I’m in a global private physician Facebook group, and I learn a great deal about health care, both good and bad, from other doctors. Because it is private, doctors share a lot of personal practice issues as well as challenging cases from which we all learn. The physician who posted this message from her hospital employer gave permission for me to use it, and hundreds of comments encouraged this post.
This missive from her for-profit hospital was presented at a staff meeting. It is shocking for both doctors and patients and is indicative of how some health systems treat all doctors and primary care physicians. (Disclaimer: Not mine. We are respected, and they would never stoop to this.)
There are so many things wrong with this message. Every line contributes to burnout, toxic work conditions, horrible patient care, and disrespect for professionals and their support staff. The jiffy-lube assembly line for patient care will lead to medical errors and missed diagnoses, not to mention terrible patient satisfaction. The hospital wants the doctors to “churn” and schedule frequent follow-up visits to make a profit. The restriction on referring out of the system to find the best doctor for the patient is frankly illegal. (They wisely put in a disclaimer that it is “patient choice.” Of course, it is, but patients usually follow the recommendation of their doctor.)
The concept of doing work in the “downtime” is insulting. There isn’t even time to go to the bathroom or get a drink of water. The patient visit time is impossible when it can take 10 minutes just to go through a medication list or get an elderly patient undressed.
The physician who posted this has turned in her resignation.
More than 83 million people in the U.S. have no access to primary care. In large parts of Idaho and Mississippi, there are no OB/GYNs. West Virginia has the worst health care access and the least healthy population with the worst outcomes. From 2005 to 2015, the prevalence of primary care physicians in the U.S. fell by 11 percent, and many of them were hospitalists who only see hospital patients. The reasons physicians burn out and leave practice completely are clear in the message given to the medical staff:
- Packed workdays
- Demanding pace
- Time pressures
- Emotional intensity
- Exhaustion
- Depersonalization
- Lack of control and personal accomplishment
- Disrespect
I don’t have a simple answer for this health care system problem, but first, everyone should know it is a crisis. Firing the CEO and chief medical officer of this hospital would be a good start. Congress should step in and ease the physician shortage by expanding training options, providing greater student loan support/forgiveness, and creating smoother pathways for foreign-trained physicians. State legislators have the power to reform and reduce administrative burdens. Outlaw private equity groups taking over health care hospitals and practices. All of this would benefit patients.
More and more physicians are leaving employed practice for concierge and direct-pay practices and regaining control for themselves and their satisfied patients. Unfortunately, that will not solve the shortage for millions of Americans who deserve better.
Toni Brayer is an internal medicine physician.
