There are difficult issues confronting physicians generally, regardless of whether they are primary care physicians or specialists or employed or in private practice. The list is long and growing as more and more requirements, costs, mandates, and regulations are being inflicted in an environment of decreasing compensation. All of these lend to the rapidly lost freedom and autonomy for a medical profession where these are foundational.
It seems clear that the issues addressed are related to the system and not the essence of the profession’s mission, providing health care to those in need in a trusting relationship between patients and their physicians. It is appropriate to conclude that the intermediaries, increasingly inserted into the care process, are the major sources of frustration. Health insurance companies, government programs, and other agencies add regulations, mandates, and required technology to the system at will. Reasons are defined as beneficial to patients, but the reality is different. This is quite simply “virtue signaling” to obscure other motives. All of this hampers physician productivity. Said differently, it subtracts from the direct care and personal interaction with patients as well as adds costs to the business of providing care in an environment of frozen or decreasing compensation. It seems peculiar that physicians sign onto the regulatory morass they complain about. All of this is “voluntarily” agreed to in contractual obligations accepted by physicians.
Studies repeatedly reveal that now greater than 50 percent of physicians are experiencing symptoms of “burnout.” I would even bet the percentage is higher and that it is likely to increase since nothing is occurring to resolve the causes. Many physicians are contemplating early retirement or changing careers away from direct patient care. Some will seek employment as a refuge. Regardless, the message should be clear: The level of dissatisfaction is increasing for primary care physicians, medical professionals in general, and consequently for patients.
Could there be some sort of peculiar web from which physicians cannot escape? If so, it should be clarified. Why should physicians be prevented from engaging their passion for patient care by an increasingly frustrating and ridiculously complicated system? There are reasons; they should be exposed. I am a mature (elderly) physician, but this quagmire was not the case in the past. Something has changed, unfortunately.
Tolerating a list of frustrations that have been agreed to contractually and cause growing dissatisfaction is not logical. Signing contracts that one knows are onerous and unreasonable and continuing to accept this without examining why this is occurring and never seeking a resolution is quite pointless. It is admirable that because of their dedication to patient care, most physicians persist in practicing in this increasingly difficult environment. But no matter how strong their devotion, the frustrations, impediments, and decreasing compensation will eventually become intolerable. The negative consequences to physicians and patients can only worsen by continuing along this same path. Access to care and quality will predictably deteriorate.
Why has this happened? How has it been implemented? And, most importantly, what can be done to at least mitigate the most critical issues and eventually provide solutions? Continuing to list the issues as repeated complaints without action steps is not a solution. Hoping for improvement is not a strategy. Wishing for others to make things better never provides resolution.
Could it be that the medical profession is nearing an honest critical look at its situation, the present health care system, and what needs to occur to restructure the relationships to return the practice of medicine to the joy and rewards entitled its practitioners? Tentatively and fearfully picking at the edges of the issues drowning the profession in negativism will result in absolutely nothing. Would it not provide more than the satisfaction of simply knowing your peers share similar feelings to understand that planning for resolution and relief was actually being initiated? Optimism is therapy for pessimism and its increasing consequence, “burnout.” Stoicism may be of value to physicians but is in no way a solution or a substitute for the joy that should be implicit in the practice of medicine. Medicine is a demanding profession, but one of the benefits of a physician’s commitment should be happiness. The profession becomes quite hollow without the joy of practice and the happiness conferred by helping others.
Allan Dobzyniak is an internal medicine physician.
