Physician Led Healthcare, Because Physicians Understand

This article articulates several reasons for physician led healthcare, and I couldn’t agree more. If implemented, I think this would be the most beneficial change that the ailing system has seen in a long time. For one, “research shows physician-run hospitals score approximately 25% higher on hospital-quality scores and overall hospital quality”.

Why is this? There is one common theme behind the arguments presented: physicians understand. They understand health care, they understand the challenges, and they understand data.

In the US, student physicians are taught to be conscientious of costs. We learn to think critically about whether a test, procedure or medication is absolutely necessary. As we practice weighing risks and benefits of everything we do, cost cannot be neglected. Seasoned physicians who have cycled through various (often declining) reimbursement models have the “creativity and fortitude to deliver financial results and not skimp on the quality.” Physicians are highly motivated to spend health care dollars wisely, because what is wasted on one patient is taken away from another.

A recent study showed doctor burnout is costing the U.S. health care system about $4.6 billion a year… The study identified systemic burden like bureaucracy and paperwork as major contributing factors to burnout. Other research has identified an association between burnout and indirect organizational costs like medical mistakes, less satisfied patients, and malpractice litigation.”

  • In other words, happy doc = happy patient. 
  • When rotating on the psychiatry consult team, it sometimes feels as if we are called to talk to a patient because their primary team simply doesn’t have the time to make them feel heard. 
    • Example; patient is “labile” so we are consulted to rule out bipolar disorder. On interview, the patient is undergoing chemotherapy for cancer diagnosis and cries appropriately. We made no medication changes and continued sertraline 50mg. Patient felt better.
    • Example; consulted to manage “severe anxiety” that improved with 1 time dose of Ativan. On interview, the patient had a renal transplant and was under excessive pressure to feel better, ambulate and have a bowel movement. We talked to her, provided supportive validation, empathetic listening and continued Ativan PRN. Patient did not request Ativan again, felt better, had a bowel movement and was discharged the next day.

“Physician leaders know that combating burnout takes more than a Groupon to a yoga class. Rather, research suggests interventions at the organizational level were more successful; that is, leaders must prioritize less on providing coping strategies and more on minimizing/eliminating potential stressors.”

  • THIS is everything. 100%. I do believe that this statement sounds more like a plan to address ‘moral injury’ rather than putting a bandaid on the symptom (burnout), but regardless, it concisely states exactly what needs to happen. One of the core reasons that physicians go into medicine in the first place (although I see more and more docs forgetting this as they are being killed by moral injury) is because they want to care for people. Not do paperwork. Not handle bureaucracy.
  • Thinking of the patients in the above examples, I can’t help but wonder… if their primary docs had more time to spend with them, would they have even needed us? Don’t get me wrong, I love seeing patients, and I couldn’t be happier that I had the privilege of helping these people – but I empathize with the primary team who missed out on that opportunity.
  • I can’t imagine a career with ⅔ of my day spent on the computer. It’s important for me to connect with patients and to understand their entire bio-psycho-social picture. To me, that’s the rewarding part of medicine. It’s a large aspect of why I chose to go into psychiatry, and why I empathize with those in other specialities who aren’t able to make that time.

No one better understands the time and commitment required to provide comprehensive and compassionate care for patients than do physicians. This means that fellow physicians are the best qualified to facilitate systems capable of reducing moral injury, which in turn will support physician quality of life, best practices, and overall patient satisfaction.

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Kailee Marin

Aloha! My name is Kailee Marin, I'm a DO student in California. I was 15 years old when I decided to go to medical school. I spent three years in Hawaii getting my bachelors, then I came straight to CA to pursue my dream. These three years have been a rollercoaster - the best and worst of my life. I've spent med school listening to, and participating in the complaining of my classmates. I've come to realized that it's all the same. It comes down to the common barriers that current and future doctors face - and it starts in medical school. Moral injury being disguised as burnout so that institutions can pretend they care... But moral injury can't be fixed by wellness Wednesdays, or fitness Fridays. I have realized, to heal moral injury, you have to treat the underlying cause. And there are so. many. causes. So I guess I have a lot to talk about! As an aspiring psychiatrist, I feel compelled to advocate for mental health. This includes the mental health of my colleagues, my future patients, and myself. 

  1 comment for “Physician Led Healthcare, Because Physicians Understand

  1. Cathy
    October 9, 2019 at 11:19 pm

    I applaud Ms. Marin for her post and enthusiasm. I applaud even more the followers of this site for not ripping her apart thus far. I thought it was satire. We were all like this at some time in our lives and most of us will eventually need a good doc to hear us . Future DOCTOR Marin……study hard and keep the faith!!!!

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