Who could imagine that physicians born with an enigmatic passion to be in a position where the health of our civilization depends on them would be caught in so many obstructive and despicable circumstances that have led to increasing attrition of physicians in clinical medical practice. It is not so much about the overwhelming challenges that physicians are expected to overcome, but far more about the fact that our government, as well as our medical schools, have done nothing intentionally to reduce or resolve these increasing permutations of the national health care system. These changes are effective and universal in our nation, which perpetuates rather than resolves the attrition of medical doctors and the recruitment of future American physicians, obvious today.
When one adds the many other restrictive factors associated with the slow destruction of the quality of our health care and the increasing trend to transfer medical care to less qualified health care providers instead of correcting or eliminating the original causes that have incentivized these trends that continue to force medical doctors out of the profession. By considering several top challenges that dominate independent private practice physicians’ survival and careers, which are surging throughout the profession, the complete disintegration of private medical practice is to be expected.
Trust in government and medical school education is lost. Private medical practice income is compromised due to a lack of business education by medical schools, medical doctors’ business ignorance, and the fact that medical practice businesses often learn as they go. Medical doctors are compromised by not receiving adequate business education, leading to predestined practice failures to some degree. As medical students, they are never told the value and benefits of business education, and students are never given the choice. Without business knowledge, physicians never reach their optimal business income or success. The lack of business tools such as business management and marketing hinders unlimited income and practice growth. Physicians are incapable of recognizing that their practice business is failing because they don’t know how to determine the signals of premature failure. They often learn too late that their practice is failing, and there is no way and time to reverse the process—even experts can’t help them by then. Persistent decreases in practice income mean many doctors cannot afford to obtain current education or new skills, and they cannot fund retirement plans or meet their family’s financial obligations.
Medical boards face increasing attacks on practicing physicians, and these go unrestricted, meaning that every physician brought before the board must have a personal attorney present. Investigations continue on overprescribing narcotics, and all boards are appointed, which raises questions about potential biases. Non-physicians on the board are deeply influenced by physicians on the board discussions and vote on medical issues against the defendant, often without complete understanding. Board determinations about punishment are totally unpredictable, and some boards do not let the defendant request a personal board re-evaluation and further investigation even when the punishment is unfair.
The deep state in medical education and our government is a concern. All medical schools now rely on government grants/money and the domination it has on everything in the medical profession administration. Medical school curriculum changes or additions, like a curriculum for business education of students, must be approved by a government committee/agency, potentially hindering physicians from becoming business and financially smart. The government’s intent to destroy independent medical practice by fee restrictions and licensure issues, pushing physicians into government-dominated medical facilities and controlling their practice, is a concern.
Malpractice consequences further compound these issues. Our government and medical organizations have failed to force our government to create a reasonable set of malpractice laws, both national and state, that keep many physicians from quitting medical practice. High-risk medical specialties and subspecialties are not protected any more than low-risk specialties. The cost of medical malpractice insurance continues to rise, creating a financial dilemma for low-income physicians. When physicians refuse to acknowledge the value of and the necessity for business education, they become vulnerable in many ways. The 51 percent of medical school classes who elect to remain in employment status believe they are protected from malpractice claims but aren’t. The consequences of medical malpractice verdicts often completely change the personal life and quality of medical care that physicians may be forced to extend beyond lawful practice limits to stay in practice. Some physicians have avoided malpractice risk situations in their practice by assisting both plaintiff and defense attorneys in their malpractice litigation cases, which paid well and provided them with a litany of ways to avoid malpractice situations that most physicians don’t know about—ones that are not taught to physicians enough.
Many other details, factors, and challenges for physicians seem to be increasing over time—each, much more offensive and intolerable over time. Two of the most important questions should be asked. The answers to these will tend to further increase the already intolerable restrictions on private medical practice. Will our government give up on the pursuit of controlling the medical profession? Will the freedom to practice medicine how we want, wherever we want, and under what circumstances we want, be in the future of all physicians? What would your questions be or solutions for?
Curtis G. Graham is a physician.
