We talk of disruptive change in health care as a tectonic cataclysm.  We’re hanging by the moment for that one innovation that will flip flop the practice of medicine and bring better, more efficient care.  But if you ask the poor lowly physician struggling on the front lines, we might tell you something different.  We are suffering through a sustained, insidious, devolution.  I see great change.

Reform takes place in fits and sputters.  Regulations are made and then remade.  The product of the governmental assault on the cost of health care is a series of forms and check marks.  Who better to be responsible for such minutia then the wayward primary care physician.  The same beleaguered professional whose numbers are dwindling in direct relation to their pay and inversely related to their work load.  With the passage of the ACA the paperwork has already increased.  The time spent typing away at a computer is multiplying.  Is care any better?

I see great change.  Physicians are looking for a way out.  They are becoming businessman, social media entrepreneurs and commentators, writers, reformers,  and career coaches.  They are retiring early and cutting their hours.  I spend less time in the clinic than ever before.  Each year I replace some of my office time with non clinical revenue generating activities.  The joy of patient care is being overshadowed by regulation.  We are quietly and incrementally bowing out.

The patient narrative is fracturing.  Primary care physicians are using hospitalists.  Patient centered medical homes and large medical groups are favoring speed of access over continuity of care.  A patient no longer has one physician but a team of doctors working on their behalf.  Unfortunately, as opposed to group think, what usually happens is that each provider knows strikingly little about the patient.  Tests are repeated, stories are retold  and modified, there is no longer a holder of knowledge.  A persons narrative not only heard but experienced over years of joint interactions and communications.  We are losing our connection.  Care is suffering.

In reality, the disruption we are looking for has been occurring in a sustained fashion for years.

Are we ready to deal with the consequences?

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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