Explore the urgent challenges in American healthcare and discover why it’s time for physicians to take charge of their own destiny and save ourselves.
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What if all the doom and gloom about American healthcare isn’t overblown? What if physicians are collectively rolling downhill towards a healthcare crisis and no one is coming to save us? Maybe we’ll just have to save ourselves.
The view from the inside
While I’m by no means a professional analyst, I am a physician. So I’ve had the opportunity to see the changes in medicine over the last 15 years from the inside. And as a writer, I’ve had the chance to write about the plight of doctors and American healthcare on my blog.
Historically, the themes that keep me up at night are physician burnout, loss of autonomy, and financial pressures from things like med school debt and lifestyle creep. These are some of the things that have affected me personally in my own career and life journey. They influenced me to eventually transition from full time employed practice as a urologic surgeon to a more balanced life now as a locum tenens physician and investor.
Doctors are hurting
Multiple studies over the years have shown me that I’m not alone. About a third of doctors were already burnt out before the pandemic, but things got much worse as Covid flooded our emergency rooms, MICUs, and inpatient floors. Burnout rates doubled to 63% in 2021, with much of it due to the way the pandemic changed and stressed healthcare delivery.
Read more:
More recent studies show that burnout has slightly improved since 2021, with about half of physicians reporting burnout in 2023. But let’s be honest – this is still an alarming statistic, especially with the association between burnout and increased medical errors and malpractice, reduced patient satisfaction, and the poorer quality of care.
It’s been a small ray of sunshine that medical school debt has recently stabilized around $200,000, according to the AAMC. However, this has to be balanced against the fact that relative to inflation, Medicare reimbursement to physicians has actually dropped 26% since 2001. This continually challenges physicians and hospitals to keep keep the lights on while still delivering quality medical care.
Even worse things threaten healthcare
But when I step back a little bit and survey the entirety of American healthcare, some larger problems scare the heck out of me even more.
Here they are in no particular order:
- The increasing control of insurance companies over healthcare decisions
- The en masse purchasing of medical groups and ERs by private equity
- The physician shortage
Why don’t we solve these problems?
As physicians, we are all scientists at heart. We are problem solvers and use these skills to tease apart our patients’ maladies and synthesize a plan of care. This process is empowering and one of the most rewarding parts about being a physician.
But when it comes to knowing how to approach large and complex issues like the stranglehold of insurance companies on American healthcare, the most common emotions I see are powerlessness, disgust, and frustration.
This is why doctors don’t just strike en masse and revolt against clear inequities like the pre-authorizations that limit physician decision making power. Because as an individual physician, it’s far easier just to accept the status quo and direct your energy to your overflowing clinic or EMR inbasket.
Some of us are taking the golden parachute
Consider the common situation where a private equity group comes to a physician group, offering a golden parachute that will disproportionately benefit the elder physician partners. It’s far easier for the senior partners to suppress their misgivings and take the payout, counting on the younger, more energetic doctors to pick up the pieces. However, when the practice is reduced to a spreadsheet and key performance indicators, billing inevitably increases and autonomy decreases. With the connection between burnout and decreased autonomy, this is a worrisome trend.
Should we all just retire?
An easy solution for older, financially free physicians is to just go ahead and retire. I saw this in my own practice, where a physician partner decided to retire a couple years before formal retirement age. He was tired of the overnight call and the bureaucracy of the day to day. His departure led to a void in our group and a loss of his specialized skills that was tough to replace.
It will be years before we know the full impact of the pandemic on physician numbers. However, any reduction in the workforce is a huge problem for American healthcare, given the physician shortage that’s already here (and projected to worsen).
The physician shortage is something that the public experiences as longer wait times to see specialists and their primary care doctors. But it also means that when a patient sees a physician, it’s often a shorter visit with a physician that’s either apologetic or emotionless, just trying to get through the day.
The shortage also disproportionately affects secondary and tertiary cities, leading to deserts of medical care. Just an hour or two outside of major cities, you’re often hard pressed to find a specialist. This creates a situation where patients often need to be flown or driven via ambulance for hours just to access specialized care. I see this myself when I work as a locum tenens.
We are acting like bystanders
When I visualize this conglomerate of major problems, I’m reminded of the “bystander effect.” This term describes a situation where individuals are less likely to offer help to a victim when other people are present.
Picture the man getting mugged on the subway platform, while a crowd of bystanders just watches in paralyzed fascination. This is the same effect that keeps most physicians in a state of disgruntled acceptance. We hope that someone else will solve our problems. Physicians are bystanders to our own collective mugging.
After a decade and a half in medicine (so far), I’ve come to the conclusion that no one is coming to save us. Therefore, I believe we are all going to have to take ownership of our own destiny.
Different strokes for different folks
This realization will mean different things for different people.
When I came to this conclusion a few years ago, it sparked a journey towards financial freedom that led me to my current dual existence as a physician and investor.
Before I decided to leave my practice in Southern California and move to Memphis, I worried about the effect on my colleagues. As chief of my department, I understood the intricacies and challenges of our care delivery on an intimate level. I knew that I was going to temporarily add to their workload, since recruitment of urologic surgeons is very difficult now due to scarcity.
In the end, I chose to make the right choice for myself, rather than the right choice for my hospital.
Not all doctors will leave medicine
I suspect that most physicians won’t undergo as drastic of a transition as I did, which is good news for American healthcare. Despite studies showing that 40% of doctors want to leave their current practices, most will find a new home in a new practice, rather than leaving medicine altogether or going part time like me.
But unless American healthcare improves, inevitably some doctors will choose to use their talents in other fields, like management, consulting, or entrepreneurship.
Become your own hero
It’s time for doctors to become their own heroes. Physicians, I’m addressing you directly now!
You have to stop being a bystander on the sinking ship of American healthcare and do something about it. This might involve temporarily stepping away to take care of your own life before you can help everyone else. As others have said, you need to put on your own oxygen mask first.
How do you start? Take ownership of your day to day. If you’re burnt out, put in the mental effort to figure out why, then try to change those causative factors. This might mean a change in your practice, hours, or lifestyle. Perhaps you need to set some boundaries and leave the office at a reasonable hour. Or perhaps you need to say no to that extra administrative position.
You also need to set aside some time and educate yourself in personal finance. The less reliant you are on your physician income, the more objective your decisions can be with regards to your career (and your patients).
So map out your income and expenses and set aside money for savings. Learn how to invest your money and move towards financial freedom. If you’re interested in real estate investment, perhaps we can help.
Read more:
- How to Save, Invest, and Become Rich
- 3 Simple Steps to Automate Your Finances
- The Official Reveal | Cereus Real Estate
Time for physicians to save ourselves
Physicians, no one is coming to save us. But we can save ourselves.
It will be easier for physicians to do this if we are negotiating from a position of strength. Financial strength is part of this. Imagine a nation of financially free, autonomous physicians. Creating this vision is the purpose of this blog, by the way.
I’m realistic and understand that this won’t happen overnight. But I’m also an optimist, which is why I maintain hope for the future.
I hope that in my lifetime, we’ll finally create a sustainable healthcare safety net that provides affordable healthcare for all Americans. I hope that the stranglehold of insurance companies and private equity companies will eventually loosen its grip.
And I hope that you’ll be part of the solution.
– The Darwinian Doctor
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25 comments
“Physicians are bystanders to our own collective mugging.” This is so perfect! Most just don’t know what to do or where to begin. Financial education and freedom are the way through.
Totally agree!
Interesting title which rings true to me.. However, what am I missing in the big picture when a urologist, typically near the top of the food chain in terms of physician compensation and control over his/her own life, is writing about financial stress and burnout? I’m a lowly family physician and at least in my market urologists wouldn’t give me the time of day. Are things so bad that even urologists worry about more than what color Porsche they should buy? (I’m serious, not sarcasm.)
It was a valuable realization for me that there is more that unites us as physician than divides us. As the White Coat Investor has pointed out, there is much more intra-specialty income variation than inter-specialty variation. For example – there are some urologists making $250k and some making $1.5 million. The causative factors behind burnout are no less powerful for urologists than for primary care.
There is not a prayer that taking care of ourselves individually will save the profession. That will require actions such as physician strikes to move the financial control corporate medicine holds. And I have been in the profession almost 50 years . . .
It’s got to start somewhere, but I sincerely doubt that large scale physician strikes will never happen. We as a profession are (currently) too fractured and moralistic. What do you think?
Sure , we all feel this. Great post but docs are like Lemurs and follow the heard. The laws should be known first. I understand that collective bargaining is prohibited by physicians. I understand that only in a private large group can it be done , not sure. That leaves the giant groups of privately owned docs to stand up. Not fair and may not be legal. It would be self destructive. Any ideas . Seems we have completely lost hope in our AMA( some saviors!!) . Not to mention that separate and destroy policies have weakened us . Gatekeepers vs specialist. Hospitalist and consultant. Managed Care. Young desperate docs chained to 200k loans willing to do anything and replace you. Separate and destroy . We need some Wharton grad to take this on. I thought the guy on Shark tank who started the online drug store at low prices was terrific. So many avenues to attack from the two tiered system of health care approach , the utilization of s panel to limit healthcare services to avoid wasteful spending. Slow downs , protests . Our media in our area is anti doc so it’s another obstacle. Perhaps the writer can best begin to direct us, categorize, prioritize, the issues . But certainly keep the conversation from ending. I’ll be retired !
Certainly the first step is recognition of the issue, which I think is finally being done. The next step from my perspective is empowerment. Physicians need to realize the power that they hold over their own lives. Currently, too much of the sentiment is self-pity without self-empowerment. We have more power than we know to change things, both at the grassroots level and the larger medical landscape.
We created this mess by giving up out autonomy. Selling practices . I am still independent and doing well. medical school debt is meanungless. It cost more to open apizza shop . Only a medical eductation gives you a garuanteed return on you investment. Quit complaining and work for yourself!!
A valuable perspective, thank you!
I have a very cynical theory that some of the factors causing physician burnout and unhappiness (need for more and more documentation, HCC diagnoses, increased workload) may be an intentional plan by insurance companies to thin the ranks of MD’s in favor of NP’s and PA’s, which they may think will cost companies less. Maybe i’m paranoid but…
That’s very deep state…. but I wouldn’t bet against it. Someone please pass this along to Dr. Glaucomflecken to create a skit about.
You nailed it! I wasn’t even able to get my financial freedom in order before “retiring” at the ripe old age of 44. I just couldn’t do it anymore… The burnout and moral injury were too great. Some of us at the extreme end of this spectrum who have already left direct patient care are finding each other. Instead of feeling like zombie docs, we are alive, hopeful, and trying to shape the changes that must come next – to save our patients and our profession. You will find our tribe at http://www.medicineforward.org
This is very interesting, thanks for sharing this resource.
I very much share your concerns and alarm about these issues. I also have a significant degree of optimism about our ability to make changes.
My own recent book addresses many of the concerns that you raise, while emphasizing the enduring importance of the patient-physician relationship and primary care, The Healing Connection: A Partnership for Your Health (7/31/23, 360 pages, 280 references, ISBN 9781954102156).
I am a seacoast NH resident and have promoted my book on KevinMD:
An emergency physician’s insights on health partnerships
I am looking for readers and of course reviewers. I hope that you have the interest and time to take a look at my webpage at DrewRemignanti.pubsitepro.com
A more condensed version of my presentation is available in my recent Op-ED at:
https://www.medpagetoday.com/opinion/second-opinions/107816?trw=no
Good luck with your book release!
Great Subject Matter. I recently viewed a very interesting podcast of all places on “The Joe Rogan Experience ‘ Dec 23 of2003. He interviews a fellow named Brigham Buhler. This interview highlights the stranglehold that Big Pharma, Big Insurance and The Government have on all of us, both practitioners and patients. Wether you agree with this gentlman’s theraputics or not ( I happen to think that maybe some of it holds promise) what his experience is in dealing with insurance companies and the big pharma folks is eye opening. I have often said that it will be “GREED” that brings this country down. The Marxists were right about this one fact and that is we will take America over without having to fire a shot. Unless we wake up. Thank you for the thought provoking article and yes I look forward to reading more from you in the future. You can find “The Joe Rogan Experience on “Spotify” if interested and I hope you are. Louis Bergeron M.D. Elko Nevada
He’s an interesting character, but he definitely has some great interviews on his show. I’ll have to check out this episode!
Well said. This has been going on for a while. Organized medicine-AUA,AMA,AACU, etc…. Like a good neighbor, organized medicine is where?
I don’t really know, and I’d love to hear from them.
The problem is arrogance and self righteousness fractionates the unity of physicians to effectively navigate the waters of a hardcore business mentality that is what your opposition has no problem with. The word opposition is not hyperbole. In a world of finite resource, the division of resources creates opposing forces. like it or not. There is a significant portion of physicians who place themselves on a higher moral plateau, and view the ruthlessness that must be the very visible but only rarely used sword that the physician workforce accepts as theirs to wield when necessary. The resistance to this is a primary inhibitor of even initiating a meaningful foray into regaining a level playing field when the opposition includes hospital management, insurance companies, and now the “my friend/my enemy” role of the PE investor who wants to own you. Not one of these entities cares a bit about your life or your livelihood. They will take from you until you quit, or die, or they replace you. Until there is physician unity and the willingness to use the power of non-performance on a global scale, and that option is put squarely on table, we will never be taken seriously. To those physicians who don’t believe this, that’s fine, because you will get to continue to live in with the “…powerlessness, disgust, and frustration…” that the author describes.
How ru going to tell physicians to stand up and be hero , after you saying that you left your hospital for your self.
That’s the thing — first you have to save yourself. Put your own oxygen mask on first.
IMHO, we are too far down the rabbit hole in most areas of the country. I see primary care practices turning to concierge medicine, specialists taking cash only or supplementing their incomes with non-medical treatments, groups selling their practices and taking employment positions. Everyone is fractured and trying to survive the best they can while competing with their colleagues. New MD, DO grads do not even consider private practice as this is not taught in school. They are groomed to be cogs in the corporate medical world.
The solution, at this stage of our cancer has to be drastic, in order to save our profession. While collective bargaining and strikes may be illegal, that is what it will take. If a critical mass of us decide to do this (which I am extremely doubtful will happen), it can work. However, I don’t think, myself included, most of us would have the heart to abandon our commitments to our patients or practices. I fear we will continue along the path we are on and our patients will suffer with cogs lead by business majors instead of physicians taking care of them.
Equating our collective situation to cancer is drastic, but perhaps accurate… Time to pick up the scalpel!