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Thursday, July 2, 2009

Physician Perspective on Health Care Reform

Like every good liberal, my primary news station is National Public Radio (I do take breaks to listen to the Dropkick Murphys every now and then). NPR had a series on the state of medical practice with physician interviews of 2 veteran doctors and 2 doctors who recently completed residency. I felt that their opinions on health care reform and what needed to change were so out of touch that it really disappointed me. To be fair, 1 of the physicians, an oncologist, was aware of current issues so this is indicative of the other three.

Now if I ask the average insurance person or pharmaceutical rep about health care reform, I will probably get some pretty stone age answers also that focus on preserving an unsustainable revenue and making their jobs easier. Also, there are strong physician leaders like Atul Gawande and Ezekiel Emanuel. Physicians for a National Health Program is a strong organization. However, we hold doctors to a higher standard and they are very smart so that's one of the reasons that their responses caused me to shake my head and have similar reactions that Robert Gibbs does whenever Joe Biden talks.

When asked about what needed to change about practicing medicine, the responses were:
1. They need to stop holding us to productivity standards and just let us do our jobs.
2. We have to go to many training sessions about the latest new topic.
3. Our patients are different than the norm and we should allow for the art of medicine as much as the science.
4. I wish that I could practice medicine like I did 20 years ago.

I interpreted those responses as being resistant to new practice ideas, being resistant to evidence-based medicine and protocols, being resistant to have any outside review, and a reinforcement of the doctor is always right concept. There is not a reverse Lake Wobegone effect where all of someone's patients are sicker than average. Finally, we all want to be able to do our jobs how we think they should be done and want our ideas to be right.

None of these responses are egregious or incorrect. It's just that these responses are not forward thinking in the slightest, especially #4. There is no acknowledgment of the rising cost of health care, how to improve medicine, or how to coordinate care with other providers. If this is the feeling of most physicians, I can see why the American Medical Association has brought forth no platforms, positions, or their own ideas. At first I thought it was the leadership of that organization but the emphasis on preserving the status quo from 20 years ago may be more widespread.

We all know that physicians are a key part of health care reform and could seize a leadership role. With responses like this, it shows a lack of desire to play a role. If physicians really want to practice like they did 20 years ago, they could propose being paid the same whether a visit is 15 minutes or 1 hour or whether the procedure had complications or not. Don't incur the expense of an office and just make house calls. An average primary care physician still makes $150,000/year after 3 years of practice so they still make a very good living even with medical school loans.

I know that physicians have strong opinions and it frustrates me that none have emerged in health care reform discussions other than they want to be left alone and not have to deal with the complicated business of medicine. As a result, physicians will find themselves working in a system that someone else designed and miss an opportunity to help form it. Where is being the change that you want to see in the world? What will get physicians more engaged in changing health care?

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