Schooling Doctors

If you haven't been introduced to 33 Charts, a blog by pediatric gastroenterologist Bryan Vartabedian, MD, ("Dr. V") take a minute to do so. I was struck by his honest post entitled "Is It the End of Private Practice?" in which he laments:

I was driven out of private practice in 2004 by rising malpractice premiums and plummeting reimbursement. In Texas at the time the trial attorneys ran the place and medmal insurance carriers simply couldn’t keep up with the greed.

Medical practices are just too expensive to run and the services that physicians provide are dangerously undervalued. You do the math. Sure it’s a complicated issue. But the end result is institutionally employed doctors with institutional pay and the risk of institutional service.

Of course we need to contain costs. And I know, it’s about the patient and nothing else. And all doctors are filthy rich. Of course they are.

Self-annointed experts blather about doctors, medical economics, and solutions. Government bean counters and consultants think they’ve got it figured out. They have no idea what we do, where we’ve been, or the staggering self-sacrifice necessary to manage a panel of chronically ill patients.

I spent the best years of my life working 15-hour days as a scut monkey training to get where I am. But the next generation will be more judicious. As society sees what doctors do as a commodity, society will see commodity doctors.

The plight of the physician in America is now considered dead last. But don’t cry for me. Cry for your self.

Almost immediately, as if to quell Dr. V's concerns, came this comment:

Hard to challenge your conclusion as well as the likely direction of the key trends. But ‘interesting energy’ Bryan…perhaps a calling to leadership?

There is way too much fatalism, and ‘poor me’ victimization in dis-organized medicine today; which I also sense in your piece.

Where is the ‘what’s my (our) part’ reflection? Where’s the ‘ownership’ of the dysfunction?

Bryan was "schooled."

Please, good doctor, don't mention these things, it is unpleasant. Don't you want to be a leader, good doctor? It's not nice to buck the establishment. You must conform now. Don't you want to achieve a senior leadership position in our organization?

For doctors, the subtle undertones of such a challenge are tough to ignore. We aren't stupid. There is a disproportionate salary reward for doctors who chose the leadership route in large health care organizations. Since doctors are exceedingly gifted at working systems to their personal advantage (can you say "medical school gauntlet?"), and with large corporate structures with large corporate management teams with large corporate human services departments eager to earn their employee-doctors' trust, they need "key opinion leaders" that can influence their younger peers. The temptation to abandon patient care in favor of "leadership" is seductive. Worse, when clinical doctors and administrative doctors butt heads in sticky situations regarding patient care, the trump card for administrators looms large now lest you be labeled a "difficult doctor."

"You must allow the EMR to order tests automatically, doctor, it's in the guidelines."

"But my patient will have to pay for those tests!"

"Dear doctor, you do not understand, this is in the best interest of quality care."

"But my patient can't afford all these tests!"

"But, dear doctor, our hospital report cards will suffer if we don't have these tests documented every six months on their chart and if our report card isn't as good as our competitor's report card, you won't make as much money either."

"But..."

"Shall we move on?"

-Wes