surgeons no surgeries other than those deemed “emergent.” This is not a call to pity physicians, but to understand the reality of what medicine has been for some time, but is even more so than ever: a for-profit-industry.
To be frank, physicians are not the ones raking in millions despite the fact that they’re the ones doing the majority of the work and sacrificing years of their life in training. In fact, physician pay has been declining in real dollars since 1990. How can we expect to have good health care when the ones providing it are unwell? We are more burnt out than ever, have more debt than ever — more stress, more pressure, more expectations — than any prior generation in the history of medicine. Perhaps the question to ask is: Who should be rewarded in this system? Because, in my humble opinion, the patient-physician relationship is sacred, and the entire system is designed to facilitate that relationship. If doctors are not the highest earners in health care, then who should be? The hospital administrator? The insurance company CEO? The pharmaceutical companies?
The COVID-19 crisis has only made more evident the growing tentacles of finance, as even front line workers, such as emergency medicine physicians, are being cut from daily staffing – a move that administrators justify due to lower daily volumes. Yet we expect those same clinicians to respond immediately should COVID19 start overwhelming these hospitals. Flex staffing, an accepted business practice with roots in the food and beverage industry, has moved into medicine; however, we are only now starting to acknowledge and accept the detrimental effect it has had on our workforce. In the flexible staffing model, uncertain work hours lead to uncertain income — and thus, a beleaguered workforce, disenfranchised from the American Dream. Is that what we want from our physicians and, by extension, nurses, techs, and all those in health care?
This is not a call for socialized health care. Italy and Spain both have socialized health care, and yet their response was inadequate. South Korea and Taiwan both have socialized health care and had phenomenal coordinated responses containing the epidemic. If anything, this indicates that it is not a system that defines success or failure, but rather leadership.
Something has to change if the world’s wealthiest, most developed, and supposedly technologically savviest, leader of the free world is unable to protect its citizens by effectively managing crises like this.
America, once a country of abundance — flush with hospitals, doctors offices, multiple domestic manufacturers, well-respected and well-paid physicians and nurses — is under siege by a virus. So, here we are, not enough hospital beds because we closed down so many, not enough equipment or medications because we do not manufacture them anymore, and not enough providers because education costs too much, and being a doctor is not what it used to be.
Raviraj Patel is an emergency physician.
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