Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Improve the inequalities among physicians

Brian J. Dixon, MD
Physician
January 7, 2015
Share
Tweet
Share

Our current health care system will fail; it’s simply a matter of time.  Yet the delivery of efficient, quality, and progressive health care is quite possible once we shift our thinking.   A true paradigm shift in medicine begins with first establishing that each pillar in health care has an equal responsibility in making a new system work:  patients, providers, and places (facilities).

This article pertains to only the provider portion.

As providers, we must manage a health care delivery system that discourages stigma, rewards innovation, and reimburses complex innovative work.  We must also create and protect transparent self-policing strategies that rebuild trust with the other two pillars.  “Getting doctors to agree on any one thing is like herding cats” is true, but the failure to try worsens our current predicament (and unduly burdens the other two health care pillars).

For providers, the first (and most important) shift in thinking is to recognize that the 3 dimensions of medicine justifiably exist:  medical specialties, mental health, and surgical specialties; and that each dimension is as important and fundamental as the others.

For example, I found myself in an argument with a colleague who said that surgeons “justifiably make more money because they save lives.”  My reply: “Helping a child of divorce with their trauma and ADHD can be pretty life-saving as well.”

Completing a triple board residency, I saw first hand how drastic the respect, time, and reimbursement paradigms differed between pediatrics, adult psychiatry, and child psychiatry.  For instance, I would see complex ADHD kids in my pediatrics continuity clinic and have 15 minutes to do the very same work I had the privilege of doing in 30 minutes in psychiatry.  Yet the billing codes awarded a very different level of importance between medical and mental health.

Administrators in medicine also encourage dimensional stigma in many ways.  One recent example was a clinic supervisor attempting to force me to see a new psychiatric patient who was 30 minutes late to her 60-minute initial appointment.  My retort:  “Would you ask a surgeon to do a 4-hour long surgery in 2 hours without a preoperative evaluation?”

And for the other dimensions, the reverse is equally true: Asking a family practice provider to complete a suicide risk assessment, prescribe antidepressants in 10 to 15 minutes and see the patient back in 2 to 4 weeks is untenable given their scheduling.   Forcing a pediatrician to create a behavior modification plan for an autistic child during a 15-minute “sick” visit is equally unfair.

To combat this, one amazing attending during residency encouraged consulting services to call us early if there was an inkling that a psychiatric issue was at hand.  While admirable, this led to inappropriate consults (being asked to do social work) and to our thin psychiatric resources being triaged and rationed.

As a child psychiatrist and pediatrician, I’ll admit:  I’m a Pollyanna.  Yes, I think our health care debacle is a behavioral problem and I fully believe most behavioral problems can be solved or well managed.  The first step is to clean the slate and start with the basics.

My suggestion: Create a universal medical record, eliminate procedure-based reimbursement, and create dimensional expectations for reasonable reimbursement within and between the dimensions.  In other words, allow providers to easily talk with one another without fear of reprisal or lawsuit.  Decrease (but not eliminate) the disparity in salary between dimensions for providers of similar training, additional certifications and years of practice.  And allow intra- and interdimensional peer review to weed out those outliers that put patients, places, and other providers at risk.

Providers are not the only pillar at fault.  Patient nonadherence/miseducation coupled with overspending by facilities will push our teetering system right over the edge.  But improving inequalities between providers is a factor we can improve in the larger paradigm shift to overhaul our health care delivery system.  I encourage honest, open, and frank discussion so that we can avoid the known sentinel event barreling down on us.

Brian J. Dixon is a psychiatrist and can be reached at Progressive Psychiatry.

ADVERTISEMENT

Prev

A physician investigates the American Board of Internal Medicine

January 7, 2015 Kevin 24
…
Next

What the chronically ill wish their loved ones knew 

January 7, 2015 Kevin 13
…

Tagged as: Pediatrics, Primary Care, Psychiatry

Post navigation

< Previous Post
A physician investigates the American Board of Internal Medicine
Next Post >
What the chronically ill wish their loved ones knew 

ADVERTISEMENT

More in Physician

  • Why more doctors are choosing direct care over traditional health care

    Grace Torres-Hodges, DPM, MBA
  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 89 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Improve the inequalities among physicians
89 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...