My friend is an anesthesiologist who has had a well-paying career and is not working in the same profession he joined over 30 years ago. While he continued to work in a group at Barnarnabus hospital where the older doctors finally agreed to sell the practice and made off with the winnings, he got a small reimbursement for his small equity in the practice while wall street used their math on how to make a buck. I did warn him that as the group saw more low-paying Medicaid patients, his salary would eventually come under pressure, but how this would happen was anyone’s guess.
After the takeover, he found himself working more hours while watching nurse practitioner-trained anesthesiologists replace doctors who left the group for various reasons. He also found himself working many more hours while the joy of being an anesthesiologist was withering away. He then decided to leave the group and join another group at JFK hospital which worked him less but as the pandemic took hold, his group too was taken over by what he described as two large money wall street groups buying up the practices and having him now manage the nurse practitioners they were hiring instead of the more highly trained anesthesiologists. He recently made the decision to work per diem as this paid as well or better as his profession is in demand and there is now a shortage of anesthesiologists and he would no longer be required to work weekends.
Basically, my friend, with a caring attitude and excellent skills was burning out, even though he was still well paid. He was burning out because the system was using him as a tool, instead of a highly skilled physician trying to keep someone safe while under anesthesia.
My friend is a microcosm of the problem in the US for-profit healthcare system. While the equation for primary care and other physician positions now in many ways favors nurse practitioners due to the cost of schooling, the number of years needed, and just the ability to get into a medical school, many trained physicians feel they are being demoted to the term practitioners as insurers, hospital systems, and drug prices suck the life out of them, while placing them into handcuffs such as the 15-minute office visit that does not allow enough time to consult and medically treat, and they become merely the referral person to the world of conveyor belt medicine where everyone charges you a fee, writes in the same electronic note and passes you along to the next person while you wait for the next scheduled visit. It’s lousy for the patient, overly expensive with too many overpriced tests and no primary care oversight to keep you out of harm’s way in the system. For doctors who truly care, once they give up their own practices and sell to the hospital system, abdicating whatever autonomy they had left.
Those who decide to stay in private practice are having their incomes harmed by the large hospitals they participate with, insurance companies that are predatory, and an overburdened staff while they try to make ends meet; a difficult position for sure. Worse; patients don’t trust their doctors as they used to for good reason, once you are working for a large practice or hospital, you do what you are told vs. going the extra mile for the patient.
I can relate as our practice is having these issues with insurers stonewalling when they should be paying the bill, a staff who tries hard but patients don’t often want to understand why they have to pay so much for insurance while their insurance pays so little. The rewarding part is helping people using a primary care approach from years ago and applying it to the musculoskeletal system, reducing costs while resolving problems and preventing patients from needing overpriced tests or having specialist procedures that are irreversible.
The NY Times in their opinion section also covered this calling it a demoralization syndrome. As in my opening paragraphs, my friend is demoralized by the system and so are we, Nobody asks us providers on the front line how to fix this broken system because if they did, the entire system would move to a primary care model and take the handcuffs off of doctors. Currently, the American Medical Association is pushing bills from state to state looking to define physicians as M.D.s or osteopaths which is wrong in so many ways chiropractors are by definition physicians as are other types of health care practitioners. This won’t solve the problem either as now you are clearly trying to fix a system-wide problem by trying to name yourself king. Worse, doctors in private practices are being starved by complicated systems that require more staff and most doctors have had their incomes eaten away by inflation, and fee schedules that are sometimes worse than they were 20 years ago, while consolidated hospital systems and drug companies continually can raise their prices. The system is killing competition and the souls of the providers who would love to be independent and offer the public a better way to keep their patients and their families healthy.
My wife is tired of hearing me answer this question when friends or family ask, but the truth is the truth, capitalism is ruing healthcare and both doctors and their patients are paying the price with inefficient and costly care that may not be needed, expensive drugs that shouldn’t be that expensive and doctors who wish for the good old days again when their skills couple be used in their entirety to help those they serve. They should also be allowed even in these systems to think and act the way they believe is in the best interest of their patients.
If we want to fix the system, perhaps we need to first allow doctors to be doctors and remove the friction that currently exists in the system.
Check out the NY Times article below
Doctors Aren’t Burned Out From Overwork. We’re Demoralized by Our Health System.
By Eric Reinhart Feb. 5, 2023
Doctors have long diagnosed many of our sickest patients with “demoralization syndrome,” a condition commonly associated with a terminal illness that’s characterized by a sense of helplessness and loss of purpose. American physicians are now increasingly suffering from a similar condition, except our demoralization is not a reaction to a medical condition, but rather to the diseased systems for which we work.
The United States is the only large high-income nation that doesn’t provide universal health care to its citizens. Instead, it maintains a lucrative system of for-profit medicine. For decades, at least tens of thousands of preventable deaths have occurred each year because health care here is so expensive.
During the Covid-19 pandemic, the consequences of this policy choice have intensified. One study estimates at least 338,000 Covid deaths in the United States could have been prevented by universal health care. In the wake of this generational catastrophe, many healthcare workers have been left shaken.