Keep insulting doctors, and good luck finding a physician [PODCAST]

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“The tragedy that’s happening in medicine today is that the loss of respect and the constant threats to fair payment are making physicians regret that they ever chose medicine. They were fascinated with science and wanted to help people, and their reward is insult.

It’s no wonder that some newly trained physicians leave anesthesiology quickly; there’s little risk to running a hangover clinic in Las Vegas. Many physicians from all specialties get MBAs because they see that the real rewards in healthcare lie in becoming a CEO. Look at the salaries of top executives: the CEO of Anthem made more than $14 million in 2018, as an example, while insurance companies did everything they could to avoid or delay signing fair contracts and paying clinical physicians for patient care.

There is a growing shortage of physicians, not just in primary care but in specialties too. The American Association of Medical Colleges (AAMC) estimates that the U.S. will be desperately seeking surgeons in the next 10 to 12 years, and looking for more anesthesiologists to work with them. As older physicians retire, and younger ones aren’t willing to work the long hours that used to be routine, this will only get worse, while increasing numbers of older Americans will need more complex medical care.

Maybe your barber will learn to operate on you, just like the barber surgeons of old, and your local gun store will sell you a bullet to bite on. Best of luck.”

Karen S. Sibert is an anesthesiologist who blogs at A Penned Point.

She shares her story and discusses her KevinMD article, “Keep insulting doctors, and good luck finding a physician in 10 years.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Karen Sibert. She is an anesthesiologist, and she wrote the KevinMD article “Keep insulting doctors, and good luck finding a physician in 10 years.” Karen, welcome to the show.

Karen S. Sibert: Thank you so much. It’s a pleasure to be here.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?

Karen S. Sibert: I grew up in North Texas in the 1960s, which was an era when little girls really didn’t think a whole lot about going to medical school, and I was no different. Even though I thought it sounded really interesting, it also sounded like being a movie star in terms of reality.

But then I was very fortunate. I was accepted, to everyone’s surprise, my own especially, into the second entering class of women at Princeton, where I got a wonderful education in terms of writing and thinking clearly and expression. But I didn’t actually have the nerve to take the premed courses. Princeton’s organic chemistry course was notorious for weeding out weak premed students, so I didn’t do it while I was there.

And then once I left Princeton, I actually went to work as a reporter for The Wall Street Journal for a while. And then I finally decided, you know, this is silly. I’m just as smart as most everybody else that went there. I can do this if I want to. So I went back and took premed classes and entered medical school with a four-year-old daughter in tow.

Kevin Pho: Wonderful. And you’ve written so many wonderful opinion pieces and articles on your own site, which is called A Penned Point, and on KevinMD. Now, what are some things from your background in journalism that you think physicians should know about or should be better at?

Karen S. Sibert: I think that it is unfortunate when people, during their undergraduate years especially, don’t take classes that teach you how to write a decent essay. If you only take science classes, if you only take classes that test in terms of multiple choice, you’re never going to learn how to write, and that’s hard to pick up later on.

There is a technique to writing a good essay that is no different from English literature or politics or anything else, and good writing helps you publish articles, whether they’re journalism or opinion articles like mine, or whether they’re scientific articles if you’re in an academic career. It’s just such a good idea to master those skills early.

Kevin Pho: And I completely agree with you. In terms of getting our voices out, having wonderful writing skills is absolutely essential. Now, if physicians want to brush up their writing skills, what are some resources online that they could go to to help with that?

Karen S. Sibert: You could start with Grammarly, which really will help you with some of the basics of grammar. But honestly, the essence of learning how to be a good writer is to read good writing and almost read it aloud. Start to pick up the cadences. Pick up something like The New Yorker, which has some of the most brilliant writing in journalism today. It’ll teach you the arc of how to tell the reader what you’re going to say, say it, and then tell them you said it.

Everybody wants to start out leading to some kind of surprise. Well, nobody wants a surprise. Your reader’s going to decide in the first sentence or two if they’re interested in what you’re saying, and if they’re not, they’re going to go on to something else, because today everybody has the attention span of a gnat. So you really got to get it out there. And, you know, a good title helps. I think the title of that article, “Keep insulting doctors, and good luck finding one,” was something that got people’s attention. It made them want to read it, and that’s half the battle.

Kevin Pho: So let’s talk about that article. As you said, the title is “Keep insulting doctors, and good luck finding a physician in 10 years.” It was shared on KevinMD back in January of 2020 and clearly resonated with my audience, and I’m looking at it now, at 162,000 social media shares. Now, for those who didn’t read that article, can you just walk my audience through it and share the story of why you decided to write it?

Karen S. Sibert: What happened, what just got on my last nerve? You’ve probably heard a lot about surprise billing, and that’s the unfortunate thing that can happen when a patient goes to an in-network hospital within their plan, but then they get a bill from, you know, perhaps an ER doc or a radiologist or an anesthesiologist for services that, to their surprise, weren’t considered in network on the insurance, and they get a big surprise bill.

Well, the truth of the matter is that very few of us these days set our own prices. I don’t have an anesthesia office where I get to charge $100 to intubate you. That’s just not how it works. Most of us have absolutely no control of the bills that are generated on our behalf, whether they’re by an academic hospital like UCLA or any other private hospital. A lot of private practices these days are owned by private equity corporations. None of us as physicians have any control over this, and yet we get blamed for it.

So The Washington Post had published a couple of articles close together, one about a patient who did receive a huge surprise bill from a surgeon, and another by a couple of economists who were really just going on about how overpaid physicians were. And for some reason, that day it just got on my last nerve. I just thought, this is so unfair to all of us who work so hard and put our own health on the line taking care of patients every day.

I wrote that actually just before the COVID pandemic really blossomed, but nonetheless it just seems so massively unfair to me, and it seems as though these days physicians, and actually intellectual achievement of all kinds, just do not get any respect in America. I think that is a tragic change. People always want to second-guess doctors, they want to second-guess vaccines, they want to second-guess all kinds of stuff based on a Google search, which is just idiocy.

When I take my car to the mechanic, I don’t do a Google search to figure out what I think is wrong with my car. I want the mechanic to fix it, and I go to a mechanic that is a reputable place that I trust to fix my car. I’m not saying that patients shouldn’t be their own advocates and ask questions and work with their doctors on establishing the best treatment plan for themselves, but there’s a point at which, we went to school for a long time. If you don’t trust me to pick out the right anesthesia drugs for you, we should have that conversation up front.

But just the lack of respect, the lack of understanding that there are people who really know a lot about their fields: Why would anybody want to work this hard and go into medicine if they’re going to face that kind of pushback and insult all the time? So that’s why I read that column, and it was really on behalf not just of anesthesiologists or surgeons, but on behalf of everybody: the primary care doctor who has to, every time a kid walks in the door: Is this a cold, or could this be the start of meningitis? You know, the internist, you would know this better than I, every cough: Should I be thinking about lung cancer? It’s just bronchitis. You know, the risk and the responsibility of what we do is kind of staggering. I mean, how we sometimes just have the nerve to get up in the morning and go to work is amazing.

Kevin Pho: Now, what do you think are some of the reasons we have this anti-expertise or anti-physician narrative that we see in some mainstream publications?

Karen S. Sibert: There’s been a long stream in America of anti-intellectualism. I mean, the urge to buck authority is why the United States existed to begin with. The people who settled the U.S. and Australia, you know, they were the rebels, they were the lawbreakers, they were the ones who were bucking authority. It’s interesting how there’s so much more attention deficit disorder in the U.S. and Australia than there is, for example, in England and the rest of Europe. And so there are some long reasons behind that.

But I do think that the ’60s and ’70s, with the protests and the social unrest that happened, really did create a generation of people that didn’t trust authority, that assumed that anything that authorities said was going to be wrong. And then, in terms of physicians, no matter how many women physicians we get in the field, there seems to be this attitude that if we tell a patient what we think is the best thing for them, the best drug, the best treatment, whatever, we’re being paternalistic, which is kind of funny in my case, but nonetheless.

So there are a lot of factors behind it, and not all of them are illegitimate, by any reason. But there is a point at which, if you don’t trust that the vaccine is safe, OK, but I can tell you, I think getting COVID is worse. So you have to have some faith in the science and in the people who are working in the science to know best.

Kevin Pho: What do you think the role of social media is in terms of fueling that anti-intellectual narrative that pervades us today?

Karen S. Sibert: The role of social media is huge. It’s funny that you should ask, because I finally, after a number of years, just canceled my own personal Twitter account. I just decided it was going to be better for my serenity, because too often it’s just so easy to go down a rabbit hole into these conspiracy theories and just flat-out nonsense. You could spend your entire day trying to refute it, but then you get nothing else done.

I think social media is a great gift, and at the same time it can be a great evil, and I don’t know what the solution to that is. I certainly don’t think it’s more government control. I don’t think that; that just leads to censorship, and that’s never a good thing for healthy public opinion or healthy dissemination of information. But it is a “let the buyer beware” situation.

Kevin Pho: So when you wrote this article back early last year, of course it was cheered within the physician community, it was cheered on social media, clearly, with 162,000 shares, and clearly resonated. But how about outside the physician community? What kind of response did you get from outside? People who agreed with you?

Karen S. Sibert: Some pushback, for sure. You know, I think that anybody who gets a large out-of-network surprise bill is horrified, and I firmly believe that nobody in this country should go bankrupt because of medical bills. Unfortunately, I think we’re taking the wrong path toward trying to fix that problem.

When you buy, you know, not exactly a great analogy, but if you buy insurance for your car or your home, you don’t expect that that insurance is going to cover every routine repair bill. You know, if something goes wrong with my sink, I’m going to call the plumber, and there’s no expectation that my homeowner’s insurance is going to pay for the plumber. I’m going to take care of those routine bills myself. Whereas we seem to have this idea that there should be no personal responsibility involved in medical care, that it should all be free, that, you know, your own health maintenance is not your responsibility, that it needs to be somebody else’s responsibility, and the system cannot possibly support that. It’s just not financially achievable.

So, you know, some patients wrote back with their own horror stories, and I’m completely sympathetic to those. And I think that the insurance companies have a lot of explaining to do about how they allow these things to happen, because they are not transparent about it. They’re not telling patients what’s covered and what’s not covered, and doctors and patients end up in the middle of this, and it really is the insurers that I think bear the brunt of the blame, or should.

Kevin Pho: Now, one of the reasons why I think there’s this anti-physician narrative in mainstream media especially is because physicians are simply too busy to fight back. We’re busy seeing patients, we’re doing procedures in a hospital, and that’s combined with the fact that we don’t have the writing skills, we don’t have the media training to kind of counter this narrative. But I’m interested to hear your perspective. So what are some of the solutions, and what are some of the ways where physicians can respond to this anti-physician narrative that constantly occurs?

Karen S. Sibert: I think that we have to respond. If we don’t respond, then we just get run over by the bulldozers. It’s hard. It is time-consuming. You do have to put yourself out there. People say, “How can you write what you do? Aren’t you afraid?” Well, no. I mean, I’m not afraid. I don’t write anything that isn’t well researched and corroborated, and when I say that the insurance companies are responsible for this out-of-network billing problem, that is just 100 percent true.

What we can do, certainly, if you don’t want to write your own articles, fine, you know, it’s a lot of time and a lot of work, but you can join professional associations. People are not, they think that somehow everybody else should pay the dues toward your county medical society or your subspecialty association, but they really are working hard to try to make sure that laws that get passed are not completely physician unfriendly, that just because the insurance companies can pay millions of dollars to lobbyists, we still have a voice that can be heard.

So the very least you can do is take part in that. If you don’t want to go, you know, I’ve been president of the California Society of Anesthesiologists, and I’ve been to Sacramento, and I’ve been to Washington, and if you don’t want to do that, fine, but then you need to cover for the people that do it. You need to pay the dues, cover for your colleagues who get involved in this kind of thing, or you really won’t have a voice. At the end of the day, you won’t have a voice at all.

Kevin Pho: We’re talking to Karen Sibert. She is an anesthesiologist, and she wrote the KevinMD article “Keep insulting doctors, and good luck finding a physician in 10 years.” Karen, one of the things you said earlier is how this disrespect and anti-physician narrative can lead physicians to kind of question what they’re doing and potentially even lead to burnout, right? And you hear the statistics all the time, 50 percent of physicians, even before the pandemic, are burnt out. I talk about it a lot on KevinMD. I have a lot of articles on physician burnout, not only on my website but on this podcast as well. We have a lot of doctors who go into coaching, we talk about side gigs, and we talk about leaving medicine altogether. But I’m interested in hearing your thoughts on physician burnout. What are some of the reasons behind it, and then what are some things that we can do about it?

Karen S. Sibert: It’s an awfully difficult problem. I’m happy to say I don’t think I’ve ever felt burned out a day in my life. I felt exhausted, I felt sad, I felt defeated, but burnout, I think, at the end of the day, is a sign of feeling so helpless that you feel as though you can’t do anything about your situation. So I’ve already outlined proactive things that I think we can all do to help support medicine, but more than that, it does come from within, in some respects.

You have to tell yourself, if this situation is so bad, if this private equity firm that just bought out my practice is really pushing production so much that it harms safety, if they are not buying us decent equipment, if I can’t practice the kind of medicine I want to practice, then you’ve got to have the courage to leave. Sometimes the only way you can vote is with your feet. And we are an incredibly privileged group. We have an education, we have resources that, frankly, most people stuck in awful jobs don’t have, all the essential workers during the pandemic. You know what? You really can find someplace better to work, someplace with the standards of health care that you want to practice. Don’t feel helpless.

There’s an old saying that says suffering is inevitable, misery is optional. So sometimes you really do have to have the courage to, if you don’t like your job, go someplace else, and it is not easy. I’ve done it. And especially, you know, when you’re an adult, it’s not that easy to go somewhere and make new friends. I can remember when I first went to UCLA after years in private practice, looking around and thinking, “Oh my gosh, where are my friends? I don’t have anybody to eat lunch with.” You feel like you’re a kid in high school. It’s not easy, but you do have resources within yourself, within the house of medicine. You don’t have to feel so helpless that you just give up and quit caring about your patients.

It’s an incredible privilege to take care of patients, an incredible privilege. I mean, I have, as an anesthesiologist, 10 minutes to go up to a bedside and make this person want to put their life in my hands. I think that’s an honor every single time I do it. And if there’s one thing that I maybe wish I had learned earlier on, it’s just the importance of being kind: kind to the patient, you know, get them a warm blanket; kind to my resident, you know, “It’s OK, nobody ever did this the first try.” You know, there’s a lot to learn, and I think I have tried more to focus on kindness as I’ve gotten older.

In anesthesiology, for example, we put in a lot of invasive lines, and a lot of the time you can put them to sleep before you do that. They don’t have to be done with the patient awake. So just bring some kindness into your day. It makes you happier and certainly makes everyone around you happier. There are just moment-to-moment ways to make the work of a physician fulfilling.

You know, my son is now a pulmonary critical care fellow, and of course he’s been through hell and back with COVID and everything, and he still, he cares about every patient. He said to me the other day that the only thing that really just got him was the Facebook goodbyes. And yet he still, you know, he gets up, and the next patient, he’s really trying to do the best he can for them, and that just brings me great joy.

Kevin Pho: And my final question: What is your take-home message that you want to leave with the KevinMD audience?

Karen S. Sibert: Being a doctor is really the best job. It’s such an honor. It’s such an honorable profession. For all these centuries, the physician has been the person who really makes such a difference in people’s lives. We are enormously fortunate to be able to do this, but we have to take care of our profession. We have to stick up for it. We can’t let identity politics or identification with our own little subgroup let us lose sight of the fact that we need to support other physicians. We need to support the practice of medicine. We need to fight against scope creep. We need to fight for fair payment. We need to do everything we can to help our profession thrive. And if we do that, I think we’ll keep going for another couple of that.

Kevin Pho: Karen, thank you so much for sharing your time and insight, and thanks again for being on the show.

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