Posted February 6, 2023
Healthcare has changed, with large health systems, insurance companies, and private equity groups, rather than doctors, in control. Because of low reimbursement rates for non-hospital based physicians and the ever increasing complexity of reimbursements and regulations, most doctors have been forced to seek employment under the umbrella of a large entity in order to practice. But that comes at the cost of autonomy and common sense. Below is an email from a family practice physician in Michigan who has had enough.
Every day a new demand
Every day I have a new demand on my workload and it’s making me hate the practice of medicine and despise the corporations and government institutions that tell me how I have to practice.
The medicine alone is hard enough. Trying to help my patients live full long productive lives is a great challenge but now that is no longer enough.
Now I am not only barraged constantly by the media with the social ills of America but some people have decided to make it my personal problem.
I hate being compelled to ask my patients if they have soap. I’m not the soap man, I’m a doctor. I hate that those in charge have prioritized soap access over smoking status. I cannot tell in a casual chart glance my patients smoking status but I know their soap access. If they do not have soap there is nothing I will do about it. Are they saying I’m supposed to give everyone who has a soap deficit my soap? Why? Am I a bad person/ doctor if I refuse to comply?
I’m not interested in human trafficking. I’m the doctor not a pimp and now the State tells me I have to be subject to hours of training on human trafficking every year. I’m not interested in this and I resent it and there is nothing I can do about it. Prostitution has been a part of human existence since time itself and will always be. This is a social problem, not a doctor problem.
I’m not interested in implicit bias. This is a moral panic that is couched in the rhetoric of racism. If you call it a moral panic you are labeled a racist and a terrible person motivated by hate. But we all have and use stereotypes. Human beings are pattern recognizers and asking them to be something else is literally inhumane.
I’m sick of being forced to work for a giant health entity. Why on earth did the federal government think it would be a good idea to pay a hospital twice as much for the same service as an individual doctor? How the hell am I supposed to compete with these amoral entities if they are literally getting paid twice what I am for the exact same service? I’m paid generously but filled with resentment and frustration.
I hate being forced to use an EMR that cannot keep track of my patients' meds. I spend my whole day managing complex medication regimes and someone in the federal gov decided that I cannot be allowed to maintain a med list but that my list must be overwritten by a list of every drug the patient had filled in the last 24 months. It’s insanity and it is dangerous.
I hate that I have to use an EMR that does not work for me but for some middleman who does not have the patient's interest at heart, only money and gaming HCC codes.
I hate being compelled to describe my patients' health in the worst possible manner. I guess that technically everyone with any LVH and the tiniest amount of leg edema has diastolic heart failure. I hate that I am called a better doctor for labeling my patient with this and preventing them from getting life/ disability insurance.
Should we really screen the entire population for HIV? Really? My patients are so pissed. They feel offended and accused when tested or counseled.
Now my health system tells me not to refer to good doctors that I have a long relationship with because they have in frustration opened their own surgery center. How is this even legal?
I hate screening for “hidden depression”. If anyone answered the depression screen honestly on 3 different occasions during the year they would be flagged. What happens when the entire country is on prozac? Did we learn nothing with “pain is the 5th vital” Who are the idiots driving this?
OMG: While writing this, I get yet another email that my employer has put more money in my retirement account. How am I going to escape?
2 kids still in college. No financial aid and no loan forgiveness for them because I chose to work in this system. I’ll just keep paying for everyone else’s loans until the last is done, then I'm done. I’m ready to pull a grizzly Adams and get the hell out.