The profession of medicine is under attack and physicians are as much to blame as the enemies that are strategically breaking down our profession. Physicians sold out to large hospital organizations and venture capitalists and now 2 out of 3 physicians are employed. Employed physicians are in a triangulated position being required to satisfy the needs of their employers (usually corporate conglomerates), insurers and most importantly their patients. Patients are no longer the sole focus and physicians are faced with loss of autonomy, lack of professional respect, perverse incentives for productivity and mounds of useless paperwork and electronic box checking.
Both physicians and patients wind up as the losers in this broken system. Physicians train for a minimum of 12 years and many times longer. They are the experts in their field. They spent a substantial part of their lifetime away from family and friends and spent significant amounts of money for their education, upwards of 100’s of thousands of dollars to become masters in their fields; only to be second guessed by lesser trained individuals whose primary motives are greed at the cost of safe and quality care.
Once upon a time, physicians owned their own practices and were in control of their destiny. In the past, physicians took care of patients the way they were trained and were not influenced by these disrupters. Today, large hospital based systems and private investors have stolen control from physicians and we let it happen. We are now manipulated to see more and more patients to pay for unnecessary and unsubstantiated overhead costs that we have no control over. We are made to sacrifice patient care by shortened visits times, use of lesser trained midlevels and constant interruptions to the patient-physician relationship primarily the use of electronic medical systems necessitating physicians to now provide all the data entry in the room which steals away critical time from the patient. These tasks were once relegated to non-clinical staff, but somehow once EMRs were implemented it became the physicians responsibility and we let it happen. Yes, there are some ways to alleviate these burdens with the use of scribes, but this adds another person into the equation adding more costs and another disruption in the room.
Physicians continue to perpetrate the problem by being silently complicit and allowing themselves to be manipulated. How did this happen? It happened because we were too focused on our patients. While we were working long hours with our heads buried in paperwork and computers, beat down by a system that no longer values our expertise. We were taken off committees and other non-clinical face to face, non-revenue generating duties to become more productive. When this happened, we lost a say in our profession and allowed people who have no business to decide what we should and should not be doing to call the shots. We allowed midlevel providers to work outside of their scope and replace more highly trained physicians. We allowed the medical profession to become watered down because we were too busy or too tired to see it happening. Some of our colleagues succumbed to greed. They sold out their practices for a big payday. They supervised midlevels and allowed them more freedom than their training allowed and now we are faced with a dichotomy of care. Midlevel providers are also being manipulated in a multitude of ways. Their national organizations and teaching institutions are promoting that they have equal training to physicians when this could not be farther from the truth. They graduate with this inflated sense of entitlement and a false sense of knowledge. Corporate medicine, large insurers and even our lawmakers perpetuate this falsehood to save money at the sake of patient safety. They manipulate data and false titles and training to further confuse the public.
Both patients and physicians suffer. Physicians suffer by burnout and loss of autonomy. Our organizations such as the AMA, ACP and AAFP have deserted us. We don’t seem to have the numbers or the national support to collectively regain our profession. We are so busy trying to be altruistic and take care of people that we are not taking care of ourselves or preserving our profession.