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.
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.
- 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
Are you ready to save yourself? Let me know in the comments below and sign up for my mailing list so you don’t miss a post!