Over the last quarter century, physicians have lost a substantial amount of ground–politically, publicly, personally, financially, emotionally. It’s no wonder we are so burned out. When we aren’t at work, we are constantly bombarded with anti-physician sentiments whether it’s on the news, on social media, on review sites. or even in our own mailboxes. We have lost so many battles, that we are starting to lose the war. And while we’re down, we’re getting kicked in the teeth.
What do you mean, “while we’re down”?
1. Physician reimbursement from the government and insurance has been declining for two decades now. For instance, the average reimbursement for removing part of the colon was $1134 just 10 years ago. Another 20 years prior (1989) it was $1256, Today, that average is $1399. Meanwhile, inflation continues to occur. In fact, $1256 in 1989 would be equivalent to $2561. We are not immune to the fact that the cost of living is growing yet wages are not. Also, ten years ago, medical student debt averaged about $154,000–converting that to 2016 dollars would be about $172,000 yet the average medical student in 2016 graduated with approximately $190,000 of student debt. That mean there’s even less in young doctors’ pockets than ever before. For more information, check out this interesting article about surgical reimbursement over the last century.
2. The nursing lobby has been far more powerful over the last decade than any physician lobby group. That is why nurse practitioners can practice INDEPENDENTLY (without any physician oversight) in 23 states. Why is this concerning? First of all, it doesn’t take nearly as much time or energy to become an NP as it does to become an MD or DO. NPs typically finish their degrees (some completely online) in two years (some accelerated programs are only one year) after obtaining a Bachelor’s degree–unlike the four years required for medical school and NPs do not require postgraduate training! In fact, They are only required to have 500-1500 hours of clinical time to become certified. Whereas a family medicine physician is required to have a minimum of 15,000. That’s right, TEN times the training before they can independently practice! Primary care specialists are losing ground by the day when it comes to maintaining their own jobs and practices. NPs are even starting to gain enough traction to perform invasive procedures on patients with less than a quarter of the training a physician would have in order to perform the same procedures!
3. If you think your doctor is directing the final say in your care, you are sadly mistaken. You may be an excellent candidate for a treatment, but the insurance company has the final say and often denies adequate therapies. See my recent post about insurance companies. Doctors are required to do more and more paperwork (and hire more and more help just to complete) it. We aren’t making money by doing this. And the insurance company isn’t saving patients money either. But the former CEO of Anthem brought home a total compensation of more than $18 million in 2017. No one is reaping the benefits except insurance executives, many of whom aren’t medically trained but only have a Masters degree–like the CEO mentioned above happens to have a Masters in Health Administration. Yet, the insurance lobby is vastly stronger than the physician lobby and they continue to delve into unethical practices, up our premiums, and pay out less…all with the government often setting an example for poor reimbursement rates.
4. We’ve let Press-Ganey scores and HCAHP scores dictate the care we provide to our patients. Hospitals rely on patient satisfaction scores for a number of things including reimbursement and physician contracting. Yet, plenty of studies show that better patient satisfaction scores do not equate to better outcomes. No one is surveying whether physicians are satisfied. Instead, patient satisfaction (and thus patient autonomy) has gone so far that physicians have very little autonomy at all when it comes to actually providing care for patients. Much of what we do is directed by someone else including the patient themselves, yet we are to blame when it goes wrong. More about why rating doctors is bad for your health here.
5. Tort reform. Thankfully Texas made significant headway 15 years ago on this. (And that was the first thing I was old enough to vote on!) But we are paying higher and higher malpractice premiums due to malpractice claims. In fact, I pay more than $30,000 a year in malpractice insurance premiums ALONE (and I’m lucky to be in the state of Texas). This is far from affordable for some private surgeons, but when you learn that some neurosurgeons pay upwards of my entire salary in malpractice premiums, that’s truly insane.
6. Losing out to hospitals and forced to become “employed” physicians. Thank goodness for direct primary care practices and the few successful private practice specialists that still exist. These people are unicorn saints. Most hospital systems have become such large conglomerates that they can easily push out physicians that aren’t a part of their “preferred” group that the hospital then contracts to provide services. While they can offer decent benefits in the form of health insurance and 401Ks, they are usually tied to a significant cut in pay. And if you say no, they’ll find someone else to replace you. We have given away our own private market to the hospitals, thus we get paid less and have less autonomy.
Now to the battles that aren’t affecting just physicians but our patients.
1. Anti-vaxxers. This is essentially an anti-physician hate group these days. They spout ridiculous things like doctors getting kickbacks for giving vaccines (which is not true) but we do get reimbursed for providing services–in fact, we do get paid to do our jobs. They say that we are blind to the “data” that say that vaccines are harmful. There is very little REAL SCIENTIFIC data that actually backs up these claims. Vaccines absolutely do NOT cause autism, the man that began that BS is no longer a licensed physician because he lied and has caused harm to thousands of people. However, these anti-vaxxers that have maybe 2 weeks worth of research under their belts send hate mail, make death threats, they even target physician’s children, and they put tons of one star reviews on physician review sites when they’ve never even spoken to that physician. Physicians are trying to better the overall public’s health. One of the best things we have to succeed at that is vaccines. Yet these people have taken their personal freedoms to such a level that other people are dying from diseases that were nearly eradicated when I was a child. They don’t believe how deadly these diseases were because they simply haven’t seen them in their lifetime. It’s pseudoscience at best. It’s a culture of lies. Yet, physicians are getting more backlash than anyone. And yes, we’ve read the package inserts. In fact, physicians are often involved in the development of these life saving mediations as they are in all clinical trials that better medicine as a whole.
2. Home births. I’m so sad to hear that Meghan Markle is going “against British Royal tradition” to give birth in a hospital. What’s crazy about this is that it’s hardly a tradition. Only since Princess Diana and those that followed have the royals given birth in a hospital. Prior to that, they gave birth at home. When Prince Charles was born at home in 1948, the maternal mortality rate (both in the US and the UK) was 1 in 1000. The infant mortality rate was 34 in 1,000. When Prince George was born in 2013, those rates were 12 in 100,000 and 3.8 per 1,000. Many people will say that home births are equally safe as hospital births and it’s simply not true. The real statistics say that the infant mortality rate associated with home births is 13 in 1,000 (that’s more than 3 times the rate of hospital births). Mind you, the current maternal mortality rate in the UK is 8.9 per 100,000; whereas, it is three times that in the US at 25.1 per 100,000. There’s a lot to be said for the UK’s maternal outcomes, both in and out of the hospital. I’m all for options and personal freedoms, but I’m not going to stand for something that spits in the face of the standard of care without ACCURATE discussions of risks and benefits both to the mom and the baby. Many moms and babies could be saved from death if they were under the appropriate care and close enough to a hospital. I’m not saying that medicine is perfect, we have our own complications and areas to improve. But that’s just it, medicine isn’t perfect, and people need to stop expecting it be so.
3. Fad diets. We have long known that a healthy diet consists mostly of plant based foods, small amounts of animal proteins, and limited processed foods. Yet, we go on low-fat, low-carb, high-fat, high-protein, vegan, keto sprees and watch people yo-yo their diet and lifestyle for ages. Some doctors even sign up to offer these ridiculous plans to people when we should be promoting healthy diets from the beginning to the end, along with healthy lifestyles. We need a lot more education about nutrition in medical schools so that chiropractors can’t claim to know more about the human body than we do.
4. Gun violence. Thank you to the NRA for forcing physicians to come together and make some educated opinions about this. I’m not saying we all have to agree, but we as physicians, shouldn’t be expected to care for the consequences of another organization’s greediness and ignorance to its own aftermath. We have every right to try to protect the public. In fact, trauma centers are mandated to have community injury prevention programs–car seats, bike helmets, motorcycle helmets, seat belts, drunk driving, elderly falls, stop the bleed… and gun violence should be a part of that too. If we can’t safely go to a yoga studio or school, then someone needs to step in to help prevent these things. Physicians have taken an oath to take care of our communities, and therefore, we need to make our voices heard. If you haven’t signed yourself up, check out your local hospital for a time to learn about Stop the Bleed–it’s the next best step in saving people’s lives.
5. Breastfeeding. Sure, breast is best. But what’s really best is a FED baby getting adequate nutrition. The amount of mom shaming around breastfeeding has gotten to a level that’s absolutely absurd and borderline dangerous. I am certain (from experience) that this directly contributes to an increased incidence of postpartum depression. Feeling like a failure straight out of the gate as a mom is awful and makes the road that much harder. Therefore, pro-breastfeeders need to take a bite out of some humble pie and stop hatefully shaming the moms that have chosen otherwise. Meanwhile, pediatricians need to not only tout the benefits of breast feeding, but also help new mothers out by educating them about appropriate supplementation and even the benefits of formula feeding when it seems to be the only viable option for cultivating a healthy relationship between mom and baby.
I’ve had enough of our being hushed by the NRA, anti-vaxxers, midwives, NPs, hospitals, insurers, and the government itself. We are one of the few large communities looking out for the best and constantly trying to better ourselves with research, reviews, and innovation.
We, as physicians, can’t be expected to be perfect, so that argument is moot. You don’t expect an attorney to be perfect, or a teacher, or even a mechanic. But you do expect someone to try to do better next time and not to be so grossly negligent that there can be no “next time”. You aren’t going to get physicians only on their good days. You aren’t going to always “get what you want” as a patient/family member. You will get what a large number of people have deemed is “best”. You will get the best we have to offer and we expect you to respect that. You can’t equate your overnight Google search as equivalent to our medical opinion in taking care of your loved ones. You can’t equate poorly constructed projects by lobby groups with double-blinded, randomized, controlled trials that have gotten medicine as far as it has come in the last 100 years. Medicine still has a long way to go. It’s a science that we are constantly learning more about (kind of like the entire universe itself). It’s also an art, and therefore shouldn’t be expected to be practiced in a way that is perfectly congruent between different providers. But when standards of care have been established, and life expectancy has significantly lengthened, and mortality rates have rapidly declined, we all need to respect the evidence and the people that produced it.
Recently, Dr. Monique Tello wrote an outstanding article about much of this. Check out her article here. Enough is enough. Enough with not paying doctors their worth and expecting them to pay off debts until they retire. Enough with giving way to those with less training and allowing them to take over our patient population. Enough with insurers making medical decisions that supersede these of the involved physicians. Enough with groveling over the results of patient satisfaction scores while sacrificing physician satisfaction and setting far too high of expectations for the healthcare system. Enough with extremely high rewards in malpractice cases that bankrupt physicians and make the next generation pay that much more to protect themselves. Enough with hospitals going the way of insurers and telling us we aren’t worth what we KNOW we are.
Enough is enough with pseudoscience, slander, and the hate spewed from those without a legitimate level of education to make claims that harm millions. Enough is enough with celebrities giving support to things that aren’t the standard of care and put mothers and children in harm’s way. Enough is enough with fad diets and chiropractors’ opinions having more weight than that of a physician. Enough is enough with being told we aren’t versed in public health and shouldn’t have a say in the things that help keep our communities safe and healthy. Enough is enough with allowing some groups to shame others with their opinion of our shared knowledge.
Enough is enough. It’s time for physicians to come back together and start making progress in a new direction. It’s time we take the lead to make tomorrow’s healthcare better than today’s. If we keep letting everyone else do it, we really will lose the whole war.
Monique Tello says
Thank you Doctor Enough for taking the time and doing the research to write this much-needed post!