Wanted: Physicians Who Will Submit

This is what it has come to.  Here is the article entitled Hospitals seeking to hire doctors who “play well with others”.   The subtitle goes on:

As more health systems form accountable care organizations, they are putting a premium on the ability to work alongside physician assistants and nurse practitioners.

So what are they saying?   There is no more chain of command.   Doctors, with all their education and experience, are not to be in charge.  Hospital administrators, who somehow think they run the healthcare system, want only sheep to work in their building.  It makes their lives so much easier when docile doctors do what they say and have no opinions.   They call it being “team oriented” which is a smoke screen.   Speak up and you’re labeled a “disruptive physician”.   Here are some more quotes from the linked article:

  • “There are certain personality attributes and characteristics that, unless it was for a physician leadership position, I don’t think most places have really asked for before.”
  • The health systems in the survey expressed optimism about finding doctors who are flexible in who they work with and when they work.
  • We’ve been looking for quite a while for physicians who would at least play well with others.

So what is going on here?  The is about breaking the will of doctors.  This is about setting us up for NPs to be in charge of the ACOs and forcing hired physicians to comply.  This is about control and power.  Hospital administrators want it and need to covertly change the landscape of the healthcare system in order to get it.  This is what they meet about all day while we are working.   Physicians are too busy seeing patients to see what is going on and even when they do they just roll over.   It is called learned helplessness.    What the world forgets, however, is that if an administrator goes missing for a month, no one notices.  If a doctor goes missing for a day, there is utter chaos.  So who is more important?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “Wanted: Physicians Who Will Submit

  1. Carol Puopolo
    November 8, 2012 at 11:43 am

    It is about power and control, but as a “seasoned” nurse, what I see is that nobody plays well in the sand box- “My way is the only way. Physician teams that can’t share because they won’t get all the credit-eg: God forbid a surgeon consult Pulmonology or Cardiology post op because it would mean they don’t know everything.

  2. Caitlin
    November 7, 2012 at 4:51 pm

    As an NP who has been reading Authenthic Medicine since I was a trainee in Central Maine with Dr. Farrago’s colleagues, I’m dismayed at this vitriolism towards mid-level providers. I am proud of my job and do it well. I collaborate with my physician colleagues and do not replace them. This article is off-base and I expected more from you.

    • Doug Farrago
      November 7, 2012 at 4:55 pm

      I apologize for nothing. I stand by what I wrote here 100%. Doctors in charge. That is the only way it should be. NPs and PAs can work collaboratively but it has changed to a competitive environment. Your profession’s choice…not ours. Game on.

  3. Robert Bailey, MD
    November 7, 2012 at 1:52 pm

    Nature abhors a vacuum, but it treats high concentrations the same. There is too much money, prestige and power in medicine to escape increasing entropy. Even excluding the “Tragedy of the Commons” phenomena in Garrett Hardin’s essay, dispersal seems inevitable. Deregulation changed the primary product of medicine irrevocably to political and economic profit first, and healthcare second. Focusing on the moral and intellectual failures of the personalities involved is a distraction; the problem is of process, not personalities.

  4. Ray
    November 7, 2012 at 9:12 am

    Enjoy your blog Douglas. Agree that the Administrators are looking for a certain personality type that is apathetic, unwilling to challenge authority, complacent, and too distracted by the everyday practice of medicine to attend the mindless meetings that administrators populate. Unfortunately for us all the “control” of our medical lives (decision making) has been taken over by “The Borg, resistance is futile” crowd. I met with an administrator recently ( he is an MD convert). I expressed my distaste of becoming a manager of midlevel providers, I simply want to practice medicine as I was trained to do. He told me ” get used to it, the future of primary care is a physician managing several midlevel providers”. Primary care devaluation continues in the form of a job description change. Victor Laslo are you out there?

  5. Pat
    November 4, 2012 at 8:38 am

    This piece highlights perfectly what medicine is about in the post-individual era. “Patient-centered care” is as big an Orweillian joke as could ever be in this job. This demonstrates why I quit teaching med students, and will not allow them any longer to shadow me at work. From Pay-for-Performance to coding to core measures, to this demand that doctors participate in their own devaluation – medicine is a fundamentally dishonest business which is degrading to the practitioner, and not something I wish to fake enthusiasm for. Society’s do-gooders, lawyers, politicians, and patients want to enjoy a doctor’s passion for work without his troublesome personality, or capacity for self-evaluation, or self-interest. Remove the man/woman from the mission, and see how that works…

    When asked in a survey question why I continue to practice, my answer was truthful: it’s the only way I know to make a living.

    • dj
      November 7, 2012 at 9:03 am

      amen dr pat.

      • Kurt
        November 7, 2012 at 10:42 am

        The AAFP with disappear in 10 to 15 years if this keeps up.
        Can hang out the new shingle AAFNP.
        They think we can be replaced with all “cheap” N.P.s. They have their place but can’t match the education experience of the M.D. I tell all students now to specialize with the current state of affairs. Sadly, I don’t foresee a time when I can change my tune.

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