In the coronavirus crisis, for-profit health care kills doctors' spirits

I am a physician. I have worked hard to get where I am in life. I went into medicine for many reasons. The intellectual challenges. Being in a field with lots of human interaction. And of course to help people. I went into emergency medicine because I ultimately couldn’t decide on a single specialty. I liked something about each one. When I rotated through the emergency department early in my fourth year of medical school, I fell in love. In love with the fast pace of the department. In love with the variety of patient presentations. In love with being able to treat multiple sick patients at the same time with skills that literally save lives.

When I graduated from residency, I started work in an emergency department staffed by a small independent physician-owned group. They contracted out to staff physicians, nurse practitioners, and physician assistants in the emergency department at the hospital where I began working as a newly minted doctor. I felt valued as an employee of this group, and my voice felt heard. I loved the doctors in my group. We were an amazing team. But unfortunately, all good things come to an end.

Eventually, our hospital became one of the hundreds across the U.S. to switch from independent small staffing groups to a large contract management group or CMG. This happened throughout the entire hospital system. As there was no other option for work at emergency departments in our city, the physicians at my hospital all stayed on and signed contracts with the CMG.

Things were fine for a while. But there were noticeable differences. Small things. Annoyances. I had a needle stick injury and had an incredibly hard time finding out who to speak to about it. I ended up getting billed for the needle stick and was threatened with a collection agency. After many months of emails and phone calls, we finally got in contact with the right employee at the CMG, and the bill was handled. With my old group, there was one secretary a phone call away who handled issues like this efficiently.

We worked for the CMG for many years without ever seeing our new bosses face to face. We never received a pay raise or bonus despite our emergency department volumes going up and our patient population becoming sicker and more complicated. One year, our volumes went down, and the response of our employer was to cut hours. Cutting hours cuts our pay. When working for a CMG, there are never bonuses for working harder. But there are punishments when things are slow. They make money off the backs of hard-working physicians.

We are now in the midst of a health care crisis of epic proportions. The novel coronavirus infection has spread like wildfire across the globe. It has affected every single country at this point. Some with dire consequences as hospitals are inundated with critically ill patients.

As the infection spread throughout the U.S., people were advised to social distance and stay home. This led to many of our low acuity or less sick patients staying away from our emergency departments. Of course, the volumes went down. Which means fewer patients to bill and less revenue. The response of our CMG was to cut our hours even further.

The crisis is deepening. The number of infections in the state where I live goes up daily. It is only a matter of time before the lull in our emergency department reverses itself and becomes a full-on surge. Instead of preparing for this surge and doing drills while things are slow, my employer is trying to save money by cutting hours for the physicians, nurse practitioners, and physician assistants.

Now we are being asked if we will be willing to help out in other departments if and when the surge happens, stretching our upstairs colleagues thinner than ever. My fellow emergency doctors and I initially bristled at the idea of “volunteering” to help out in the ICU. For one, we will likely be overworked and stressed in the emergency department as this situation worsens. For another, we do not feel obligated to put our lives at risk to give more free labor to our short-sighted for-profit health care system and contract management group.

The ironic thing is, I would happily volunteer my time off to help out in a crisis if things were different. I have long been an advocate for some form of socialized health care in America. With a socialized health care system, the government would be my employer. The same government that is elected to represent the people. I would be a doctor of the people, by the people, for the people. I would feel pride in helping anywhere I could. Our current for-profit health care system has beat down my spirit. I do not feel like “volunteering” my precious days off to give free labor to a company that makes money off the backs of hard-working physicians.

I know there are small independent physician groups out there still. I know they are hurting and cutting hours too. Still, I would love to be in a group like that, as I know we would all be in the same boat. With my CMG, I feel like us docs, NPs, and PAs are the steerage class passengers being asked to bail water from the sinking ship while the CEOs and administrators are up there in first-class loading into the lifeboats.

I feel horrible and guilty about these thoughts. I used to be an idealist—someone who wanted to help people. But I think I have been “working for the man” for far too long. I’ve become jaded. I am a cog in the wheel. I am an employee. No longer do I feel like the bright-eyed “let’s change the world” doctor I started out as.

My hope is that when all the dust settles from this coronavirus crisis, that we will take a good hard look at our health care system in America. The system that bankrupts people who cannot afford their medical bills. The system that should be the best in the world but has horrible outcomes with regards to infant mortality, life expectancy, and maternal health. Our hospitals should not be centers for profit-making. They should be centers for healing and science.