Thanks to the marvels of medicine, newly vaccinated Americans are returning to life as normal and partying like it’s 2019. Doctors, who are emerging from the pandemic as national heroes, would like to turn back the clock even further—to the halcyon days of 20th-century medicine.

But doctors, unlike their maskless and freewheeling patients, will be disappointed with what the future holds.

Trying to turn back the clock

Physicians have had a rough century, so far. In addition to battling COVID-19, doctors have spent the past two decades fighting the health care industry’s fiercest players and losing, badly.

Power in the industry now belongs to health insurance companies, major drugmakers, and hospital tycoons. Physicians feel beaten up, burned out, and abused by a system so overrun with regulations that clinicians now spend more time filling out paperwork than helping patients.

Doctors long for the last century. Back then, they were paid well, revered by everyone, and largely left alone to practice as they please. As the war against COVID-19 winds down, doctors believe now is the time to demand a return to the glory days when physicians ruled medicine. To get there, doctors want more money, respect, and autonomy. They’ll get none of that because our nation can’t afford to give it to them.

A cruel reality

Nearly half of Americans are struggling with financial hardship amid the economic fallout of the pandemic. The nation’s uneven recovery has 35% of small businesses worried about surviving the summer. Meanwhile, the federal government now owes foreign lenders $28 trillion ($85,000 per American).

Soon, reality will set in for physicians: Any solution that depends on giving doctors more dollars or fewer responsibilities will be a nonstarter. Twentieth-century medicine is dead and, with this loss, doctors will experience the five stages of grief.

Doctors and the five stages of grief

The first stage is denial, a coping mechanism that’s hardwired into the mind of every doctor. It’s a necessary, and sometimes helpful tool for dealing with the often gruesome, tragic, and painful realities of practicing medicine.

But this same psychological defense leads physicians to dismiss the role they play in the growing unaffordability and declining quality of health care in the United States.

Examples abound. American doctors prescribe 99% percent of the world’s hydrocodone, contributing to more than 500,000 opioid deaths in the 21st century. In addition, 200,000 Americans die each year from medical errors, 500,000 families go bankrupt from medical bills, and 30% of all medical treatments are shown to add little or no clinical value.

Research shows that the U.S. has the most expensive and least effective health care in the developed world. To reverse course, doctors will be expected to more closely follow evidence-based guidelines and adhere to safety checklists (giving them even less autonomy than they have now, not more).

Anger in the medical profession is pain turned inside out. It is how doctors externalize feelings of fear, hurt, or guilt.

All over social media, doctors post all-caps indictments of America’s broken health care industry. “Physicians didn’t create the idiotic system, nor the management that fuels the dysfunction!” said one physician commenter.

Doctors are suffering from all they’ve lost. But like the American tourist who yells louder and louder at locals who don’t speak English, physicians act as if repeating the same words at higher decibels will change the responses of insurers and hospital administrators.

It won’t because the problem isn’t the volume. It’s that doctors are speaking a different language. No matter how loudly physicians yell for higher salaries and fewer patients per day, their demands don’t make economic sense to those on the receiving end.

Bargaining is an attempt to negotiate a better outcome. Some doctors have already begun this step.

During COVID-19, a poll found 53% of independently practicing physicians worried their practices wouldn’t survive COVID-19. As solo practices struggle to survive, more than 70% of all physicians work for a hospital or medical group—a means to gain bargaining power with insurers and increase financial security. But as economic pressures intensify in the post-pandemic era, all doctors will feel the pinch.

Small to medium-sized businesses can’t afford the projected 5.5% annual increases in health care costs. State governments, which must balance their budgets, won’t be able to increase Medicaid payments. Nowadays, politicians from both sides of the aisle see the futility of pushing for any health care plan that would raise taxes.

So, rather than bargaining for a bigger slice of the pie as they did prior to the pandemic, physicians will find themselves bargaining for less of a reduction.

Depression follows failed attempts at bargaining and is an increasingly familiar feeling for doctors. According to national studies, roughly 15% of physicians struggle with depression, while 20% report having had suicidal thoughts.

The causes of depression and suicide among physicians are multifactorial, deriving from workplace stresses, unhealthy coping mechanisms, and systemic obstacles that make their jobs difficult to perform.

Against the nation’s lingering economic problems and the health care industry’s ongoing belt-tightening, these anxieties will only grow in both prevalence and severity. Doctors are trained to hide emotions and repress pain. Therefore, the heightened period of depression to come will be the most dangerous part of the grieving process for physicians.

Acceptance of the need for systemic and cultural change is the ultimate destination for doctors. Like the twin snakes that coil around the staff of the Caduceus, medicine’s systemic and cultural problems are intimately intertwined—neither functions independent of the other.

After decades of battling and blaming the health care system, doctors will find it hard to accept that they must play an integral role in solving medicine’s cost and quality problems. In physician culture, this will feel like surrender.

But acceptance is not about feeling good in the face of loss. It is about acknowledging reality and deciding to move forward, despite the discomfort. Acceptance will require doctors to embrace new norms and more realistic expectations.

They’ll need to abandon the fee-for-service reimbursement model, which drives them to over-test, overtreat and overcharge patients. They’ll need to collaborate and coordinate patient care to improve medical outcomes and lower costs. And they’ll need to embrace more efficient and effective approaches to medical care delivery.

Robert Pearl is a plastic surgeon and author of Uncaring: How the Culture of Medicine Kills Doctors and Patients. He can be reached on Twitter @RobertPearlMD. This article originally appeared in Forbes.

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