Keep up the insults, and good luck finding a physician in 10 years

If physicians are “muggers” and co-conspirators in “taking money away from the rest of us”, then journalists and economists are pontificating parasites who produce no goods or services of any real value.

I don’t think either is true, but the recent attacks on physicians by economists Anne Case and Angus Deaton, and “media professional” Cynthia Weber Cascio, deserve to be called out. You could make a case for consigning them permanently, along with the anti-vaccination zealots, to a healthcare-free planet supplied with essential oils, mustard poultices, and leeches.

My real quarrel with them — and with the Washington Post, which published their comments — is that they have the courage of the non-combatants: the people who criticize but have no idea what it’s like to do a physician’s work. More about that in a moment.

Ms. Cascio was enraged by the bill from her general surgeon, who wasn’t in her insurance network at the time she needed an emergency appendectomy. She doesn’t care — and why would she? — that insurance companies increasingly won’t negotiate fair contracts, and it isn’t the surgeon’s fault that Maryland hasn’t passed a rational out-of-network payment law like New York’s, which should be the model for national legislation. She doesn’t care that Maryland’s malpractice insurance rates are high compared with other states, averaging more than $50,000 per year for general surgeons. She just wants to portray her surgeon as a villain.

The two economists are indignant that American physicians make more money than our European colleagues, though they don’t share our student loan debt burden or our huge administrative overhead for dealing with insurance companies. They resent that some American physicians are in the enviable “1%” of income earners. But do they have any real idea what physicians do every day?

Stress?  What stress?

I wonder sometimes what it would be like to go to work in the morning and NOT have to worry that I might kill someone. If journalists or economists get their facts or predictions wrong, it might be annoying, but it won’t be fatal.

If anesthesiologists have trouble getting enough oxygen into a patient’s airway for very long, permanent brain damage or death result. Every time we put in an epidural, for a woman in labor or a patient who needs one for post-surgical pain control, we know the epidural needle is mere millimeters from the spinal cord. Our ever-present fear is that we might injure our patients.

That’s a stress level most people wouldn’t even want to think about.

My stress level, though, is arguably less than the surgeon’s — especially when their day involves using a saw to cut directly through the breastbone, taking care not to saw through the heart in the process, or dissecting out a brain tumor millimeter by millimeter, where the smallest error could leave the patient unable to think or speak.

Even routine operations can turn quickly to disaster. Gynecologists perform laparoscopic procedures every day — but could puncture a hole in the aorta with their instruments. The gynecologist and the anesthesiologist are well aware of that, but we try not to dwell on it, or we wouldn’t have the nerve to come to work.

Ms. Cascio, in her Washington Post column, sounded irked that her operation only took 35 minutes, as if that somehow justified less payment. In fact, that’s a sign of an efficient and experienced surgeon, who didn’t puncture her intestines or her liver in the process, and kept her from being under anesthesia longer than necessary.

The primary care physicians aren’t exempt from fear and stress either. Think about it. A patient comes in with a persistent cough, and the internist or the family practice physician ponders whether this could be lung cancer, and how much grief the insurance company is going to cause if they try to get authorization for a CT scan. The pediatrician sees a child with a fever, and always has to worry if this is a self-limited viral illness — or the beginning of meningitis that could lead to death within a day.

I wish the economists, the journalists, the pundits, and the lawmakers could watch a busy OR getting started for the day. The ritual of putting on hats, masks, gowns, and gloves always reminds me of girding for battle. Everyone knows all that can go wrong, and we’ll do all we can to make sure that none of it happens that day, on our watch.

Even more gallant are the young interns and residents who are starting out in their careers. They’re often moving from one moment of anxiety (or terror) to another, before they start to gain some confidence and hit their stride. Our role as faculty is often to reassure and cheer on as much as to teach, and to let them know that we have their backs.

Regrets over choosing medicine

The tragedy that’s happening in medicine today is that the loss of respect and the constant threats to fair payment are making physicians regret that they ever chose medicine. They were fascinated with science and wanted to help people, and their reward is insult.

It’s no wonder that some newly trained physicians leave anesthesiology quickly; there’s little risk to running a hangover clinic in Las Vegas. Many physicians from all specialties get MBAs because they see that the real rewards in healthcare lie in becoming a CEO. Look at the salaries of top executives: the CEO of Anthem made more than $14 million in 2018, as an example, while insurance companies did everything they could to avoid or delay signing fair contracts and paying clinical physicians for patient care.

There is a growing shortage of physicians, not just in primary care but in specialties too. The American Association of Medical Colleges (AAMC) estimates that the US will be desperately seeking surgeons in the next 10 to 12 years, and looking for more anesthesiologists to work with them. As older physicians retire, and younger ones aren’t willing to work the long hours that used to be routine, this will only get worse, while increasing numbers of older Americans will need more complex medical care.

Maybe your barber will learn to operate on you, just like the barber surgeons of old, and your local gun store will sell you a bullet to bite on. Best of luck.

____________________________

Gentle readers:

Please be aware that I will not publish further comments to this post on scope-of-practice issues, or on the role of non-physician professionals in healthcare. Enough has been said already — perhaps too much.  Comments about the actual issues discussed in this post are welcome.

It is difficult for all of us to know what we DON’T know, but the more education and experience we have, the less likely the knowledge gaps are to cause harm to a patient. I will always be happy to work on a medical team with anyone who wants to work with me, and I will always oppose the elimination of the physician from the team.

Yours very truly,

Karen Sibert, MD, FASA

____________________________

Recommended reading:

Nobel prize winner insults all doctors, by Skeptical Scalpel

If doctors wanted to be wealthy, they would have become UPS truck drivers, by Neil Baum, MD

 

127 COMMENTS

Hans Kristian Lauritsen

I have read this post with great interest. As a European colleague, I cannot say we have the same situation regarding insurances, but I can say for sure that we have EXACTLY the same problem regarding loss of respect etc. We are constantly met with the demand “more healthcare for the same money” which is just a way of saying that we need to see and treat more patients for less money.
We see a decrease of doctors in primary healthcare because of dwindling reimbursements and more obligations. And we see that same loss of respect as described in this post: patients very often comes with loads of printed papers from internet-searches and demands specific treatments etc.
I am happy to look forward to my pension in 5½ years.

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LA Marrero MD

What’s a pension? In all seriousness, this is another aspect of income not considered when comparing US to other nations. In short, if physicians decided to take our cognitive talents to other fields of employment, I’m pretty sure we’d earn as much if not more.

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Christina Marie Menor, MD

Be happy you have a pension in 5 1/2 years

Most of us here don’t have a pension to speak of and must also use income to put into retirement or we will work until we die…and sadly some doctors do.

All of us physicians need to come together and demand respect from the public

[Reply]

See Free2Care.org 37,000 physicians and 3million people that feel exactly the same way. Also see citizenhealth.io

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Jo Ann Licetti

Amen. I agree with you entirely. The statisticians and economist are trying to run healthcare which they know nothing about. The Doctors need to demand respect and take back control of health Care. The money in health care today is going to people who don’t know anything about medicine not the doctors. I agree with Colleen. If you want to cut costs start with JCHAO,Administrators and tort-reform and Insurance Companies.

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Dr. Kathryn duplantisMD

Well said! We need to come together as doctors and start fighting for our patients who deserve better than this kind of care! It is hideous and dangerous! Also, we doctors absolutely deserve more respect!

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Dr. Kathryn DuplantisMD

Well said! My 25 year old practice of cosmetic surgery is now retired! My patients cried when I told them I was retiring! Many of my referring doctors also were upset because my hair transplants were very unique! I will be teaching the residents part-time at the VA, reconstructive and cosmetic surgery! I love our veterans and my specialty is hair transplants,facial plastic surgery and body work and I got tired of the environment that all docs are in the middle of these days! Too much liability out there! We are doing some cool things at the VA for our deserving veterans! We are all veterans in our family so I can relate to veterans! We will have a shortage of doctors in less than 5 years! We will see less kids going into medicine due to the changes made 10 years ago!( the 2008 bill crushed us)

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Fariha Shafi

Thank you so much for this. I was surprised and disgusted by the Washington post article! Can’t believe that they did not do their research before publishing it. I recently wrote an article for KevinMD, “ who are the physicians who end their own lives?” Sadly, people have decided we are the villains. Can’t index why. My patients are so sad that they get seen by mid levels half the time and get sub par care. My own hospital and insurance billed me over $300 for a vaccination mandated by the state and threatened to send me to collections!!! We ARE victims of this pathetic system. When it take 65 peephole to be hired to admit one hospital patient ( not the doctors but the administrators) it is time to rethink how healthcare is delivered in this country!!’
BTW, shame on Washington post. I pray that when the editor gets sick, he ends up being seen by a quack or a barber or someone with an online degree!!!!!!!!

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Not subpar PA

Your patients are sad they’re seeing a subpar “midlevel?” Really? If you are referring to nurse practitioners or physician assistants, you are sadly mistaken. I have my own patients who request to be put in with me. We take patient care every bit as seriously as you do and have the same stress and risks. I have great respect for the medical assistants and nurses I work with every day and help me give the best care I can. No one would call me midlevel.

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Jack

How do you have the same risks? Isn’t it your supervising physician whose ass is on the line if you mess up? Don’t they get dragged into litigation to be your scapegoat when you mess up? Despite how much you insist that you’re equal in every way to a physician, I doubt you’d want that risk and responsibility squarely on your shoulders and no one else’s. Furthermore, you go on about how much you appreciate your medical assistants etc. yet how would you feel if people insisted you refer to yourself and your professional level of skill in a manner indistinguishable from the MA? That’s basically proportional to what you NPs do when you insist on being viewed equally to a physician.

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karen

Please everyone — I would rather this didn’t turn into a scope-of-practice debate. I write about physician-slamming because I’m a physician and I find it so discouraging if people don’t appreciate what goes into healthcare. I appreciate what EVERYONE does in healthcare, and we all have our own stresses and frustrations. My work in the OR isn’t possible without the whole team. I only get annoyed in terms of scope when people want to eliminate the PHYSICIAN from the team!

All the best,

Karen Sibert

[Reply]

Steven Johnson

Many, if not most, of us are behind you 100%. Thank you for calling out issues help make sure we get a more complete story from media sources who hope to be credible. Thanks for all you do and all you have done to prepare and care.

Susan

Very well said. Unfortunately, the long hours, unfair compensation, student loan debt for physicians is what is deterring those who may desire to be a physician, choose other careers. I don’t believe anyone is trying to eliminate physicians, but PAs and NPs are a solution to fill gaps. Of course we will NEVER replace, nor should we replace, physicians- but we are capable of doing perhaps more than most think. There is a serious shortage of physicians, and I fear this will only get worse. Who will be there to care for the patients? My patient panel in any given day, are very sick patients, needing to be seen, and because there is no room in my physicians’ schedules to see urgent patients, they are out in my schedule. While they are seeing their routine follow-ups, I am seeing their sick patients ( CHF, A-fib, chest pain etc).
I don’t want to replace my physicians, but who would be seeing them if I weren’t there? Not only are we helping fill the gap, we make their work life a bit more bearable- taking call and rounding on weekends to help their load.
We are trying to help the problem- not replace you.

Respectfully,

A caring NP

Deb

I agree with Karen, this isn’t about career shaming. We, in healthcare, are all in this together! I love my general surgeons I work with. They are the hardest working people I have ever met. If I can help decrease their workload and stress then I feel I have helped keep my physicians from imploding. I have been a nurse and now a NP for almost 30 years. I have seen the transition of how this industry has changed our profession and our professionals. I was self employed for ten years and my reimbursements dropped almost 70% after Obamacare. It’s the hospitals, insurance companies and pharmaceutical companies that have created this monstrosity.

I agree wholeheartedly with the body of Dr. Sibert’s post. However I am puzzled that she attacks Ms. Cascio’s article in the Washington Post. Ms. Cascio underwent an emergency lap appy by an out of network surgeon who charged her $17,000! Only after prolonged attempts to receive payment did the surgeon grudgingly offer to discount the fee by 30% to a still outrageous $10,500. How can Dr. Sibert defend that amount?

karen

Dear Mr. Stauffer,

Both of the Washington Post articles were terribly unbalanced. It would be interesting to know, for instance, which insurance company the patient buys her policy from, and whether that company ever made a good faith effort to negotiate a fair contract with the surgeon. Or, as is so often the case today, does the insurer keep its physician network intentionally narrow in order to dodge paying the out-of-network physicians at all, as happened here? Second, how can the hospital justify having an out-of-network general surgeon on its emergency call panel? That should not be allowed to happen. Certainly the surgeon could have handled the situation far better, but tarring all physicians, by extension, as “muggers” is just over the top, and fails to acknowledge the role of the insurer and the hospital in creating an unworkable situation.

Thank you so much for reading and taking the time to write.

Best,

Karen Sibert, MD, FASA

dr brent clark

i agree,,,, when u weigh it,,, no one wants to b dr no more,,,hate to c medical people at each other,,,,,whats the answer,,,????,,,,,unions???,,,,socialized medicine??,,,,or go back to leaches?,,,,it does need fixed,,,,,,,very obvious to prioritize health care,,, and weigh just how important each Tx porcedure is for the money,,,,no need for insurance to have all power,,,,, give us a Mesiah!

[Reply]

Rachel A

Replying to “Not subpar PA”
Maybe I missed it, but I didn’t see anything in this article about “mid levels” or other non-physician practitioners. Trust me they will start coming after you guys too. Just wait. Where I work we have great relationships with our Nps and PAs. Sorry if you’re not experiencing that.

[Reply]

Pa2ed

The reference to “sub-par Care” was in response to a comment posted, not the article.

If you, as a physician, feel threatened by PAs or NPs, you need to examine your own self.
If you, the PA or NP, believe you are “just as good or better” than the physician, you need to examine your own self.

I am in my 40th year as a PA. I’ve worked in surgery, internal medicine and interventional radiology. I have worked along side hundreds of physicians And residents, thousands of nurses, even more thousands support staff. Each and every one, with few exceptions, are dedicated and work diligently for the patient. We all want to provide the best care.

This scope-of-practice bickering does nothing but further distract us from our real work and, dare I say, negatively impacts the care we provide. I do extremely complex procedures….. a skill set honed over my 20 years in IR….. and I do them knowing I have the support of the physicians I work with, many of whom I trained as residents. note I said “with”, not “for”. I stopped “assisting” 30 years ago.

We All should be advocating for a better understanding of each others role, hiw to better collaborate, and practice as a team, not adversaries. You will all be a bit happier in your practice. I want to reiterate….the PA practice model does NOT espouse “independent practice”. We are educated to work in collaboration with physicians using a team-based approach. There is nothing better than an MD/PA team practice based on mutual respect.

Back to the subject at hand….“non-physician providers” experience stress as you do. We have the same concerns, the same doubts, the same second guessing. I do every procedure knowing full well I can cause great harm or death. I often joke my grey hair and beard are not due to old age or my kids, but rather the stress associated with my work. I advised every student, every resident I teach to Meditate daily, and find a healthy outlet for the stress…be it sports, a non-medicine hobby, something/anything to relax.

Thank you Dr.Sibert for an excellent presentation of the stress associated with the practice of medicine.

[Reply]

Duane Sipes MD

Thank you. Well said/written!

MommaOlive

@not a sub par PA…I’m afraid you’ve missed the entire point of the article! She is not saying PAs should not exist as part of the team. She is simply saying doctors must exist. A PA is not a physician replacement. You love and respect your MA. Can she do your job without oversight? Or the job of an RN? No. To function in those roles would require more education. That is literally all there is to it. Does that mean she isn’t a valuable, respected, and vital part of a team? Also no. We need the whole team. The point of this article is that if the jabs don’t stop, there won’t be a team at all anymore

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Tea

Im romanian. General surgery resident doctor and i can do the work of a RN, i can do anything. I can provide all the healthcare that my patient needs. I do my job with great respect for my pacient, nurses and collegues. No matter how hard it is for you to understand please make a try: Doctors can do a nurses job but a nurse will never understand life and death situations like a surgeon can.
Once a month i collapse. But my patients never see that. My brain and body hurts but i dont give up.
Respect the doctors you work with and try to understand that not all of us are complete fools…

[Reply]

Colorado Doctor

Thank you. Well done.

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Michael

Cue the non-physician provider (and their constituencies’) responses s****ing all over us, saying they are better anyway, and how they know just as much as us and care more, and have empathy, yada yada. It’s unfortunate that the Flexner Report has faded from memory. This country is doomed, from a healthcare perspective. And it’s going to be way too late by the time John Q Public realizes what’s happened.

[Reply]

Alex Keller

Could not agree more vigorously with the points made within this article. My more succinct response upon reading the article published in the WP was “ these people are idiots”, but the comments above are likely more productive.

How is it that people who have attained Nobel laureate status can be reduced to making such global, misinformed, and unscientific statements based on a single personal experience. Embarrassing.

[Reply]

Christine L Saba Pharm D, MD F. A.A.P

As a pediatrician in practice the past 20 plus years and the first Senior Clinical Pharmacist in the PICU at Johns Hopkins Hospital prior to making the decisions to go to medical school
Yes is that fever : viral or meningitis or early sign of leukemia
Hope this journalist has that level of stress on her as we pressured to limit our sick visits to 10 min slots
Thank God I am in my own solo practice and can control the costs of running a business
I feel for those physicians who are being told by administrators how many children or Pts they must see in a day to recooperate the “ rvu” so their corporate entities and administrators make the profits of the backs of us physicians

March on Physicians and continue to educate the public

[Reply]

Aileen

As an RN for over 40 years I am so sad to see the state of healthcare today.In the beginning the patients care was the primary focus with observation,physical examination listening as the doctors tools.With advanced technology and demand for paper work and profit by companies the doctors,mid levels,and nurses cannot deliver the quality care that patients deserve.It takes a whole team working together for the best outcomes.People seem to forget about the weekends,holidays,overtime and shift work that the medical professionals are required to do.There is no pensions at our local hospital except for the upper management.😡The main reason that most of us do these jobs is because we love what we can contribute to our patients.I fear that this situation is only going to get worse,Priorities need to change.

[Reply]

Irene

Well written article . Exactly mirrors my thoughts.

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Jay

Great response!! I hope this circulates all over the media!!

[Reply]

STL Doc

Well said. The idea that doctors are the source of most of the heathcare problems in the US is such a common misconception. Most people don’t understand that surgeons and internists have little to no control over procedure and hospital costs. Reimbursement for procedures is determined by Medicare, not doctors. How much of the total cost the patient is responsible for paying is then determined by their insurance, not doctors. The whole system is so complicated that’s it’s hard enough to understand as a physician, so it shouldn’t be surprising that the average healthcare consumer can’t understand who to blame. I wish I had half as much wealth and power as the villainous doctors portrayed in the media. My life would sure be a lot easier if that were the case.

[Reply]

RS

You have expressed everything we are going through very well in this article. People need to start listening and the public needs to be educated. There are so many misperceptions about physicians. I had many too prior to becoming one, and now realize what physicians experience.

[Reply]

You got it right

Karen, you are exactly on point. It is very easy for journalists and TV reporters to throw stones when they have no idea what it is like to be a physician. Ask those journalists if they have ever interviewed a private practice physician (NOT an academic physician who lives/ works in an insulated fantasy world) about their work day. The answer will be NO. It is clear that physicians earn less today than at any time is the past, yet insurance premiums, copays/ co-insurance, and medicals costs in general have skyrocketed. If those costs have skyrocketed, and physicians are earning less, than clearly physician costs are not the problem. The insurance companies are stealing the premium money.

As for insurance “contracts” and “in-network,” the whole concept of “networks” needs to be abolished. This is a scam perpetrated by insurance companies and Medicare to eliminate the options patients have in choosing their physicians or hospitals. Think of your auto insurance or homeowner’s insurance. If you have an auto accident, you are free to choose any shop to do your repairs, including the most expensive option: the dealership (how many times have you heard from friends or family how a minor “fender bender” became a 10s of thousands of dollars in repairs?). The auto insurance company cannot tell you which shop to use. There are no “in” or “out” of network repair shops. If you have auto insurance, you can choose any shop you wish, and the insurance company pays the bill directly to the shop. Likewise for homeowner’s insurance. If you have a claim for fire, water, roof leak, etc., you are free to choose any electrician, plumber, framer, roofer, contractor, etc., you believe will do the best work. The insurance company cannot tell you which contractors to use. However, when it comes to your HEALTH, the insurance company WILL tell you who can and cannot choose. You are not allowed to choose the best cardiologist, neurosurgeon, anesthesiologist, etc. for your care. The insurance companies contract with the lowest cost physicians to save the insurance companies money and pay outrageous salaries to their CEOs (10s of millions, to HUNDREDS of millions per CEO). How many CEOs have ever taken care of a patient?? The American public for decades has been so brainwashed into accepting the concept of health insurance “networks” that we no longer even question the concept. The insurance companies are now working tirelessly to convince our legislators (state and federal) of the same thing. Their lobby is all-powerful and physicians have to contend with a Goliath battle. The public is very unaware that the best physicians are NOT “in-network,” but that is because they only choose from a short list of physicians given to them by their insurance company. Even those lists are inaccurate. The public needs to wake up and battle the “network” issue. Just like auto insurance and homeowner’s insurance, If you have health insurance, you should be able to see any physician or hospital you wish. Eliminate the concept of “networks” from health insurance. Clearly, your health is more important than home or car.

[Reply]

Or better yet, eliminate insurance altogether with the exception of catastrophic-only plans. Pay direct, via HSA, for routine services and join a Direct Primary Care practice. SB 3112 and HR 5596 are bills that make HSAs available to everyone and raise caps to make them useful for the above services.

[Reply]

VV

Hallelujah to that!!! There was a great article written a number of years back which followed the money. It is time for another. Frankly, I feel all the hospital and insurance administrators salaries should be published. Then Joe Public should speak as to why everything costs so much.
VV

[Reply]

You got it right

We physician’s are facing bombs from every direction; insurance companies, hospital administration, un-informed media outlets, private equity companies. All of these non-medically trained entities are eroding the private practice of medicine.

[Reply]

Complete ignorance. Both the author of the Washington post article and the patient who was upset about the procedure that likely saved her life. It doesn’t surprise me though. Americans are so quick to take for granted the blessings they have especially when they have no clue that it takes about a decade for doctors to be educated, trained and equipped to care for patients. The real issue is the way that doctors are being professionally bullied by government and big business. Instead of being treated as the all-star player, they get slighted like they are just a water boy for the team. Medicine would not be what it is today if it wasn’t for physicians. They suit up for battle every day to fight against all of the health challenges that people face. Instead of treating doctors like they are the problem, we should be celebrating their sacrifice, commitment, and service to give us the patient more opportunities to live life abundantly.

[Reply]

GenXObGyn

Thank you for this article. I am a “mid-career” Ob/Gyn, married, but with no kids. I fully expected to work, full-time, without interruption, until I was at least 70. Instead, I find myself already out of my field and likely out of clinical medicine altogether due to the complete instability of our “job market” and overburdening regulations, “credentialing”, and “voluntary” board certifications that you can’t find work, without.

Luckily, I am smart enough to be a doctor and surgeon…which makes me smart enough to be “lots of things”, so I’ve exited stage right.

Good luck finding an NP who does hysterectomies or can deliver your breech baby. 🤷‍♀️

[Reply]

Shannon Mitchel, MD

Thank you so much for writing this!!!

[Reply]

ARR

THIS THIS THIS THIS THIS. u captured the reality of physician life SO well. excellent work. im a young anesthesiologist who has been disillusioned from very early on. i am sad for the future of my profession.

[Reply]

David

Good article. I do disagree with the premise of your title though. “and good luck finding a physician in 10 years”

Young people will still enter the profession, but as the work becomes emotionally less rewarding, the fidelity and devotion that physicians have historically devoted to Medicine will erode. The next generation will (justifiably) have a civil servant mentality. The mantra each day will be “don’t hurt anybody and stay under the radar” and they will sleep with their employee handbook on the night table.

[Reply]

karen

Dear David,

You’re right that there will still be doctors. But will they be the doctors patients need, when and where they need them? Will we have enough vascular surgeons, for instance? That’s one of the fields projected to have the greatest shortage. If what we have is part-time shift workers, in less demanding specialties, then that’s what we have. But that doesn’t make it right, nor does it meet patient needs.

Thanks so much for reading and taking the time to comment!

Best,

Karen Sibert

[Reply]

VascPA

Dr. Sibert,
I completely appreciate your concern for the future of the vascular surgeons. I share your concern, and I am just a vascular PA working in a private practice setting. The future of private practice vascular surgeons does not look promising. The local hospital system has hired “employed” vascular surgeons and interventional radiologists, and are trying to push the private practice surgeons out. Even though the vascular surgeons are essentially the “firefighters” of the hospital, and the volume of vascular patients is definitely enough to share (especially during “busy season”), it seems vascular surgical patients are being diverted to interventional radiology and/or cardiology. Any procedures that are “significant RVUs” and don’t require hours to complete are being “cherry-picked”. Yesterday I had the joy of listening to the chief of surgery tell my surgeon that they wanted to add the IR physicians into the surgical QA/QI. The dedication, length of training and years of work that vascular surgeons put into their training is definitely lost to those that truthfully do not understand. Unfortunately, not everyone recognizes that “you don’t know what you don’t know.”
I feel that medicine is broken and there seem to be many individuals who are working within the field for the wrong reasons. Each specialty has different training, and while some specialities may have some overlap, I think the interventional cardiologists would have a fit if the vascular surgeons started doing cardiac caths – but they don’t seem to have an issue doing legs. IR would have an equally volatile reaction if a vascular surgeon decided to start doing PICCs, paracentesis and biopsies, but again, have no problems doing elective leg angios during the daytime hours — just don’t call them to do an emergent angio and drop a lysis catheter at 11pm — but make sure you’re available for the perclose that occludes the femoral resulting in no pulses, severe leg pain and numbness at 2am. I think one of the first steps to fixing some of these problems are for people to understand what their roles are across the board. My role is to act as part of a team with my surgeon to take the best care of our patients. I do what I have been taught and can safely and competently perform – my role is NOT to replace my physician colleagues, but to compliment them as part of their team. People need to respectfully “stay in their lane,” follow the rules, and act like a team. Physicians in each of their specialities are leaders, and healthcare as a whole needs to take a step back, recognize and respect that and start supporting the teams they are leading. Instead everyone is getting a participation trophy.

[Reply]

Sean

I get the frustration in the article from a patient’s standpoint. Most people have insurance that is very expensive to have and use. When they decide to use it, it’s virtually nonexistent to see a provider that will dx your flu without ordering a CT for your cough/sob or if you’re overweight with the same sx a PE study. And the patient is has to deal with financial fallout of our new culture of over ordering so the provider feels safe from potential future litigation. At this point excluding acute traumatic injury which despite most ED providers belief is not an injury that occured 3 weeks ago, or cardiac arrest. ED providers and triage nurses could start to be eliminates in 10yrs. Their ordering habits have basically transformed them into data aggregates that rely on ancillary departments for test results to verify a duck is a duck. Eventually someone is going to streamline patient throughput and cost by simply having either a bank of touchscreen kiosks in the ED or urgent care lobby. Even if the triage algorithms were super conservative they would simply do exactly what most of these providers do now. Order all available labs and imaging studies that visualize the areas of concern. I’m honestly waiting to see an AI component created to help Radiologist’s with their insane workload. I’ll bet within 10 years there will be an AI assistant that pre screens radiology images and tags potential pathology radiologist review. The idea that people will leave the medical profession or stop going into is almost laughable. People work in the medical field for many altruistic reasons. We also do it because it pays better than working in an Amazon warehouse, driving for uber, roofing, or slinging water ice at Rita’s and that’s not going to change. The medical professional’s quality of life isn’t going to get better, but it will always be markedly better then most career alternatives. In the end you have the freewill to change your profession to improve your own happiness. Someone is sitting in a classroom right now getting ready to take your place.

[Reply]

Nate

I am a Dermatologist in my early 30s in a very underserved area. I am still driving my vehicles from college, I live in a very small house, and I have already paid off my student loans. I am working on getting my mortgage paid off now.

All because I know full well I’m not going to have a full career in medicine before it becomes untenable. I’m planning my Galt moment for exactly the reasons stated in this article. There is no respect. Patients google for 5 minutes in my waiting room, call it “research,” and argue with me about it. Patients call me by my first name ALL THE TIME. These are things I wouldn’t do at a doctor’s office.

I seriously worry about my aging parents. I won’t let them go to a visit without me there to make sure they actually see a physician.

[Reply]

Bosley

Excellent. I have been a patient longer than I have been a doctor and with the way things are going I truly worry about the type of care I will be getting in 10 years. Smart kids are turning away from being a doctor to become some form of mid level. Why wouldn’t they??? It is a lot faster and a lot easier, with much less of the liability and responsibility and in many cases the same pay. But no matter how smart, they miss a lot and their knowledge is very limited. I worry about my self and my children!

[Reply]

Todd Adams

Well said Dr. Sibert. I also agree with Sean that we should cut the patients some slack. These poor slobs don’t have a clue what economic factors drive the costs behind their bill. Anne Case & Angus Deaton are hacks. The Washington Post editor simply leveraged their sensational comments to antagonize the public and increase readership.

[Reply]

Meagan

As a midlevel provider, I see the dedication and sacrifices made by my physician colleagues on a day to day basis. I witness their souls being poured into their work with little to no reward or gratitude. Many, if not all, have families that they put second to their patients. Articles, like this one from Washington Post, that demean your work sickens me. Many of these people have never stepped foot in a hospital or clinic to witness what really goes on behind the curtains, yet they write as if they have first hand knowledge.
To the physicians reading this, I see you and your countless hours of hard work. You are appreciated, you are valued. I am proud to work with physicians like you everyday. Keep up the fantastic work and don’t ever question why you pursued medicine. Your hearts are admirable.

[Reply]

eloi rubio

I am so thankful for medical doctors. I never realized the pains they experience until my son became a doctor. I also learned to say “please let me see a doctor, not a nurse practitioner or medical assistant. I am glad, as a retired teacher, who had parallel experience with parents demanding what they considered the “fix” for the student’s inattention problem. I hope doctors will continue to provide helpful healing, in spite of all the obstacles, to those who hurt and are in need of healing. Thanks, and God Bless Doctors.

[Reply]

Matthew

Great article. I’m one of those pediatricians who left in my mid-30’s to get an MBA and join the corporate world. Why? Because the private practice where I was employed became a factory for seeing as much as possible as fast as possible. 10 minutes for a sick visit, 20 for a well. Half the time was usually spent doing things to check off boxes for the insurance company due to value-based care contracts, but were totally unrelated to patient need. All of this was for a salary less than what I could have been making without any graduate degree at all. I was afraid I was going to miss a cancer, or a meningitis (or an appendicitis) because I was too busy trying not fall too far behind in RVUs. No thanks. Now I make more money working 9-5 weekdays only, no call, and the flexibility to work from home. And I still get to work on projects that actually might save lives, just at a more macro level.

[Reply]

Joe

Sooooo
Now that you are admin how do you treat the docs in the trenches still seeing patients?
Asking for all the docs who deal with Unethical MD’s who sold their Hippocratic Oath to hospital admin for a paycheck……

[Reply]

CGallMD

Thank you Karen..very well written.
The curiosity is how Medical care is being disassembled (demonozing of physicians, replacing physicians w non physicians, crushing bureaucracy, loss of autonomy, dispair) and the replacement with Healthcare (the very lucrative industrial complex of corporatized medical care…for which physicians are a wee tiny part). Neologisms like Scope of Practice, Access and Provider are great windows into the intent. But the real question is why? Is it only $$$ (bcz Healthcare is expensive but we know Medical care doesn’t have to be -DPC) Or is it something else? Just too many conicidences as the whole thing uncoils.

[Reply]

Julie

Thank you Dr. Sibert!

Sadly, the Washington Post has stooped to the status of a fact-less blog focused on sensationalism. Journalism, once a noble profession, has assumed the “rent seeker” role and the WaPo is the king daddy.

When I am in a room with my colleagues, I am surrounded by a century or more of post-doctorate years of education – more than you’ll find in room of PhD economists. The WaPo insults of “muggers and rent seekers” do not match up as these are some of the most caring (albeit exhausted) people I know.

As a surgeon, I am grateful for my team as we navigate the minefield of this broken healthcare system that was legislated to us – bought and paid for by AHIP. Hey by the way did anyone see that UnitedHealth reports $14 billion in 2019 profit? Ahh! That’s where the $25,000 in premium is going.

[Reply]

Brittany

I wish this article talked more about the root of the problem, which is a broken healthcare system. Some of the commenters are saying the solution is for doctors to get together and “demand” respect…what about the country coming together to demand a healthcare system that is fair and accessible to all?

[Reply]

Dr XYZ MD

Thanks for writing this article. The doctors don’t even know what is the bill for the patient ; it is the administratos who decide that and insurance companies / hospital management are the billers. The physicians are salaried people just like rest of the U.S

[Reply]

nancy petersen

Anger directed at physicians is about the angry person not the physician trying to help. Yet it is common where diagnoses are elusive or where little help is possible for the condition results in an avalance of angry diatribes fired at physicians and their staff. I manage a large (90,000 member) facebook education page and while we do allow unsatisfactory comments to be made, they must be neutral and factual. Most often we encourage the members to talk their concerns thru with the caregivers involved. Not infrequently, the unrest has arisen out of a misunderstanding, often resolvable with discussion and understanding. It helps no one to blister another with anger. And yes, being ugly may well have long term consequences. Those trying to help do not deserve castigation

[Reply]

Barklie W. Zimmerman, MD, MHA

Thanks for a great article Karen! I have forwarded this to my three MD children whom I feel need to know the importance of restoring the public’s understanding of the challenges faced by our profession. We have our share of “bad actors”, as does any profession. But, because of the gravity of our responsibility to patients, and the lack of perfect predictability of outcomes, the actions of “bad actors” in this profession get far more attention than they do in most other professions, and are assumed by many to be typical of all doctors.

The result, in part, has been excessive medical malpractice litigation, expanding medical malpractice insurance costs, and most importantly, a degradation of the public’s trust in the one profession best equipped to protect and maintain the public’s health. Why, then, would any college student at the top of their academic career choose to subject themselves to the gauntlet of the medical school admissions process, four years of medical school, three to eight years of specialty training, and overwhelming academic debt only to finish these years of training to face ever increasing expenses and a public who has diminishing trust in the medical profession.

I would pursue this profession again. I fervently hope my children will feel the same forward the end of their medical careers. But you are absolutely correct: if things continue on their current course, good luck finding a physician, especially one you would really want.

[Reply]

Steve

As a physician, I’m okay with these idiots blaming everything on the physician. Many things change as the world changes but two thing are for sure –

1. Humans will get sick and will die.
2. Humans really want to live

One day they (or their families) might need to beg a physician to save their life. But they don’t have to trust physicians or beg…we have enough patients crowding the ICUs that I am okay with these people dying and suffering at home..it’s called population control.

I however will never ever beg an economist to save my life. That’s the difference between you and I. Sorry buddy.

[Reply]

Jess MD

Thank you for your article. I shared it on Facebook with a commentary and was pleasantly surprised by the support from both medical and non-medical friends.

Here is part of my post:

According to the fee schedules created by the Centers for Medicaid and Medicare Services in 2018, my professional services as a neonatologist are not worth very much…

Per their website, every time I resuscitate a newborn baby (help a critically ill baby breathe to save his or her life) I am able to bill 2.9 work RVUs for my portion. My 2.9 work RVUS are worth (and reimbursed by insurance for) approximately $104.

Is $104 too much to be paid for saving a baby’s life?

It’s less than our monthly cell phone bill. It’s less than a ticket to see a show like Hamilton or to spend a day at Disney World. It’s also less than I have paid for a haircut and highlights. Or having a plumber come out for an emergency.

So, the next time you see a medical or hospital bill that is outrageous, please, please remember that most of it is not actually going straight to your doctors. And that we are not all “money-grubbing” villains like a lot of recent articles have portrayed us to be.

Our system is just so broken…

[Reply]

Dr Pat Scanlon

I read both this article as well as the Post piece in order to understand the issue. On the surface I was angered by her tone, as a General Surgeon myself, deal with similar issues on a daily basis. However, learning that the surgeon in question brought up a fee Before taking the patient to the OR, and then quoting an unusual and uncustomary fee that is probably 10x what it should be, I began to understand her plight. Don’t get me wrong, I do think the insurance companies have caused this mess, especially with “networks” and list of “in network” physicians. The biggest problem I see is that most patients deductibles are higher than the fees of most procedures I perform, but in this instance, the Surgeon should have taken care of the patient first, and worked out details of their fee, with discounting it to a reasonable and customary average of what private insurers agree to.

It infuriates me when I hear of physicians “make too much money,” when the facilities and the insurers make the land share of the profit. As I practice in MS, underserved and lacking in providers , I never have turned away a patient in the ER, for inability to pay, as I recall, I took an oath both upon completion of Med School, and when I was inducted into the American College of Surgeons years ago.

[Reply]

karen

Dear Dr. Scanlon,

Thank you for your comment!

Medical charges are comparable to prices in a middle-eastern bazaar: nobody expects to pay or receive the sticker price. Haggling is expected. Good insurance companies negotiate for their patients up front, have adequate physician and hospital networks, and the patient knows what the deductible and copay are going to be.

Bad insurance companies (more and more of what we have today) have narrow networks, and no guarantee that your in-network hospital will have an in-network physician on staff in the specialty you need, when you need it. Hospitals also have a duty to make sure that if they admit the patient and accept the patient’s insurance, they have an arrangement with the physician who’s covering for emergencies so that the surgeon and the patient aren’t put in this untenable position.

Could the surgeon have handled it better? Maybe, or probably. But is it better NOT to disclose the out-of-network problem in advance? And surprise the patient afterward? There’s a nearly 100% likelihood, I would guess, that the surgeon never in the world expected to be paid the entire $15,000. Would love to hear the surgeon’s side of this story. But in any negotiation, you start high so that you can end up somewhere close to what you expect. Is this a stupid system? You bet. But physicians didn’t invent it; we suffer through it just as patients do.

The whole issue of prior authorization more and more is being used as a technique for insurance companies to torture both physicians and patients in an attempt to deny services and payments.

Best,

Karen Sibert

[Reply]

karen

Dear Readers,

Please be aware that I will accept no further comments that relate to scope of practice or the role of non-physician professionals in the delivery of healthcare. These issues are not the subject of this article.

Thank you–

Karen Sibert, MD, FASA

[Reply]

James

The insanity of it all is beyond belief. At this very moment as I read this article- a Muslim patient is laboring (presented to the hospital at 9 cm with out time for me to call in another provider). Her husband request no males, to comply I have an intern delivering while I stand at the door way. So Insistent that he glares at me while she pushes with the intern. Yet if something were to go wrong I would be liable to the sum of millions maybe. If I intervene and they feel it non-urgent thus infringing on her religion/ rights/ personal wishes… then I can be held liable for “assault”.

For all this I stand to earn the equivalent of $500 US.

But what people fail to forget- walking away for care for a patient like this increase poor maternal and fetal outcomes.

[Reply]

Scott

USA could really use some of that universal public healthcare right about now, lol. Good article, though.

[Reply]

Brian Hudes

So how many people want to go to the discount cheapest doctor they can find? How many people want to use the cheapest surgeon to operate on them? Do you want cheap instruments used? How about discount sutures and cheap equipment? How about if you save money on your surgery by having an anesthesiologist use a 40 year old vital sign monitor and old respirator? You could save money and have surgery in another country with cheaper healthcare. You can always price shop and ignore recommendations from friends and family and your primary care doctor on who to see for your medical problems.

[Reply]

Robert Naruse, MD

Thank you Karen for such a thoughtful, concise synopsis of what health care has become in the 21st Century and where it is going. Sadly, I think you are 100% correct.

[Reply]

Rahul

Bitter truth the world going to face in the near future due to lack of healing hands , the situation of medical fraternity is quite worse in India with mediocre training,u could see bulk of reputed medical professionals governed by PRO who had never idea of medicine.

[Reply]

Raul B. Palma, MD

Journalists and economists finished degrees that can be completed by Doctors of Medicine in one week, while journalists and Economists will never finish the Medical course even if they had 9 lives.

[Reply]

R. Kurt Nicewander M.D. FAAFP

Great article! I am retiring from FM after 50 years and agree we have many negatives that we see in our healthcare system today. We need updated Marcus- Welby-like programs showing the POSITIVE results of primary care and their consultants working together.

[Reply]

Jochen Dr. Hübner

So true,
amateurs always experience pain when reading the bill.
None of them see the experience and work behind.

[Reply]

Well written article Dr Sibert.
In South Africa, We had a similar issue that has lead sent shockwaves through our fraternity.

“Chetty told the POST that the doctors were arrested based on media reports and before any inquest, medical-legal or negligence review were completed.

“Our council and board have asked the police to wait, but due to possible political and media pressure the doctors were arrested.”

Petition for arrested paediatric surgeon Dr Peter Beale, anaesthetist gets massive support

COMMUNITY NEWS / 8 JANUARY 2020, 12:12PM / JANINE MOODLEY

Durban – MORE than 42 000 people have signed a petition for authorities to drop the criminal case against paediatric surgeon Professor Peter Beale and anaesthetist Dr Abdulhay Munshi.
They believe the culpable homicide charges against the medical professionals were premature.

Beale, 73, and Munshi, 56, were arrested after Zayyaan Sayed, 10, died following a routine laparoscopic operation at Johannesburg’s Park Lane Hospital last October.

The operation was expected to last an hour and a half but took almost four.

Zayyaan’s lung collapsed soon after surgery. He was taken to the intensive care unit, but died.

The pair, accused of negligence, were suspended from the hospital pending an investigation by Netcare.

The Health Professions Council of South Africa (HPCSA) is conducting its own investigation into the boy’s death.

But before the investigations were completed, the pair were criminally charged with culpable homicide.

In December, both doctors handed themselves over to the Hillbrow police and appeared in the Johannesburg Magistrate’s Court on December 17.

They were subsequently released on R10 000 bail each and the matter was adjourned to March.

However, the charges did not sit well with Durban orthopaedic surgeon, Rinesh Chetty.

He started the Change.org petition called #dropitandwait SA doctor’s profession and patient care under threat.

On Change.org Chetty said that he did not like bullies.

“I love my profession and I will protect it at all costs. #SADoctorsUnite.”

Chetty told the POST that the doctors were arrested based on media reports and before any inquest, medical-legal or negligence review were completed.

“Our council and board have asked the police to wait, but due to possible political and media pressure the doctors were arrested.

“The NPA did not wait, and hence this has sent shock waves through the medical profession. Doctors have asked the departments of health and justice to please clarify what has happened, and despite our numerous pleas, nothing has been said or addressed.”

He said media reports had caused a major issue.

“It has not been helped by the fact that all doctors are bound by a confidential policy and that there was an active medical investigation going on about the case.”

He said since the arrest and public outcry, investigations were now clouded and even stalled.

“The poor family will not get the answers they need or be able to move on in their grief with all this anger.”

The petition, which is addressed to the South African Department of Justice, the Director of the National Prosecuting Authority, the South African Department of Health and the South African Minister of Health, called for due processes to be followed.

“Drop the criminal case allow the medico-legal investigation to take place. Make an informed decision after all the facts and evidence have been reviewed by both medical and legal experts.

“Stop this unprovoked and unprecedented attack on the medical profession.

“It will only cause harm. The doctors and their legal teams are co-operating. Was there a need for handcuffs, jail and police vans?” read the petition.

Several medical organisations have since rallied around the doctors and have signed the petition in support.

Dr Schalk Burger, president of the South African Spine Society, said cases like these were generally complex.

Burger shared concern over the doctors being unable to generate an income while awaiting the conclusion of the process, as well as their grief, anxiety and the public humiliation they were facing.

The Association of Surgeons of South Africa believed that surgery and anaesthesia could not be regarded as precise arts.

“The spectre of adverse events, including death, is ever-present. We will engage with the national minister of health to frame legislation providing immunity from criminal charges for surgeons and anaesthetists in all cases until due processes have been completed.”

Phillip Webster, president of the South African Orthopaedic Association, opposed the actions of the NPA, saying he believed it was creating a potentially dangerous precedent that could have serious repercussions for clinical autonomy in the future.

Dr Moogandra Naidoo, chairman of the KZN Specialist Network, said as far as they were aware, there had never been a warrant of arrest issued for a healthcare practitioner in a criminal matter and such issues were normally handled via a summons or warning.

“Why is it necessary to treat medical professionals like common criminals, by handcuffing and then placing them in an overcrowded holding cell, pending their transfer to court in a police vehicle with sirens wailing?” Naidoo asked.

Dr Angelique Coetzee, chairperson of the South African Medical Association, said the accused doctors had rights and were innocent until proven guilty.

“Medicine is inherently risky, and severe consequences are unfortunately not uncommon – even when there are no mistakes involved. Until an investigation is concluded, there are not yet enough facts to make any medical conclusions.”

Daphney Chuma, of the HPCSA, said if the legal approach used in the case of Beale and Munshi was perpetuated, the board was concerned that medical doctors would in future allow patients to die naturally without intervening, for fear of being criminally prosecuted.

Bulelwa Makeke, spokesperson for the NPA, said: “Even though there are still investigations to be conducted, from the evidence already in the docket, there appears to be a prima facie case against both the accused. Nothing prevents the NPA from using a warrant to ensure someone accused of a crime goes to court.”

According to reports, several more families also came forward to complain about Beale and Mushni’s alleged negligence.

https://www.iol.co.za/thepost/community-news/petition-for-arrested-paediatric-surgeon-dr-peter-beale-anaesthetist-gets-massive-support-40258571

[Reply]

SchroedingerDoc

Medicine has done a great job of eviscerating itself. The system ahead is truly unsustainable. I wonder on one hand if docs will unionize like pro sports teams. That always seems to pit the talent equally against the management. It did wonders for pro sports salaries in baseball!

The other thing that I’ll throw out there is don’t be afraid to say “No” and if a patient is disrespectful and calls you by your first name… don’t have that patient (I’m so sorry “client”) as a part of your practice. You’re nobody slave. When they write a bad review of you online (and they will), write a response back noting how rude and disrespectful they are. Then, when they doctor shop others will have a heads up.

With doctors becoming harder to find, that *should* increase our bargaining power in the marketplace. With corporate medicine, it’s hardball and don’t be nice like you want to be. You’re just a number to them. When it comes to service, always always give your colleagues and their families your best.

[Reply]

Dr. Eleni M.D.

Dear Karen:
I am a family physician, in Massachusetts and I read your article and then read it to my husband, an accountant, who has watched me for years working 7 days a week, 52 weeks a year. I work on holidays, I work on vacation… I just don’t ever stop. The reason I work so much is because Hospital CEOs have decided that a doctor, the person on the top of the ” food chain” , the one that should be administering patient care, is also a ” data entry clerk” , a ” billing and coding clerk” who must do everything in his or her power to make patients happy so that our ” patient satisfaction scores will not suffer”. I really believe that these overpaid CEOs of hospitals and health insurance companies insist on physicians performing clerical duties because they know that if we are exhausted, we will not have time to unite and fight against the stupid and pathetic ideas that we are constantly being forced to accept as ” modern medicine”.
So, I sit here on a Saturday night, once again, thrilled at the idea that it’s a long weekend, not because I am going to go anywhere fun, but because it gives me an extra day to ” work on my tasks” .
God Bless You!!!! Please do not stop writing, do not stop telling the truth… if people like you stop…. we , doctors, eventually , will become extinct… and will be replaced by ….Dr. Google…
God help us!!!!

[Reply]

Aly

I so appreciate this post. My husband is a critical care/pulm physician…and though I am not directly in the trenches with you as a physician, I have a front row seat. The patients don’t know that he put his life on hold and gave up the entire decade of his 20’s for medical school, residency, and fellowship. They don’t know that he went nearly $400,000 into debt to become a physician. They don’t know that while he was a resident and fellow, we could barely scrape by as a family with his meager training salary. They don’t know that he lives and breathes for his patients…he carries it home with him, and he often grieves with them when the worst outcomes arise. They don’t know that our oldest son was 9 years old before our husband was able to be home with us on Christmas morning to see what Santa brought…not to mention all of the birthdays, school performances, and baseball games he has to miss. They don’t know that he had to leave me in labor and delivery alone because our second child came early and he had to wait until his partners could provide backup in the ICU. They don’t know any of this, and yet it would never occur to my husband to make this a point to anyone. He is deeply devoted to what I truly believe is his calling. If all the public sees now is a high salary, it bothers ME to no end, but as the brilliant doctor he is, he tunes it out. This isn’t a journey I would necessarily want for our children, it’s a long, lonely road…it is so sad that some want to make it even more of an uphill battle.

[Reply]

EM “Provider”

Ah, it’s people like @Sean who love to trash their colleagues that are undoubtably a large part of the problem. I find that those who don’t work in the emergency department, stating that we are nothing more than triage nurses, are often the most clueless and vile people to work with.

More than once I’ve had an off-service rotator who was so sure of themselves once they had all the time in the world to morning quarterback but haven’t one iota of thought about where to even begin when the patient comes in with no records, no idea what their meds are, aren’t taking half of them, and vague complaints with some very concerning physical exam findings that could be a number of different diseases or absolutely nothing at all.

Not everything is cut and dry. Had a patient with a left sided torsion despite RLQ the other day; totally well appearing and only mildly tender in the RLQ (nothing on the left). Would have been able to argue that might not have needed imaging but I’m glad I “over-ordered” her work up. I’m sure @Sean would be the first person in line to jump on the defendant’s stand with me if we were to do decreased testing and tell the litigators that it’s totally okay.

The fact is, we have a society now that allows for a zero percent miss rate and expects us to have psychic abilities (no sir, I don’t know what the white pill you take for your blood pressure is that you don’t have with you and your records aren’t in our system). We have colleagues who expect the exact diagnosis handed to them on a platter and often have no idea about the 70% of people I’ve already discharged after determining what they have at the moment isn’t going to kill them just yet.

Please excuse the typos- back for another night shift after flipping from days to work with people who think I’m just a triage nurse despite doing medical school, residency, and fellowship.

[Reply]

Babs C.

My daughter and son-in-law are in fellowship and residency respectively. Their student loan debt is astronomical. They are both in their early 30’s; both work 80 to 100 hours a week, and have yet to earn salaries that reflect the ridiculously stressful work they do every day. They both gave up their college years, 20’s and early thirties to medicine. They have EARNED every single dollar they will make one day, period!

[Reply]

An MD

Thank You!
There will be a time in the near future when patients will demand that they be evaluated by an MD, but the MD will no longer be available. This is already happening in urgent cares. But…doctors, don’t dispair! Every action has a reaction and the pendulum will swing back eventually. Just maybe not in time for the currently practicing demoralized, exhausted people who have given their life to the profession at a great personal cost. Have you ever looked at your paycheck and thought: I just don’t care anymore. I don’t care about the money. I feel disrespected, abused, exhausted, controlled, unappreciated. Used. But then—you look at your young kids and your massive student loan with an even more massive interest rate and you realize you gotta keep going. So you play their game. And you wish you had never become a doctor. You beat yourself up over not having gone to trade school. I bet it’s not just me feeling this way. I am not depressed. I have made my peace with the situation I am stuck in. So I am doing everything I can to pay off my loans asap so I can feel like I can breathe again, wherever the road may take me at that time. The funny thing is, even though I love my patients and they love and respect me for the most part, it’s just not enough for me to be looking forward to going in every morning. I anticipate mountains of paperwork, everyone else but me making the decisions and my orders being shot down by insurance companies, having to explain myself to everyone and everything for every medical decision made. It is exhausting. Do you ever feel like you are getting dumber every day in the process? i sure do. My decision making skills are not being used to treat the person but to navigate their formulary and insurance rules. My time is spent justifying the code I billed in the electronic health record rather than spending time looking deeper into the patient’s problem. Sometimes I know exactly what test to order and that test is very much justified, but I know lI have no chance of getting it approved so I send the patient to the specialist because I know they will have an easier time getting the test approved. It is so sad. I don’t really know what is going to happen, but things are not good in healthcare right now.

[Reply]

Geeta

Well written and we’ll timed article. Doctors facing similar/ worse situation in India. Patients relatives storm the hospital and resort to violence. I have been a primary care physician all this while but dissuaded my kids from pursuing medicine seeing the reality of the situation all over and the intensely narrowing scope of practice all over the world.
If it goes on, things will truly be sad in a decade as you rightly have pointed out in your article.

[Reply]

Dhiraj

Hi,
I am really saddened and surprised that the situation we are facing in our country I.e. India is more or less experienced by each and every medical professional all over the world. What we are facing every day here is not only verbal insults but many times physical insults as well. As discussed aptly in this article, we are under constant pressure to work for less money due to fierce competition and various government funded schemes in private hospitals (eg. For performing Modified radical mastectomy, a breast cancer operation, surgeon gets 100 USD a per government schemes.)
Only way forward now is that all the doctors world over to come together and fight against this discrimination or else invest your money in other businesses and retire early and keep connected to your colleague at present as those are the ones who will be treating you

[Reply]

SepMD

Thank you Dr. Sibert for being the voice of reason.

[Reply]

Dear Karen,
Your article is spot on and a significant amount of colleagues in Portugal are sharing it on social media in our country right now.
Physicians practicing in Portugal fear our Government is making health policies that are leading medicine on the same path.
You gave us a glimpse of our nightmarish future.
Thank you for speaking and for calling out the ones who wrongly insult us.
Your words are will helping us to wake up before it is too late and, more importantly, you are setting the record of misinformation straight: some in our country believe American health policies are an example to what we should have here! While you indeed are an example in many technical aspects, you have faced problems we should try to avoid. You are ahead, and we must learn your lessons, the good and the bad ones! Thank you!

[Reply]

Colleen FNP

This whole system is a crying shame. I’m a nurse practitioner – not a doctor, didn’t want to be – and I cannot do my job without physicians. The practice I work at couldn’t do their job without me. Out of 160 work hours in a week among our clinicians, a solid 40 of those hours are spent on the phone obtaining medication/imaging/treatment approvals from insurance companies. We don’t have an insurance specialist in the practice – can’t afford one. I prescribe 10 sessions of physical therapy, the insurance company “approves and allows 6.” When in the hell did we allow insurance company algorithms to become PROVIDERS and PRESCRIBERS?!?!

What is the solution at this point? I had an MBA in finance before changing careers and attending another 6 years of school to work in my current career, and the thought of going back to the boardroom makes me sick. When I used to work in the hospital setting and CFOs would say “you wouldn’t understand,” my response of “What do you have? An MBA in finance? Cool, so do I, TRY ME!” was never well received. Nor was reminding them that I was more than qualified to do their job, but they certainly could not do mine. When I worked in the hospital as an RN, patients would start to ask me insurance questions, and I would stick my fingers in my ears saying “LA LA LA LA” because I didn’t want to know ANYTHING about their insurance, so that I could not be accused of discrimination based on insurance provider (yes, that’s a thing we’d get accused of).

If we want to cut the fat out of medicine, let’s start with JCHAO, administrators, and tort reform.

For the love of all things holy, let the doctors do doctoring.

[Reply]

Ziva

People don’t understand the length and intensity of medical education. Not to mention the high standard to even getting in to med school. Or the high tuition (my medical schools tuition was 40,000$ a year! Who can afford that?) And there no such thing as parttime medical student. There’s no ability to work while studying. This is not a degree that can be obtained “online”. And working 80 hours a week as a resident. And withstanding insults and bullying of some of the educators and the other healthcare team members during those 80 hours a week in residency. I am still a resident, will have spent 10 years on my medical education total (the least amount possible as I am only Family physician, not to mention some surgical specialties). I feel like a slave. Why would anyone want to go through it if there wasn’t passion for it and some notion that in the end I will have a well respected career and have autonomy and enough compensation to live comfortably and afford my kids colleges (after I pay off my $200,000 student loan debt).

[Reply]

Totally agree
I’m a 60 years old Ophthalmologist in México and the situation it’s becoming the same
Best regards

[Reply]

Dr. Koo MD

A timely rebuttal to the unsavory transformation of clinical medicine and the physicians tasked with the societal changes. We should be careful about indicting Professor Case based on one poorly written, shallow, Progressive article by a immature reporter. The facts are these. Blaming physicians about the opioid crisis is a false narrative. We all agree a small minority of physicians were bribed by Big Pharma to overprescribe powerful narcotics. The list of causes for the deaths also include societal embracing recreational narcotic use, a porous southern border and overwhelmed enforcement agencies, a hugely well organized criminal trafficking infrastructure, miscalculating the effects of legalizing marijuana use as a gateway drug, the Obama administration encouraging the release of “low level” drug dealers, mandating “pain control” as the Fifth Vital sign and monetarily punishing physicians in the ER and in the hospitals.

We, our U.S. society, did this to ourselves. Stop blaming doctors to provide cover for a societal failure.

Clinical medicine is now a volume proposition. Is there anyone reading this who knows what it feels like to see 30-50 patients a day every day? Is there anyone reading this who knows what it feels like to be in the OR 5-10 hours per day doing very high risk procedures many days in a row? Is there anyone reading this who knows what it is like to be on call from Friday 5P until Monday 8A straight without a break? Is there anyone who knows what it feels like to try to save someone’s life at 2A when they are trying to pass away from a massive STEMI? Is there anyone reading this who commiserates with the on call anesthesiologist struggling to control a high risk airway while you are trying to save someone who is in complete heart block and cardiogenic shock?

There are published data in the medical literature estimating there are at least 1-2 physician/medical student suicides per day. I noticed the WaPo article failed to mention this metric. Maybe Dr. Case mentioned this in her novel. Maybe not.

With this in mind, the WaPo words “rent seeking conspiracy” just sounds like a bunch of hyperbolic Progressive rubbish intended to pander to a political ideology of perpetual dissonance. The actual execution of the ACA with all of its biases combined with changes in societal values combined with nasty Federal politics are the real causal agents. Administration costs are 30-40% of the cost of health care delivery. Surreal even for Washington DC politics. Even the New England Journal of Medicine has published data the ACA hasn’t changed any of the economics of health care in a concrete way. The Oregon Medicaid experiment has been an utter economic failure. Yet the lens is focused on the sweat equity of our profession and whether we deserve the fruits of our labor subsidized by chronic sleep deprivation, physician suicides and despair, and growing apathy. Indeed, the WaPo article is just a smoke screen from the realization the ACA is a Federal failure and the real problem. Not physician paychecks. It’s easy to chase a soft target like physicians and surgeons.

Dr. Sibert- hang in there. Your clinical colleagues are in the Foxhole with you and we have your back. There are those still enthusiastic about doing our job and will stand with you shoulder to shoulder during those tough long cases. We know exactly how you and others feel. It is not a regional or State problem. It is a National Crisis. Heaping blame on the heads of the exhausted physicians who are pawns on the chess board is a short sighted strategy by the talking heads. The ACA is a Federal Failure. 10 years into this Federal Code and Income Tax and everyone will agree things are much worse. Everyone is paying more money than ever. Everyone has less access to the same services. There is less choice and less competition. Early retirement and physician suicides and burnout are at pandemic levels. In some time folks will realize the term “Affordable Care Act” is 3 lies in 1 and is a Federal Oxymoron.

We wholly agree. Keep it up with the academics and bureaucrats and the politicians assigning blame to the clinicians. Keep it up with the crushing burdens of running a practice and trying to pay attention to the rest of life. Keep it up with these shallow Progressive newspaper articles written by hacks and the aloof bluster by non-clinical “experts” trying to make a name for themselves on an elite college campus.

It is tragic but true. When it is 3AM New Year’s Eve and the average citizen is sick and in need of a hard working experienced clinician capable of deploying the assets to do this difficult job, and that physician is dead, retired or unavailable because we are all weary of being blamed for the choices society has made, what will happen to that patient? Who will be responsible to do one of the most difficult jobs on the planet? Who will take charge and take care of the desperately sick patient in the middle of the night?

[Reply]

Robert Halpern md

Who would have expected the day when the Washington post would single out doctors as villains for editorial click bait. We can debate whether the added financial value of a medical career versus the costs and sacrifices necessary to become and to practice medicine are justified, but there has always been an understanding as to their value in society. As one pragmatic colleague said to me during a period of physical and emotional exhaustion, “if all the advertising people and the mayor Detroit(his home town) disappeared tomorrow life would go on without a hiccup. Can you say that about physicians?”
I will go one step forward and forward the notion that without the fantastic wealth of Jeff Bezos, would the Washington Post even be published? Other than its agenda driven editorial staff, would anyone even miss it?

[Reply]

AJO, DDS

I felt I needed to respond from a Dentist point of view to what is happening in my profession. When I completed 4 years of college, 4 years of Dental school, 2 years of military duty and some specialty training, I openened my own private practice. This was over 50 years ago. I was deeeply in debt but was happy once my practice was established to be making enough money to support my wife and 3 children.
There was no DENTAL insurance. Several years later it all started. Dental Insurance began. They told me what I would be paid based on the procedure I performed. Those fees were much lower than what I had been charging and in the case of crowns, bridges and dentures barely cover my laboratory expenses. My choice was to start “participating” with insurance plans or not which would cause the loss of many patients. We had one of the biggest pharmaceutical companies in the world located a few miles from my office. I knew that if I did not become a participating dentist I would lose a lot of patients. Most of the area dentist decided to have a meeting to discuss the issues. Top on the list was the reimbursements for procedures that required outside laboratories such as crowns, bridges and dentures. Since the insurance allowances were about half of what our normal fees were, it left us two options. Not to participate or find much cheaper laboratories to do the work. At the time, my overhead and most of my colleague’s was about 65% and reimbursement was about 50%.
THAT DOESN’T WORK MATHEMATICALLY! I cecided not to participate with insurance. Many of my patients left to seek treatment by participating providers. We kept track and found that about 80% returned within 2 years.
At the next meeting of our local dentists many talked about the cheaper laboratories they found and ways to cut costs. After all my years of training and treating patients this was not something I was going to do. As an aside, one of the largest insurance companies found out about our meeting and threatened to sue all of us for interfering with their business. Eventually almost every local dentist started participating and found ways to cut costs and still make money. Many of my patients returned and told me that they knew something wasn’t right when they went from a 1 hr hygiene appointment in my office to 30 minutes and dental assistants were placing filling rather than the dentist.
I am retired now but have seen many changes in dentistry that I find deeply concerning.
The point of this long note is to let you know that not only Medicine has undergone some significant and concerning changes but so has Dentistry. Now in some practices “trained” people are doing almost all procedures other than the actual tooth preperation to place fillings and make crowns bridges etc. Obviously a “trained” person makes significantly less money and has a great deal less training than a dentist allowing the practice to be more profitable.
Is that what YOU want? I am retired now but still have concerns for my profession and our patients.
Thanks for reading this,
AJO, DDS

[Reply]

S Kowal PAC

Your article just skims the surface. Nonmedical individuals do not have a clue in regards to operational cost of practices, huge overhead because of the personnel needed to man an office in order to constantly work accounts and keep up with mandates to CYA. Suicide rates! From my perspective, as a spouse of a Head and Neck Surgeon, they are completely ignorant to the impact the daily grind has on physicians health and limited family life. To my family it is commonplace for my husband to work 14 hr+ days, sometimes 7 days a week. My husband always asks the question “Where did I go wrong?” When he sees his nonmedical buddies setting their own hours working 4 days a week, catching every child’s events and making higher salaries. When you equate time/ pressure to income medicine is not necessarily as lucrative. He has no desire for our children to follow suit as physicians.
I will also add that it is not just outsiders showing a lack of respect but also those in medical administration making half a million and higher treating physicians as if they are no better than the uneducated minimum wage hospital employee. We have a huge problem heading towards us like a freight trainer…..full out disaster lies ahead.

[Reply]

Thank you for such a well-written and timely article. I predict it will be less than a decade before more physicians decide to call it quits. In a system where administrators and bean-counters our number physicians 10:1, but often don’t provide the needed resources to effectively and efficiently care for patients, more and more physicians are turning away from medicine to non-clinical careers. It’s a travesty. We all went in to the profession with noble goals and dreams, but being turned in to a glorified data entry clerk whose value is measured by the number of patients seen per hour is NOT conducive to keeping good physicians in the field. Replacing us with under-trained practitioners puts patients’ lives at risk. Fortunately a group of us has woken up and realized that we are ALL being manipulated my middlemen and profit-seeking higher-ups who put #profitsbeforepatients.
Enough is enough. Time for us to take back medicine.

[Reply]

PL Town

For medical care providers concerned about their increasing stress in return for lower income, it could get worse for both you and your patients. Patients are going to get hit with higher costs their insurance will not pay—even if you charge the same fees as you do right now. As a consequence the conflict over “fair” charges and “fair” income is going to intensify.
To obtain unbiased news coverage, medical providers are going to have to speak up about costs of service. By speak up, I mean engage in public disclosure and discussion of actual costs of services and their relationship to fees charged. Before anyone expresses outrage at this idea, please be aware that other licensed professions have been required to provide price information—by the US Supreme Court—since the 1950’s. Here’s why providers should want to speak up:
It’s no secret that Medicare has enormous influence on public perceptions of what constitutes legitimate medical charges. Medicare publications now list Medicare Advantage plans as the first option for obtaining additional insurance to cover expenses Medicare doesn’t cover. “Gap” policies (aka Supplemental coverage) used to be the first add-on insurance mentioned by Medicare. There’s a big difference between Gap and Advantage policies. If you accept Medicare patients, any Medicare patient can seek treatment from you & their Gap policy will pay you also.
In stark contrast, Medicare Advantage insurers establish private networks of providers. If you aren’t in an insurer’s private network, the Advantage plan may not pay you and it will hit the patient with the costs of your services.
How many patients will know which providers are in their Advantage network at any point in time? Moreover, how much will it cost you to participate in these private networks?
Because Medicare is so much in the news, it’s actions influence pricing. The type of insurance Medicare lists first obtains a competitive benefit. [If you think this statement is ludicrous, consider that a champion college football team influences the perception of the educational quality of a university.] Being “first” matters. Advantage plans are currently beneficiaries of being identified first. Advantage plans will gain market share. This has consequences for both you and your patients. Patients will get hit with “out of network” bills they don’t expect, and providers’ overhead costs may increase—the conflict over what medical costs are “fair and reasonable” will grow.
In theory, news reports should present balanced information on medical costs. I say “in theory” because the actual medical costs for services aren’t readily available. It is not enough for medical service providers to complain amongst themselves. The patients have to be well informed too.
Independent of political opinion, just the growing use of the phrase “government-run health care” is an indicator of the public’s growing concern about being at the mercy of an unregulated healthcare industry. Medical practitioners aren’t being singled out—you are part of the industry. Moreover, by definition, a profession holds monopoly privileges. Which is why medical care providers must be licensed.
To an individual patient you are the face of the medical industry. Your income, student debt, patient load, insurance reimbursement contracts are unknown to your patients. An individual patient doesn’t know if she can afford an exam because she doesn’t know the total price before the appointment is over. She can’t pick and choose which lab tests to take and which to forgo. She can’t negotiate your price once she’s standing at your checkout counter. She can’t knowledgeably debate your choice of prescription drugs. She doesn’t know if that second appointment is really necessary.
The foregoing comments are based on published research. Here’s a few questions:
If medical care providers don’t like their press coverage, where are they speaking up? In what news outlets? Are those outlets readily accessible to the public?
If you are stressed out, struggling to manage your workload, and regret going to medical school, what quality of medical care do patients think they are getting? (Those online website reviews and annual “top doctor ratings” aren’t valid indicators of quality because they aren’t based on scientifically valid surveys.)
The medical profession is not suffering out of proportion to other licensed professions. Nor is the medical profession the only one responsible for the public’s health, safety, and well-being. Lawyers, architects, and engineers are licensed professionals because their actions affect health and welfare, including making life and death decisions. Moreover, many professionals’ career expectations have been dashed. The growth of professional corporations and the large corporate clients they serve has changed the nature of professional life. Not everyone automatically starts a successful private practice, becomes a partner, or ends up in the upper-class. Most professionals work long hours doing work that often goes unnoticed.
An unflattering article in a respected, nationally distributed newspaper is a symptom, not an assault. There is a shortage of medical care professionals in this country. There are people who cannot afford medical care for their children. What is the medical profession going to do about these problems? I suggest that, disillusioned as some of you may be with your careers, that you start looking for cures for these problems. And speak up about realistic solutions.
The public you serve has granted the medical profession monopoly powers. That grant is based on public trust. Another option the public has is nationalized (socialized) medicine. Which, as a practitioner, do you prefer?
PLT, Ph.D.

[Reply]

Dr C MD Not PhD

Where to begin on the above viewpoint from a PhD reader.

Medicare Advantage is not what you think it is. Medicare Advantage (MA) plans are CMS plans where the Federal Government actual pays a commercial insurance company (BC BS Aetna United HC etc) a premium on top of customary CMS charges to administer to a CMS enrollees’ health care. In exchange for regulating a Medicare patient’s policy, the patient typically pays nothing out of pocket but is severely restricted in terms of network, medication choices and hospital choices. Typically a MA patient cannot cross State lines. The insurance company gets to keep the margin on top of the 103-104% of customary Medicare charges. If as a Medicare enrollee you decide not to join a MA plan, you are responsible for co-payments but you are given the freedom to go wherever you would like for your care.

Your perception about doctor prices is way off base. Every single doctor’s office or procedure charges have been transparent and completely available for inspection. You can go to the WSJ Medicare database and plug in names, States and medical subspecialties in a easy to use boolean search tool and pull up anyone’s CMS charges for multiple years. IT’S THE HOSPITAL/PHARMA/COMMERCIAL INSURANCE CORPORATIONS that refuse to disclose their pricing structure. In fact President Trump tried to shove an Executive Order forcing the disclosure of these data but he was sued. They are claiming their pricing is an industry “secret” and the key ingredient to their success and cannot be disclosed. A filthy legal excuse but probably one complicated enough to buy them time for the next election cycle. The ACA was written with these industries signing off on this exemption so good luck for the price transparency you are looking for.

Thus the rub. How can our capitalistic society whose success was forged with meritocracy, ingenuity, and free enterprise hope to introduce “market forces” to health care when the ACA did not mandate price transparency to the very players who are the culprits for this inflationary environment? Wake up Dr. PhD. The big corporations are not compelled by Federal Code to display their prices publicly because the ACA fully endorsed their power over the nation. Your angst is aimed at the wrong target. Physician reimbursement has been cut to the bone by the ACA. There is no more margin to squeeze from clinicians. How can our society willfully vote for Socialization of health care when its very survival is wholly based on a capitalistic environment and corporate participants who do not embrace a uniformity of the market metrics? Remember you voted for the ACA.

I disagree with your perception about the dark human issues facing our profession. Physician suicides are at epidemic proportions. Surrogates are now bridging the gap: Nurse Practitioners, Physician Assistants, Technicians, Secretaries. The shortage of physicians not just “medical care professionals” will continue and accelerate. 10,000 new Medicare enrollees are joining every day. That’s right 10,000 new Medicare recipients DAILY. Who will take care of these patients? PhDs?
Who will teach the medical students and interns and residents and fellows how to get through a long and dangerous day filled with desperately sick and dying patients? I doubt it will be folks like yourself.

This mess (and it is a big mess) is the end product of a good idea contaminated by a horribly written Federal code by the DNC Progressives called the ACA. 10 years into this mess, it is clear everyone is paying a lot more and getting much less. Oregon Medicaid experiment? Complete failure. PQRS metrics indicating hard advances in population heath and cost savings? Sorry. Even the recent NEJM manuscript threw cold water on that Progressive theory. Shocked at your co-pay/deductible/out of network bill? Sorry. American voters were told by Jonathan Gruber at MIT they were too dumb to appreciate how economically painful his plan will feel. Do you even recall who Dr. Jonathan Gruber PhD from MIT is? Look it up on YouTube.

So no one should be shocked, ashamed or surprised because we all voted for it as a nation. We own this awful mess from soup to nuts to Gruber to ACA to co-payments. So be grateful for what you currently have because it wouldn’t shock me if all of us will have to make do with a lot less soon.

Think I’m wrong? Google “physician suicide rate epidemic”. Try to get a new patient physician appointment that takes less than 2 weeks. Google “list of hospital closures since 2010”. The cure for this debacle is discarding this decade old Progressive/Socialist experiment. This is a Federal Failure.

I have enough gray hairs on my head to vividly recall the USSR and the description of what those folks had to endure. During that time, bread was cheap but limited in quantity and choice. Shortly after the Berlin Wall fell, those same bakeries had dozens of different types of bread for Muscovites to purchase at a market derived price. So these veiled threats you type about society embracing a pure Socialist system doesn’t frighten any physicians. Go ahead. Convince yourself what is happening now won’t be worse when one Federal entity controls every single penny for every single problem for every single person. Look at a VA Medical Center and ask yourself if a fully Federal controlled health care agency truly represents what you would expect for the standard of medical care in the U.S. Is government controlled transportation superior than private transportation? How about education? How about housing? How about food? So is your hope that the Federal government control every single aspect of health care? Be careful for what you wish and vote for.

A group of Soviet metal factory workers were once asked shortly after the Berlin Wall fell why their productivity was so lack luster despite decades of Central Soviet governmental oversight and resources. One of them said, “….the government pretends to pay us so we pretend to work…”

So stop blaming the physicians. Blame all of us.
Food for thought.

[Reply]

PL Town

Thank you for commenting on my remarks. Clearly we speak two different languages. Which is OK with me—I don’t practice medicine, I do research, part of which focuses on the evolution of professions. Professions, as I noted, are monopolies of a special kind. But, like other professions, medical practice is being run over by bigger players. And some of those players have monopoly powers too. For instance, if doctors looked at who owned the practice or clinic in which they worked, they may be shocked to see who they really work for. Some of you work under a name common to a few clinics. But that clinic group made have sister clinics with different names & in different states. Lot of sister clinics. And all those clinics are owned by one holding company. That holding company can also own one of the very same monster insurance companies you wrestle with to be paid fairly. Neat, huh? You could buy stock in your parent company maybe. Finding out who you ultimately work for is not easy (and asking around the office may not be wise).
But, within the comments about the critical newspaper article, I see comment after comment expressing discouragement, anger, and regret of people who chose to enter the medical profession. My interest in these comments is to understand how disenchanted practitioners express their frustrations. And I see a pattern in the expressions that, in the long run, is unlikely to produce a sound strategy for re-establishing the medical profession as an honored contributor to social well-being.
Specifically, both medical professionals and patients are grappling with a shared problem and blaming each other for it. One consequence of this finger pointing is that no one is holding the insurers accountable.
It’s possible to hold an insurer accountable. Insurers are regulated. If they cheat, there are government entities to punish them. But those entities need information to establish which insurers need attention. If medical practitioners and patients are busy calling each other names, who is watching the big insurers and giving regulatory entities data? No one. So who is speaking up on behalf of the profession/patients collective. No one. Except those who have made a commitment to pay attention to the industry and to speak up.
By pay attention, I mean look at the industry structure and industry dynamics and understand how it all works. Advocate for what’s good and lobby for fixing what’s not.
Medicare serves as an example. Medicare has teams that investigate participant insurers’ compliance with Medicare rules. Medicare has the power to investigate and ban a non-complying insurer from enrolling patients. And there are ways to nudge an investigation and ban along if the insurer tries just hand wringing and saying it’s sorry while continuing to dodge the rules.
But people have to know this stuff to either take advantage of or to change industry structure and dynamics. It requires both knowledgeable professionals and knowledgeable patients to advocate for two things: a) keep the insurers on a tight leash so they get punished when they violate their responsibilities; and b) act in concert to find ways to restore professional-patient trust—so that 100s of millions voices influence the size, number, and power of insurers.
This should not be viewed as a political exercise. Politics will always be with us, but right now the public and the profession need to understand the industry. That might go faster if the two groups actually spoke with and about each other without rancor.
For instance, one tiny step might be to drop jabs at the initials that follow a person’s name when printed on a document or business card—say, for instance, the Ph.D. at the bottom of this reply. All that “Ph.D.” means is I have an advanced research degree. This reply is directed to a comment written by an MD—a licensed physician. Neither Ph.D. nor MD. identify a degree holder’s specialty. Yet we may have attended the same university, just not the same school within the university.

PLT, Ph.D.

[Reply]

Perspective vs reality

The perception physicians have an iron gripped “monopoly” is just a mirage. Physicians are pawns whose scope and position are being discounted and underestimated. Read Dr. Sibert’s title to the article. 10 years? More like 5 years when folks will ask where the seasoned physicians are as they receive more care from non-physicians like techs and Nurse Practitioners and Physician Assistants. Much cheaper to use physician substitutes but is that really what folks want? When the average layperson reads these comments the take home message is the public angst about health care is directed at the very people who are trying their best to mitigate this failure of a social experiment. That’s right ObamaCare is a Federal Failure after 10 years of drinking this poisonous White House Kool Aid. Look at the trigger for this blog- the WaPo, a failure of a newspaper until it was salvaged by Jeff Bezos, writes an inflammatory article about an upcoming book written by a bunch of elite economists with an ax to grind. Their targets? Physicians of course because we are a bunch of “rent-seekers”. Really? More Progressive Politics from another shrill cohort from an Ivy League campus filled with Snowflakes?

I find your comments about the integrity of Medicare very shocking but not surprising. Medicare is incapable of regulating any of its activities. Fraud, waste and abuse are RAMPANT. That’s why the administration of CMS benefits are garnered through vendors, not Federal employees. The Federal government is not agile. It is not quick. It is not driven by some pure sense. It is a POLITICAL organization. Wake up people. It is a dysfunctional, inefficient, abusive, wasteful, apathetic organization comprised of our citizens and everyone’s tax dollars. It is precisely why no sane doctor trusts the Federal Government to be in charge of every single problem, every single time for every single patient.

This is really a difference in philosophy. There are those of us who work 12-16 hour days where the rubber meets the road in ICUs, offices, clinics, ERs, ORs, and wards. We see the impact of one centralized entity trying to control everything all at once via a messy power grab. A more functional process would be a sharing of power. A distribution of resources. A respect for the workforce tasked to clean up this mess. Instead the polar opposite has occurred. The ACA/ObamaCare power brokers took power via more taxes and concentrated that power into the hands of a few. The insurance companies and pharma companies and mega hospital corporations cut a slimy deal with the Federal Government. Please wake up and open your brain. The public was sold a bill of goods. Yet the PhDs like you, Gruber, Case and her husband will hold their cheeks, mouths agape when they realize their academic experience does not fit reality. Instead they focus on the statistical pyrotechnics, flash a graphic and then lay blame at the feet of physicians all the while they try to hawk copies of their book on Amazon.

I am sure some of the PhDs are decent people. I am sure some of you are mature enough to realize you are in no position to impart any expertise into this debate turned debacle. But many of you do try to inject a cringeworthy Progressive spin to this profession.

A similar phenomenon is occurring with how the general public recently perceives its relationship with the police. It is fair to say some elements of the police are unfortunately criminal and evil. But the vast majority of police interactions reflects the overall goodness and overwhelming courage in this very important institution. Yet CNN, MSNBC, the NY Times, and Progressive Elites will convince society the police are heavy handed thugs who deserve to be insulted and denigrated with thrown buckets of water and assassinations.

Same thing for physicians. The lay press including the WaPo and the campus centers of the Princeton Progressives are convinced physicians are the sole bad actors in this horribly dysfunctional health care system. Not the Federal Government. Not the insurance and mega hospital companies. Not the Pharma companies. Why? Because they would have to confess the ACA was a nasty backroom political deal purely to centralize power into the hands of the elite wealthy and the political power brokers. Not the Virtuous Contract it was made out to be but a deep bucket of political filth contaminated with gobs of tax money and the sacrifice of the entire medical profession.

So now the PhDs are reading and feeling and tasting the issues from our side. Are the Progressive PhDs open minded enough to entertain the possibility rank and file physicians offer the most accurate eye witness account of this crisis? Or are you going to seek the whitewashing from the media outlets?

And remember Dr. Sibert’s take home message.

When there is a crime and you dial 911 and the police are too weary to respond, what will happen to society?

When patients are sick and desperate and you are seeking a physician willing to save lives in the middle of the night and we are too weary to respond or dead or retired, what will happen to society?

[Reply]

PL Town

I agree with much of what you said. But attacking my input as though all PhDs were of one belief system gets none us anywhere. I’m not a “Progressive” nor do I believe Medicare is perfect. Moreover, I thought the design of ObamaCare was & is a horror.
Having said that, I’ll try to clarify a few things I didn’t say clearly:
I referenced “Medicare” as an example most readers could relate to. I’m not proselytizing for it as the appropriate model for the U.S. medical system.
Next, being a monopoly or having monopoly power does not mean life is full of roses. A monopoly theoretically (emphasis on theoretically) controls access to services and/or products. That does not mean that “control” actually works all the time and in every instance. But if a patient needs diagnosis, an MRI, physical therapy, or a different drug, etc, they must work with medical professionals to get those.
Moreover, having monopoly power does not mean the medical profession is the most powerful component in a hierarchical and complex industry. In fact, the medical profession is the at the bottom of the hierarchy.
A mega hospital—that may seem huge and powerful to a medical professional—is merely a dot in comparison to the 5 largest insurance companies.
Medicare—in theory—has some “control” over these insurance companies’ behavior, but only within the Medicare system. Because Medicare is large, it also can “influence” public perception. But Medicare isn’t any more perfect than any other component of the medical industry. Which is why there is an oversight entity—a watchdog—to investigate Medicare’s interactions with insurers. That watchdog is the office of “an” Inspector General. This Inspector General’s office is not identified as Inspector General of Medicare. It’s the Inspector General of HHS.
I have called this Inspector General’s office before and seen results of its power. But medical professionals and the public must know their way thru the labyrinth of both the medical industry and its government oversight system. Most don’t.
My concern, as a researcher, is that the infighting within the medical profession and the disdain shown to outsiders distracts the profession from seeing both far more opportunities do exist and far more threats than actually exist. Other researchers have observed the following:
1) entities that look only inward—limiting their attention to their own world—is reflected in their language. An inward-looking entity is more likely to fail than an entity that maintains both an outward & inward focus.
2) a profession gains monopoly power based on 3 things: public trust, recognition by the legal system (licensing and right to self-governance) and maintaining control of its area of expertise. Control of expertise means, as one instance, not letting the drug companies influence what you prescribe. This requires knowledge of sound research practices. Medical practitioners don’t have time for this. That doesn’t mean you can’t have an internal review system that is strong enough to prevent a drug company from pushing a drug on TV or social media—until it passes the medical profession’s own review process.
Another concern is that medical professionals are too often practicing in silos with little time to talk with their peers or even know the practitioners to whom they refer patients. A third concern is that professionals starting private practices may be thwarted by insurance companies. Those fledgling practice may not survive for even a year.
In this forum, medical professionals are free to let off steam, to complain about patients, make unflattering remarks about practitioners who aren’t MD’s or DO’s. Please ask yourself however—how much of that frustration and disdain shows up in your day to day encounters with patients and other practitioners? If it shows often, it’s not only a matter of professionalism. It’s also really really bad for business.
Sneer, as you please, at the comments of a Ph.D. As a Ph.D., however, I have no qualms whatsoever about calling an Inspector General, a code of compliance officer at a hospital or medical school or a clinic. And I will bypass a hospital ER receptionist to communicate directly with a medical professional when that receptionist tells someone having a stroke to “take a number”. In doing those things, I’m exercising my professional judgement as a researcher and I’m trying to protect your professional right to be the ones practicing medicine.
PLT, Ph.D.

Coleen Schmidley, CRNP

Well written article and interesting comments. In my almost 40 years of working in healthcare, it has changed in tragic proportions. I spend an inordinate amount of my time on clerical tasks, documenting, prior authorization, peer to peer reviews etc. electronic records have increased these tasks yet the time to do these tasks does not materialize. I know I am not alone. The insurance companies do not care that the “tasks” take out time away from our families as well as from our patients. The medical and nursing communities are too exhausted and stress out to fight them. We have relinquished this to administration and expected them to fight for us. Unfortunately, money is the root of evil. Your article has helped to open the eyes of many. I appreciate the comments as well. I realize the focus of your article has nothing to do with Scope of Practice but note many comments bringing out emotional responses and fears from MD/DO/PA/NP realms. This is sad. Bullying of physicians, PA’s, NP’s, nurses etc occurs by non heath care professional as well as by each other. It is a sad statement but true. It is unacceptable and we need to speak out. We need team work. We are all of value. We can’t work without each other. That said, the focus on out of control costs will effect us in both receiving and delivering care. I work in health care and have a very high deductible. I’ve had healthcare costs that were astronomical in the past few years and despite having treatments in one hospital, I had variable providers with some “not in network” without my knowledge that they were not in network. I am intelligent and informed, yet, when I needed care the most, I could not navigate these insurance issues as I was unaware they were occurring. I did not receive transparency on charges and did not ask “how much does radiation cost each day. If Dr. A is on duty, will I be charged a different fee than when Dr . B is on duty?” As with most “patients”, I did what was recommended only to receive the bills and explanation of benefits after the service was obtained for care. And yes, despite appealing to insurance company, I was responsible for payment. Transparency needs to occur to reduce these situations. Fortunately, I’m healthy today. I’m very fortunate I LOVE me career as a Nurse Practitioner. Unfortunately, I have no control as to my reimbursements and my fees are set based on guidelines. I’m hopeful that new healthcare bills will allow for 100% payment for my services rather than 85% of the amount that is reimbursed to a physician that would provide the same office visit charge. I would like to offer a non insurance rate to a patient just as I would like to have transparency to see the rate charges for my own healthcare and have an option to choose to receive the care or “shop” elsewhere. I can’t reduce a charge, just as I can’t increase a charge due to fear of being charged (in either case) with fraud by insurance companies. Yes, I am stressed working in healthcare. I believe anyone working in healthcare has an amount of stress that is significant. We need to be politically involved. We need to speak out. We also need to support each other in a positive manner. Thank you for caring enough to write your article.

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Anita Sharma

Your article resonates with me,although I am on the other end of the globe,in India.
Here not only are patients very demanding,ignorant, extremely litigious and to top it all even physically violent.In their limited thinking there is no such thing as a poor outcome
These are indeed sad days for doctors.We entered the profession with all the enthusiasm and euphoria of youth and are now a disillusioned lot!
Nothing to look forward to ,except maybe retirement.
But there are sadder days ahead for the patients! No doctor wants a seriously ill patient on his / her watch and this has resulted in over investigation, early referrals and so on.
Perhaps things have to hit rock bottom before they can get better!

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Dr C

Dear Dr. Sharma,
It is a shame physicians in South Asia have to endure violence but physicians here also are targets of violence as well. In 2015, a very talented vascular surgeon was shot and murdered by a disgruntled family member while he was working at Harvard Medical School at the Brigham and Women’s hospital.

https://www.bostonglobe.com/metro/2015/01/20/boston-police-investigate-report-shooting-brigham-and-women/Jhig9z8LO8A5PH9Er4vTiP/story.html

So when smug PhDs who have a sheltered non-clinical career try to weigh in on what our profession is facing, I can’t help but cringe at their sophomoric ideas. I would never adjudicate if a Astrophysicist should shape their day based on my opinion of their trade but somehow the elite PhDs always find that extra energy to utter their Medical grievances to satisfy their Progressive agenda and their cronies.

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This is a good and timely article.

We at angrydocs.com feel your pain and we write and hear about these issue from our colleagues, friends, and associates frequently.

The public has been bamboozled into thinking that we are “rich, entitled, money grubbers with God complexes, who take advantage of their patients, and want to poison people with vaccines.”

How have things gotten so bad? We have some ideas on our new website and would love to hear your thoughts as well.

How many people here would become a physician again or advise a loved one to go into medicine?

http://www.angrydocs.com

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Sgrehome

The real issue here is that her insurance doesn’t have a provision for covering out-of-network emergencies. The burden is on her to know and understand her coverage and select her insurance provider appropriately. This is also why many excellent physicians in all disciplines are gravitating to HMOs – they can practice medicine without the hassles of also running a business and dealing with multiple insurance companies. I have nothing but respect and admiration for anyone willing to do this most essential of professions.

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Thomas Dodson

Thank you for standing up for our profession. The thing that is great about our profession is that we have so many intelligent people who serve their patients in all kinds of capacities. Doctors are often the scapegoat if not because of our incomes, mistakes, or inability to fix or cure the many maladies we encounter. The stresses are great and so are the rewards. In my opinion their will be plenty of physicians in the future because the joy of practicing is worth it in the end. I do think that physicians, all of us, need to stop whining about burnout, and buck up. Yes, it is a rough road, full of many hazards, but so is laying floors on your hands and knees or crawling around underneath machines trying to fix them like machinists I treat. Yes, our failures can result in death, and this is a terrible burden but it doesn’t justify compensation per se. It is the price we pay for the privilege of practicing the science and art of medicine in all its varied forms. We are well compensated and many of us have more money than we know what to do with, realizing that it is unlikely to bring the type of satisfaction that we need which is often just some rest and relaxation with fun people. I find that their is a place for economists and journalists, and their professions have monetary value so they probably pay a few taxes as well. My bigger concern is for a general trend to drop out rather than contribute to the economy in a meaningful way among the young.

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JFB

Hi Dr, I recommend reading Thidwick the Big-Hearted Moose. Quite enlightening.

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Bone surgeon

Excellent. Thank you.

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Landon Berger

Excellent, thank you.

This is what happens when we go from “medicine” and “physicians” to “health care delivery systems” and “health care providers”.

Landon

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Agreed on many counts. Thank you for this powerful piece.

For many of these reasons – and more, I created SoMeDocs (and somedocs.com), and hope that it serves as a useful so as to start both private and public discussions on these matters. We need to preserve our beautiful field so that the younger generation continues striving to become our future healers – kind, smart, respected (and happy!) physicians.

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Misses the point. Docs are fundamentally a dying profession. A memorized body of knowledge has been replaced by the Internet; classic medical algorithmic thinking can now be done by any computer. (And please don’t tell me about the valuable “hunches” brought on by experience. Studies show these just as often lead to costly dead-ends as saved lives.)
Students intuitively know these facts…which is why the best and brightest now eschew medicine for high tech, investment banking, etc.
None of which helps “cognitive” physicians now treated like surfs by MBAs and slapped on the wrist if they ever dare defy the EMR and demonstrate any “ownership” of what they do. Those docs can only put in their hours, kick the dog at the end of the day, and count the days to retirement.
Medicine IS stressful..but not for the reasons given. Physicians rarely fret over “life and death; they fret because of 1) the never ending (and worsening} assembly line of patients and 2) the frustrations of having responsibility without authority…and on.

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MD

Uh, that ‘serfs’ Michael. Good luck with AI care.

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Jean Sprenge

Thanks for sharing what we do every day. I don’t know that many physicians, including surgeons who work with us, understand. (From a fellow anesthesiologist.)

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This conversation is long, over-due. Thank you for taking the time to say what so many physicians feel. I salute you with gratitude.

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Mark MD

Great reply to the WaPo. Enjoyed your point of view!

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Thanks you so much for your writing. My wife and I are both physicians and the part of medicine we love (taking care of patients) is being ruined by administrators, insurance companies, etc.
Our group will negotiate with patients that get caught in the “out of network” storm. Most of the time it is a win/win.

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Cobin Soelberg, MD, JD

Dr Sibert – Thank you for your advocacy and courage to be a public voice. It’s not easy, you take a lot of personal hits that are uncalled for, in addition to all the professional stress.

It’s sad to me that so many of my colleagues are trying to find a way out of medicine after 10 years or less. The healthcare system in the US is terribly dysfunctional. The stress levels are astonishing, the administrative burdens increase week to week.

Physicians (and NPs and PAs) are not the villian with medical billing. Insurance companies are! I have watched with amazement and horror and the way insurance companies get to sit on the sideline while those of us in the ‘arena’ are bloodied and beaten. It is insane.

Caring for patients is a privilege, but it is one more and more health care providers are deciding is not worth the stress, the risk and the abuse.

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Steve Kennedy, MD

Having just read your article as well as the comments, I have an observation. The Washington Post should have never published such a “fake” article. But the media in the US are only interested in “clicks”, ie how many people read their articles and ultimately, how much advertising can they sell. Most of the population truly respects their doctors. Doctors are not perfect and there are a few bad players who seem to make it onto the National News. How often do you see the good doctors on the news? And you never get any perspective on the millions of patient encounters everyday where doctors, PAs, NPs, RNs and MAs are helping patients. Let’s see a journalist tackle that issue! It’s not only the medical profession that is not respected by the media, rather it’s everybody except themselves. Media is all about “news”, factual, embellished or completely fake, it doesn’t matter. The only thing that does matter is sensationalism. Watch any TV News program and listen to the descriptors and tone of their voices as they attempt to bring emotion into the news. They seem to have cornered the market on shock and awe, danger and disgust, anger and sorrow, all crammed into 30 mins just to sell advertising to support their meaningless jobs. Check any newspaper article in any paper and you will find hyperbole camouflaging the facts. The media has sunken to a new low in the US regarding actual reporting of facts to the point that the Constitutional guarantee of Freedom of Speech should be questioned. Your article was timely and perfectly accurate but I doubt you will get as many clicks as The Washington Post article about “surgeon muggers”!

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Muta

Great piece – you put into words what a lot of docs encounter daily. The media / govt have catered to care of patients ( and this is the right thing ), hospitals , nurses , insurance companies ( they can’t be sued for denying tests that could have made a diagnosis ) , healthcare costs – but have often vilified physicians and advocate for the dumbing down of high quality medicine by overpromoting the use of mid- levels ( tho these are in general conscientious people but just don’t have the in- depth training ).
Has lead to a generally disrespectful attitude and earlier burnout and cynicism amongst doctors , leading to poor performance in care-giving.
Thank you and keep going !

Please accept. Keeps saying “ already submitted “. Not.

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Dr. Jeffrey Belkin

A fellow 40 year anesthesiologist says:

RRIGHT ON SISTER. Wow so well said! I hope you have sent this to the WP.

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Gil Alfonso

Dear Dr. Sibert
I am an Anesthesiologist with over 30 years experience and I have seen the steady erosion on our reimbursements and the steadily increasing demands on our time . I love my specialty and would love to keep practicing but because of the reasons you cite and others I retired 2.5 years ago and for a while have been working part time because I hate to give up my love of medicine but because of fear of liability I am quitting . I too have observed the compensation and deference bestowed on administrators and felt the unfairness of it . I have often said that there is ( or at least should be ) a special place in hell for ambulance chasers and hospital administrators both of whom I feel bring little value to our lives and create much misery for those of us in the front lines actually enduring all you so eloquently described for the sake of preserving life . I wish you the best of luck , keep training and encouraging the next generation of colleagues and most of all take care of yourself.
God bless you.
GJA

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Kristan Guenterberg, MD

I enjoyed the article and agree. I also read the article about the surgeon mugger. I am a general surgeon in private practice who does these operations. The amount I bill for an emergency consult and operation is about 10% of what this surgeon billed. To me, charging $17,000 doesn’t make any rational sense. Obviously what it costs to deliver medicine where I am is different from where he is, but that seems way too much. Not knowing all the details, I could see why a patient would feel cheated in this situation.

I find it hard to support colleagues who seem to manipulate the system. A patient who has to go bankrupt or is simply cheated out of hard earned money is a concern to me, much like a patient who can be injured by an error in the operating room, or will have further health consequences due to avoiding care due to concerns of the costs of care (like the current issues with access to insulin).

In my experience, most patients don’t resent fair charges and recognize the expertise, skill, and knowledge I bring to their care. Most actually seem to think I deserve the money, but I think there is a limit to that feeling. I know I would be upset at having to pay more for a surgeon’s fee for that operation than I have to pay for a good car.

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karen

Dear Dr. Guenterberg,

I do agree with you. The surgeon could undoubtedly have handled the situation far better, and the charge seems excessive. But the point of using this example is because it is just so easy for the Washington Post and patients to jump on this isolated instance and blame physicians for EVERYTHING that’s wrong with American healthcare costs, with no balance in the portrayal. I felt the need to point out, on behalf of all of us, that one outlier doesn’t make all physicians “muggers” conspiring to rob the public. Enough is enough of standing by quietly for this kind of insult.

Thank you so much for taking the time to read and write.

All the best,

Karen Sibert, MD, FASA

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Best Article Title Ever.
As an older career anesthesiologist I agree with the terrific points brought out.
I would only add that I am dumbstruck at the relative lack of criticism directed toward other, less “noble” industries. Example: the rampant bloom of money grabbing, culture changing tech/business companies. Our computer screens are bombarded by unsolicited popups which exploit our own information, fighting for our clicks and dollars, all for someone’s else’s profit. And the money involved in the tech/service industry is astonishing, yet not “disrespected” like in medicine. New college grads (like my son) in some young companies in the Bay Area are starting at $65 to $100k, and those figures can double in a few years. Good for them, but how about a little public perspective for the much-delayed gratification for an MD, who is almost 30 by the time they start their career?
The good news/bad news part of this is that the competition for medical school admission is more fierce than ever, which I have learned as my daughter preps for admission. So while physicians will still be very smart and dedicated, it is unlikely that a pendulum swing for more “respect” will result from a lack of qualified applicants. I am also concerned that young physicians-to-be will be ill-prepared for self-advocacy, given the trend of “out-volunteering” one another among applicants to check boxes and prove selflessness and compassion. On top of that, there is the recent politization of the admissions process and of the MCAT (read about it: led by activist CEO Dr. Kirch.) I’ve read the MCAT topics list and practice questions, and they cover “social inequalities” and the like. Which is not necessarily a bad thing, but I really worry that our young doctors will be bred to be so “woke” as to be “compliant” rather than self-advocating.
The movement to re-gain respect will need to come from existing physicians, so thank you all for your efforts.

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Well said, Karen.

This is exactly why I developed a “second career”, where anesthesiology is no longer my only bread-and-butter.

I experience far less stress doing “my other job”.

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Dr Andrew Vardanian

Excellent and truthful

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You cover a lot of ground here and do it really well. You should look into Free2Care.org as we can use writers like you. Feel free to contact me for a briefing. We have 37,000 physicians and 3 million patient advocates who share your views.

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Greg

I appreciate the article! I’m a pediatrician in private practice in Northeast Kentucky. I’ve been practicing for 30 years. My wife and I have seven children: One is a pediatric nurse practitioner and my right arm, three are physicians (2 in residency and one a hospitalist in Cincinnati), one is in medical school and one is in pre-Med. The youngest, wants to be an attorney, and I’m kind of glad about that. For the first time that I know of, I missed diagnosing appendicitis in a seven-year-old this week. He was vomiting with a mildly elevated and left shifted white blood cell count but no guarding or tenderness that I detected and with good bowel sounds. He came in the next morning with obvious signs of perforation. I thank God that he is doing well!

My local hospital, from my perspective and consistent with previous warnings from the medial director, started a Pediatric practice to “compete” with me when I resigned my privileges because they shut down the inpatient pediatric unit. They have hired 4 pediatricians and 3 nurse practitioners and spent a lot of money on advertising. A PA that I trained and worked with for 10 years was hired away by an FQHC 3 miles down the road. Close to 50% of the patients we see are insured through Medicaid, and I figure that the FQHC gets reimbursed about three times per patient more than what I get through Medicaid, and so they could pay him more, offer better benefits and virtually eliminate his risk of lawsuit. They put his picture on a billboard near my office for at least a year after he left, advertising for pediatric patients.

But don’t feel sorry for me. Though I’m having a little trouble shaking some sadness due to the sick seven year old for whom I am responsible, I have the best family that I can imagine and the greatest job in the world. I get to work with my daughter and another PNP who is a wonderful friend. Our staff is great, I have outstanding specialty and subspecialty support from Nationwide and Cincinnati Children’s hospitals. I get to see a lot of kids get well. I get hugs and smiles and laughter everyday. And my patient’s parents respect me, and some of them even love me.

This is how I deal with the stress: Proverbs 3:5-6 NKJV
[5] Trust in the LORD with all your heart, And lean not on your own understanding; [6] In all your ways acknowledge Him, And He shall direct your paths.

Thanks again for fighting for us all!

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JFB

Lots of agreement in these comments, but realize that things will not improve if you all keep voting for Democrats. If this is not obvious to you, then enjoy your slavery.

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[…] insults on the profession, physician anesthesiologist Dr. Karen Sibert of A Penned Point warns, Keep up the Insults, and Good Luck Finding a Physician in 10 years. She states, “I wonder sometimes what it would be like to go to work in the morning and NOT […]

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I work in Canada where it is a public system. Our patients don’t pay directly and the fees are lower. However, we have exactly the same issues. Our governments (and their media arms) constantly make the same arguments and compare us to European docs. It is interesting that topline revenue is usually referenced rather than income after overhead since European employee-doctors may not have the same overhead expenses (we are largely independent contractors here). Also lost are the number of hours worked per doctor and pensions/benefits.

Another interesting point that is born out when you look at behavior here is that there is a difference between big cities and small towns. In big cities, doctors are an easily replaced faceless commodity. In small towns, if you treat your doctor poorly, then the threat of not having one is real. And you might see them in the grocery store. The probability of real consequences modifies behavior.
-LD

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Lawrence Tenkman

Very interesting article. Being a doc / surgeon has a lot of pressure.

I read the original article though. Important to hear both sides always: https://www.washingtonpost.com/opinions/the-health-care-industry-is-letting-surgeons-behave-like-muggers/2020/01/13/f2089094-3636-11ea-bb7b-265f4554af6d_story.html#comments-wrapper

She shouldn’t call the doc a mugger… he saved her life. He had to work 120 weeks I bet to get through residency. So many of a general surgeon’s cases are emergent / middle of the night. Very hard on a person.

But for some reason, the surgeon fee was 6 times what it would be if it was in network. $15,000 instead of $2,330. Totally understand her frustration.

I’m not sure why it was like that. I heard once that pharmaceuticals list a cash price higher than what they want to be paid because insurance companies may have contract to pay 20 or 30 percent of their asking price. Then they have to charge that full price if someone pays cash or else Insurance’s will slash what they pay to an fraction of that fraction. Not sure how true that is or if this concept plays a role here.

I don’t understand it all.

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Gregory Craner

I was overhearing a conversation as the person was complaining about his anesthesia bill. “All he did was put me to sleep!” I could not contain myself and asked him if he woke up. When he said yes I told him anyone can put someone to sleep he was paying for the expertise to wake him up!
I have read a lot about physician burnout and its relation to the increasing administrative and data keeping burdens. This is the first time I have read about my cause of burnout. After 40 years, I found my self afraid to go to work for fear of injuring someone. I made a few mistakes in the 40 years (probably no more that others) but I remembered ALL of them and the fear of another became too much.
When my brother-in-law (a PHD in education) that he “was a doctor too” my wife’d eyes told me not ask him if he goes to work everyday knowing that if he is not at 100% someone may be injured or even die>

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