Letter from a Specialist

This came to me from a loyal reader of this blog:
Not a primary care doc, so the details are different, but cut from the same cloth.
Here, with a few adjustments, is the meaty part of an email I sent to a colleague who is a senior member of the Department of Medicine at a major (redacted) University teaching hospital. It was written in response to his observation that he and many of his colleagues find themselves trudging through the day looking at the floor, having fundamentally lost control of their professional lives and at risk for losing control of their souls.

The question: Cui bono (To whom go the benefits?)

The answer: Senior management – grotesquely disproportionate salaries and benefit packages, short workdays spent schmoozing, leaving abundant time to work on paid side jobs, go on junkets, attend fundraising dinners, etc. Health system chiefs (names redacted) pulling down serious seven figures, for what value created? I consider it obscene for an officer of a nonprofit to be paid anything above mid-six figures; that is plenty for a very comfortable lifestyle, and beats the hell out of anything I have managed. Not to mention that the administrative big shots have multiplied like maggots on a corpse; when I came on board at the (Redacted) in 1974, there were two vice presidents, and now that level is at least 30, and none of them is breaking a sweat.
As for the worker bees, throw out the experienced senior people and pretend that beginners can run a complex patient care area, in the name of saving money. Make sure that everybody is in full compliance with the rules, no matter how arbitrary and destructive. See to it that the physicians understand that their real job is not taking care of their patients, not even writing papers, but pulling in funding for their chiefs to use to aggrandize their fame and power. Call the ever-changing bedside flash mobs “teams” when they hardly know each other’s names, much less have any feeling for the patients upon whom they are employing their truncated cookie-cutter skill set designed to stuff the check-boxes of a billing-centric EMR. Call the individualists, dissenters, moral traditionalists and deep thinkers “out of touch” or “disruptive,” and get rid of them.
I believe that medicine is a great profession and a great calling that has fallen upon hard times in the deep and icy shadow cast by the enormous superstructure of the American healthcare system, and in our case and specifically the corrupting influences of big business medicine run for the benefit of its overseer class and an academic hierarchy based on fame and fortune rather than doing hands-on good in the world.
Keep smiling, and keep your moral compass true

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] 

  4 comments for “Letter from a Specialist

  1. December 26, 2017 at 1:50 pm

    Yes, a lot of people try to point their fingers at doctors for “lining their pockets,” especially if they try to provide affordable medical and surgical care options for patients, and are just making a good income, often free of government mandates that add cost. As this doctor pointed out, and has become well-known but largely ignored, it is the administrators that are making the big money and offering questionable, if any, value.

    • Steve O'
      December 27, 2017 at 8:40 am

      It’s called redirection. The wealthiest physicians who derive their wealth from patient care, such as the specialty surgeons can earn what – $5 million over a lifetime? That’s nothing. Barron Hilton cut his daughter out of his will by only giving her $5 million. What a slap in the face!
      Get the average person to hate the wealthiest person with whom they have contact of any sort. The car dealer in your town, they’re rich, aren’t they? Worth maybe $20 million dollars? That’s a rounding error in the big rollers’ circuit. Summer rentals in the Hamptons are going for $2 million dollars, and that’s not to buy a house – that’s the monthly rent. $2 million dollars. And Joe Buick from Podunk’s not going there.
      Hate the “visible rich.” You never see the real rich, for their jobs are good enough to insulate them from real citizen contact. When’s the last time you’ve met one of the Waltons of Wal-Mart? They don’t entertain citizens like you. That’s what Wal-Marts are for.

  2. Stephen Rockower
    December 26, 2017 at 10:02 am
    • Steve O'
      December 27, 2017 at 8:34 am

      The average Joe was dissatisfied with the healthcare system thirty years ago because:

      1) There was no way to tell how much things cost,
      2) The means of acquiring and evaluating health insurance is incomprehensible.

      Then the owners kicked into action. Now what do we have?

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