The Physicians’ Bill of Rights
For quite some time now, I have been reading about the state of medicine from physicians in the trenches. Their attitude has gone from dismay to alarm and then to stirring entreaties to fight against the forces that control our time and the care that we deliver to our patients. The articles, stories, and blogs all seem to fall into a few categories:
- I’m really smart. No one told me that things wouldn’t work out the way I planned. It’s so unfair.
- I can’t believe that no one appreciates the intensely arduous road to become a doctor. I know a lot but no one really cares. Everyone, and I mean everyone, thinks they’re smarter than me.
- I am barely treading water, trying to love my job and take care of my patients but the tide is rising and I am going under any day now.
- It’s time to fight back against all of the forces against us. If we could unite- but not take a risk that our rebellion will cost us our livelihoods-that would be great.
- I can’t get along with anyone anymore. I resent all the people I work with- administrators, extenders, specialists and staff. I need to get out but I don’t know how.
- HELP! I am so overwhelmed and I’m being eaten alive- but I’m so busy being eaten alive that I can’t help myself.
I may have missed a few types but most of the articles can be distilled into one of these. The plaintive mewling has got to stop. It’s time to put our heads together and come up with a PLAN. I propose that as physicians we band together to create a Bill of Rights that we universally adopt.
A couple of decades ago, the medical establishment adopted a patients’ bill of rights but we neglected to come up with one for the individuals who turn the wheels of healthcare 24 hours a day, 7 days a week. We shoulder the burden, assume the risk, provide the accountability and struggle to keep our patients healthy.
Here is a diagram which shows major gaps in the control physicians have in their profession. It should serve as a springboard to generate a bill of rights that we can circulate. We must demand adherence to them from the organizations that pressure us to perform and that control our streams of revenue.
Our professional organizations have not served us well for the most part. As a pediatrician, I am happy that the AAP does a great deal to advocate for the global welfare of children’s health. However, I have yet to see that care and concern extended to its members. Five colleagues of mine can’t afford to work as doctors anymore. And even though the AAP is separate from the American Board of Pediatrics, the relationship does not appear to be as distinct as they claim. Most major ABMS organizations have faced backlash from their member physicians regarding MOC and numerous articles have helped to publicize some of the egregious financial shenanigans in which these boards have participated. See the series which begins with this article:
Meanwhile the professional associations support the ABMS with inane MOC activities. I’ve been reading the biography of Alexander Hamilton, and I’ve been struck by comparisons between the academic physicians who work with these organizations to create MOC requirements to the opportunistic Tories who supported the Crown.
The lesson I draw from these writings is that it’s time to stop seeing ourselves as members of a particular specialty but instead as physicians who need to rise up against the numerous forces that try to divide us and conquer our morale and our ability to control our profession. We have permitted the colonization of our profession by not taking the reins and by letting every carpet bagger who arrives in town parade yet a new senseless scheme that lines only their pockets, leaves us with less and less and aggravates the already inflamed relationship we have with our patients more and more. (EMR, anyone?)
There are many broad categories of rights to be addressed so it’s time to take action and stop complaining. The exquisite writings, complex statistical studies, exhaustive analyses, and searing soul searching articles about the unwelcome changes in healthcare and our lack of control over it, have unwittingly served as a form of “SOMA”, (the ideal “pleasure drug” from Aldous Huxley’s A Brave New World), to distract us and to prevent us from recognizing our unique leverage in the medical power balance. For the most part, we are an intelligent group and we don’t need to prove it repeatedly by yet another “attitude survey” or statistical frolic into self-evident information.
The Bill of Rights is a good start but it will not be accepted until every physician who has ever been frustrated by the byzantine tactics of the government, insurance companies, and our medical specialty boards, decides that they will sublimate their frustration and self-pity and instead, turn their energy towards protecting their chosen profession. This means pressuring every group that has influence over our revenue including our specialty organizations, our politicians in government, our employers, our insurance representatives, our vendors, and our malpractice organizations as well as many others.
Once a Bill of Rights has been properly promulgated, how will we as a profession protect them and keep them enforceable? Perhaps these are sweeping questions that assume that massive changes will materialize quickly. But a bold vision is necessary before the details can flesh out a working order.
In every century, physicians need to re-write their place in history and with the arrival of the new millennium, it’s time for us to stand up, join together, and claim our rightful place. If we continue our craven, piteous whining in the face of the battalions that appear much more powerful, then our profession will hold the place that it deserves.
“The limits of tyrants are prescribed by the endurance of those whom they oppress.”- Frederick Douglass