I love teaching my children about history, and in the process, I often see a clearer perspective of events I learned about at a young age when I had less life experience under my belt.
As I have been revisiting the evolution of our country, the formation and restructuring of our society, and the emergence of periods of oppression, rebellion, and social change, I have been struck by the concept that over the past few decades, our healers have been subjected to systematic oppression and disadvantage by certain constraints, in a way that threatens the fabric of health care in our country. The causes and reasons are many, and the forces at work are complex, but nonetheless I am inspired to follow the historical precedent of our forefathers to present a simple Physician’s Bill of Rights, as a framework to promote further thought and conversation about how to preserve the independent spirit of the profession, and reject the ongoing psychological abuse and economic oppression. Physicians have become the enslaved worker bees in the health care economy, under the powerful subjugation of the government and insurance companies.
The United States Bill of Rights consisted of the first ten amendments to the Constitution, and were designed to prevent government intrusion and oppression of the minority. While physicians in general do not tend to elicit sympathy for their plight, it’s time we publicly realize that the job, and the very process of becoming a physician, bear certain challenges. The well-meaning and caring healer endures a tradition of abusive training, a staggering burden of debt, and the grueling nature of medical practice, including long emotionally draining hours under the looming threat of malpractice. Physicians experience this as a baseline condition, to which is added the unnecessary stress of the complex and frustrating contributions of Medicare regulations — from electronic health record mandates, meaningful use requirements, accountable care organizations, and ICD-10 conversions, to constant criminalizing assumptions of fraud. The prerequisite respect bestowed on physicians as responsible professionals in the past has been eroded such that any humane or moral entitlement which could be classified as an inherent right now needs to be declared.
Surprisingly I discovered that there have been inadequate similar attempts in history. An actual Doctors’ Bill of Rights Act of 1999, HR3300, was formally introduced to Congress but was never enacted. Not exactly designed to foster physician wellbeing, it was crafted to increase resources to prevent fraud in Medicare, and even stated that physicians should not be arrested at gunpoint. Under “findings” it acknowledged the problem of many physicians leaving the Medicare program due to fear of criminal investigation, and “overly complex” regulation, stating that “keeping track of the morass of medicare regulation detracts from the time physicians have to treat patients.” Twelve years later, from another perspective, a Doctor’s Bill of Rights was proposed by Dr. Elson Haas in 2012, to address the rights of physicians in establishing expectations for a better physician-patient relationship, with a matching Patient’s Bill of Rights. Neither of these two bills was directive or inclusive enough in protecting our healers.
The Physician’s Bill of Rights presented here broadly addresses a multitude of concerns without dictating a particular course of action, to stimulate further consideration and planning in the current unstable matrix of our health care system. Facing record-breaking rates of physician dissatisfaction and suicide, as well as a diminishing physician workforce, we can no longer employ the traditional stalwart attitude of expecting that physician grit will overcome such obstacles. Our organized medical societies and academies, which purport to advocate on our behalf, have seemed too plumped in administration and politics to realize the challenges encountered on the front lines, and have been unable to effectively define and defend these rights.
The Physician’s Bill of Rights
1. The right to learn and train without physical and emotional abuse and discrimination.
2. The right to ongoing access to supportive and confidential mental health services, without fear of retribution.
3. The right to humane working hours, whether in active patient care, on-call duties, or charting, and with reasonable compensation for time spent on completion of paperwork, forms, and prior authorizations.
4. The right to practice medicine in the best interest of the patient’s health, rather than solely for cost-containment, or for performance measures which lack clear evidence of benefit or are beyond the physician’s control, or for patient satisfaction scores when satisfying the patient would be an unnecessary intervention or a detriment to health.
5. The right to practice medicine with reasonable compensation for treatment of psychosocial issues related to health.
6. The right to practice medicine and be licensed independent of the use of an electronic medical record.
7. The right to practice medicine without reimbursement being dependent upon the patient’s health behavior or health status.
8. The right to practice in an independent setting in a competitive free market, with price transparency for our patients’ medication, lab tests, radiographic studies, consultations, and procedures.
9. The right to earn a living which allows for the payment of student debt within a reasonable time, with the preservation of a work/life balance which includes time for self and family.
10. The right to affordable and uncomplicated continuing medical education and maintenance of board certification, and to be awarded such credit without complicated exercises of unproven benefit.
While these rights are written toward a physician perspective, the fulfillment of these criteria promises to improve the quality of care of the patient via improved well-being of the physician. Access to care would improve, both by better retention of physicians and discarding the inherent incentives to discharge noncompliant patients who fail to meet quality measures. In fact, these rights for the physician would improve cost-effectiveness, efficiency, communication, safety, and patient satisfaction. The epidemic of physician dissatisfaction which is driving the physician shortage, would be resolved.
Clearly, this list of rights is not all inclusive, nor does it attempt to propose how to implement these changes. The physician organizations and legislators charged with reshaping the landscape of health care might consider the virtues and benefits of incorporating the concepts within these rights, for the sake of physicians as well as patients, and in fact to save health care itself from imploding. Until then, we shall echo the historical words of Dr. Martin Luther King Jr. when he wrote in his letter from the Birmingham Jail, “Freedom is never voluntarily given by the oppressor; it must be demanded by the oppressed.”
Michele C. Parker is a physician.
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