7 minute read
Mad As Hell
from "2020:The Year Of Clear Vision For Physicians & Patients Alike" Cover Created by Dr. Dana Corriel
I AM MAD AS HELL... ...AND I'M NOT GOING TO TAKE THIS ANYMORE!
Written by Dr. Marlene Wust-Smith, M.D.
When I first sat down to write this column for the inaugural issue of Physician Outlook magazine in late December 2019, I was paralyzed by inaction. I knew what I wanted to say but was continuously distracted by rapid-fire thoughts that interrupted the process of putting pen to paper.
The average human is estimated to have 40,000-60,000 independent thoughts while awake every day. If I had the attention span to count or record my own thoughts, I would venture to say that I am more likely to be in the 60,000-80,000 range!
I strongly believe that I am not alone. Most physicians are not “average” and are likely to be outlier companions on the far right of that bell curve of thoughts per day. The process of deciding to become a doctor starts when we are very young and requires a vigorous course of studies and tenacious determination that never lets our minds shut down.
The ability to produce all of those thoughts is both a super-power and a curse.
Our brains and thoughts have helped us get to where we are today. In order to earn the title of "Medical Doctor" most of us had to sacrifice our childhood, adolescence and our 20’s to early 30’s to an educational tract that forced us to delay gratification and give up our autonomy.
Many of us go into a tremendous amount of debt to finance medical school (to the tune of $250,000 to $300,000) even though intellectually, we know this is not a “smart” thing. We do it because we care. We do it because we want to be physicians with every fiber of our being.
So, what has happened? Why are so many of us finding ourselves so unhappy with the profession we dreamed about since we were children? I think most of us ignored what was going on around us.
In order to be successful doctors, many of us have a tendency to bury our heads in the sand, to take on the persona of “the absent-minded professor.” We put our “nose to the grindstone” and do what needs to be done without paying much attention to the outside world or cues.
We ignored what happened when Health Maintenance Organizations (HMO’s) came into being.
We looked the other way when “Managed Care” became synonymous with "health" care.
We didn’t push back when insurance companies started to request “prior authorization” and “peer review” at every turn.
We turned a blind eye when the Medicare fee schedule became the standard by which all encounters are reimbursed.
We didn’t speak up when the volume of patients seen was rewarded over value.
We ignored it when more and more of us came under the employ of corporate America and left our private practices.
We didn’t understand the Affordable Care Act, and, like the legislators who signed the Act into law, we never read the fine print.
With few exceptions, we kept seeing our patients instead of participating in the design process for Electronic Health Records.
We did not attend the Town Halls when healthcare legislation was being crafted.
We did not speak up when we witnessed injustices being committed.
We assumed it was the responsibility of others, thinking that someone else had the best interest of the patients in mind...and if it’s good for patients, we would comply obediently in the name of “Doing No Harm.”
What we didn’t bank on is the myriad of special interest groups who have inserted themselves in between the physician and our patient. When it takes 32 clicks to order a single flu vaccine in an Electronic Health Record, it doesn’t take a rocket scientist to figure out that doctors are getting fed up. The order that used to take a physician a millisecond to jot down (granted, in a hieroglyphic scribble that only his or her nurse could probably decipher) now takes a series of steps and clicks that drive even the most tech-savvy amongst us to exasperation and burn-out.
It’s no wonder that most physicians report frustration because they feel they have been demoted to an overpaid, overworked “data entry clerk” who spends more time charting than they do with their patients.
The “business” of healthcare has taken front seat to patient care delivery. It’s #profitsoverpatients every place we turn, and it’s not good for anyone (except maybe the stakeholders at the top of the collusive mergers that plague our healthcare system today).
Physicians are being replaced in droves nationwide by less educated, often scantily trained alternatives.
When I get on an airplane, I expect a fully licensed and experienced pilot in the cockpit, not a flight attendant who has taken a few flying lessons and whose experience is primarily from a simulator.
Yet marketing campaigns for nurse practitioners consistently throw physicians under the bus, describing N.P.s as being equivalent to, if not better than, their M.D. and D.O. colleagues who have actually attended medical school, completed internships, residencies and fellowships. They describe themselves to patients as having the “Brains of a Doctor, Heart of a Nurse.” I don't know about you, but I believe that I have BOTH brains and a very large heart.
In the U.S., there is a movement advocating that we change the name of “physician assistants” to “physician associates” to appease those who resent the impression that PAs are "merely" assistants for doctors. The U.K. changed the title in 2014, and the United States-based AAPA is apparently trying to follow suit.
We are at a crucial time in history. Physicians are looking for a way out of medicine almost as quickly as they finally finish their training to become Attendings. Most of us try to dissuade our children from following in our footsteps instead of being proud and flattered when they express an interest in becoming physicians.
Many of our readers may be too young to remember the movie “Network” which came out in 1976, but it’s high time to open up our windows and shout “I’m mad as hell and I’m not going to take it anymore!”
I am launching the Physician Outlook Magazine to help others who are fed up, like me, open that window up in unison.
There is strength in numbers.
We need to--as the younger generation would put it--become “woke.”
We can’t continue to passively allow our patients and our physician colleagues to suffer silently.
Hospital and Health System Administrators, Insurance Companies, Pharmaceutical Benefit Managers, and Group Purchasing Organizations are herding us like sheeple. We are being forced to supervise and assume liability for care provided by non-physicians and asked to stay quiet while under-trained and under-prepared replacements are being exploited in the name of the almighty dollar and “access” to care.
It’s time to put a stop to the madness and, at the very least, spread awareness and change things where we can. The answer is not to leave our profession in droves (either by suicide or by leaving Medicine for non-clinical jobs or “side gigs”).
Those who are staying in the profession are plagued by issues with addiction, either in themselves or in their loved ones, who are suffering the consequences of having a physician-relative who is burning out and feeling powerless to stop the process.
Who will take care of US as we age? Many physicians in the workforce in place today have, by and large, become disengaged. We passively obey our masters as we click and F2 our way through long notes that are nothing more than billing documents.
We need to collectively put our individual 40,000-80,000+ daily thoughts to good use and pull the rug out from all of those who think that they know how to best take care of patients and reform health care.
Medicine is OUR house, and we are taking it back!
Written by Dr. Marlene Wüst-Smith, Publisher, January-February 2020
