In recent years, an alarming trend has emerged within the health care system, one that is eroding the very backbone of medical care delivery: the physician. What once were rules and regulations designed to protect and elevate the standard of medical care are increasingly being exploited by medical authorities as a tool to extort, reprimand, and harass physicians. More disturbingly, this extortion is now cloaked as “education,” forcing doctors to pay exorbitant fees to sustain bloated bureaucratic systems that feed on their labor, all while pretending to “improve care.”

If this issue is not confronted with urgency, we risk dismantling the foundations of health care entirely. The harrowing decline in medical fellowship applications is just the beginning, a bellwether of a larger crisis that threatens not only the well-being of medical providers but also the health of patients who rely on them.

Regulations as a business model: Exploiting physicians

Doctors face extraordinary pressure on every front: the demand to see patients in high volumes, the expectation of making life-altering clinical decisions in short windows of time, and the responsibility of managing the complex web of human suffering. Despite these challenges, many physicians do their best to uphold the sacred bond between doctor and patient. But what happens when the system begins working against them rather than for them?

At face value, regulations seem helpful, designed to ensure quality control, patient safety, and accountability. However, in practice, the regulatory frameworks have devolved into vehicles for profit and coercion. Medical boards, accrediting agencies, and even private third parties force physicians to pay steep fees under the guise of continuing education, compliance reviews, and licensure renewals.

In this transaction, the intent of education is secondary. Doctors are paying these fees not to increase their competency but to keep their livelihoods intact. The “vetting” of charts from years past, where organizations retroactively find minor deviations from arbitrary administrative guidelines, has become a lucrative practice. These post hoc critiques are often irrelevant to patient outcomes but end up costing physicians thousands of dollars in penalties, legal defenses, and time away from their clinics. This practice isn’t “quality improvement”; it is extortion.

The frontlines of medicine: Forgotten heroes under attack

Physicians are the linchpins of health care. They are the only members of this labyrinthine system who sit face-to-face with patients, listen to their concerns, and make critical clinical decisions based on incomplete or evolving information. The complexity of modern medicine means that the expectations placed on them are immense, yet the system treats them as disposable.

Rules, guidelines, and administrative requirements often fail to account for the nuance and human variation of bedside care. Furthermore, the imposition of excessive, often redundant documentation and regulatory practices detracts from patient care. Doctors are forced to spend more time feeding an inefficient administrative machine than taking care of the very people who need them.

What’s more egregious is the psychological impact of these punitive regulatory practices. No matter how dedicated, skilled, or hardworking doctors are, they are often presumed guilty by oversight organizations. The intrusive chart reviews, criticisms over trivial issues, and looming threats of unnecessary disciplinary action create an environment of fear and demoralization.

The tipping point: Decline in medical specialties

Unchecked overreach is beginning to show disastrous results. The number of applications for pain medicine fellowships, a critical subspecialty addressing one of the most pressing issues in American health care, has dropped by 46 percent. This is no coincidence. This is based on a recent article published on June 21, 2022, by the American Society of Anesthesiologists (ASA).

Pain medicine has become one of the most overregulated fields in health care, with doctors often subject to punitive measures for prescribing pain medications, even when such prescriptions are medically appropriate and necessary. Physicians in pain management must navigate landmines of legal threats, administrative burdens, and an ever-changing landscape of requirements, making it an undesirable career.

When physicians lack the ability to provide care without fear of retaliation or economic ruin, they naturally begin to look elsewhere. After years of schooling, residency, debt accumulation, and sacrifice, fewer individuals are willing to enter a field that punishes them for trying to help people.

What happens when no one wants to be a doctor?

The cascading consequences of this crisis are unimaginable. The frontline of health care, the relationship between doctor and patient, will disintegrate under the weight of bureaucracy and attrition of clinicians. No amount of administrative posturing or technological advances can replace the expertise, empathy, and intuition that physicians bring to patient care.

Patients, particularly those in need of complex care such as pain management or chronic disease treatment, will be left without access to skilled providers. Waiting times will grow longer, outcomes will worsen, and an already fragmented health care system will descend into chaos.

Medicine is not just another profession; it is the cornerstone upon which the health and well-being of society depend. When physicians are forced out of the field or fail to enter it altogether, the entire system crumbles.

An urgent call for reform

This is not fearmongering; this is reality. Unless immediate action is taken to curb the excessive regulatory overreach, we will lose the very people who hold the entire health system together. Here are key actions that must be considered:

• Protect physicians from predatory oversight: Regulatory bodies should not act as profit centers or punitive organizations. There must be safeguards to prevent unjust audits, unwarranted penalties, and the abusive overreach of licensing boards.
• Streamline administrative requirements: Administrative burdens must be drastically reduced so that physicians can spend more time on patient care. Quality is not improved by paperwork; it is improved by meaningful time with patients.
• Subsidize, not penalize, education and training: Continuing education should be provided in a supportive manner, not as a cash grab. The financial responsibility for ongoing training should not fall solely upon overburdened clinicians.
• Rethink pain medicine policy: Pain management is vital to improving quality of life. Physicians require a safe environment to practice appropriate care without the constant threat of repercussion.
• Prioritize physician retention: Policymakers must examine the root causes of the declining interest in medical subspecialties like pain management and act swiftly to reverse these trends.

The time for change is now.

The decline of pain medicine fellowship applications is only a symptom of a much larger disease, a systemic failure to respect and support physicians. If we do not address these issues today, we risk leaving future generations without adequate medical care. Regulatory overreach, masked as protection and progress, has turned into a business that feeds off the sacrifice and dedication of doctors.

Physicians are not just a part of the health care system; they are the health care system. It is time we treated them as such. The health and survival of society depend on it.

Kayvan Haddadan is a physiatrist and pain management physician.