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Yes, Doctors Matter

Dr. Wes recently reviewed a documentary film entitled “The Vanishing Oath,” in which a young emergency physician explores the reasons for his growing dislike and hatred of the field of medicine.  Based on the review the movie certainly seems interesting, though not something I’d add to my (non-existent) Netflix queue anytime soon.

What caught my attention was Dr. Wes’s concluding remark [emphasis added]:

At times I felt the film leaned too heavily on the question of why doctors are unhappy at the expense of other critical health care issues. After all, not everything in medicine hinges upon whether doctors are unhappy or not, and that question is probably the least important to the public at large. Still, the issues of physician burnout and attrition, coupled with our ever-burgeoning health care bureaucracy and the loss of physician autonomy, will no doubt continue to affect the recruitment of future generations of physicians and perhaps the caliber of doctors in the future.

This dual sentiment is not uncommon when it comes to physician grievances.  There is the exposition of some force that makes physicians unhappy, burnt-out, less effective, etc., coupled with the caveats that there are more important issues out there, and that patients and the public don’t care about those overpaid physicians anyways.

These caveats should be left to become quaint rhetorical devices of the past.

Yes, the healthcare system in the US is extremely complicated.  Yes, there are many important actors and moving parts besides physicians.  Yes, all of this would ideally come together to benefit patients’ health.  But if physicians, and especially their representatives, really believe that they have something of value to add to their patients’ health, if they believe that the physician part of the “patient-physician relationship” is really all that important, then they should be willing to state it boldly and clearly.  They should be willing and unafraid to make the case that if the public wants physicians, then people have to want to be physicians.

If the public doesn’t think that physician unhappiness and burnout is important, convince them.  There are structural forces driving physician “unhappiness” and “burn out.”  Fewer students enter the field.  Fewer graduates last that long in the clinical environment, and more become “burnt out.”  Dr. Wes suggests that medicine might start losing the competition for talent to other fields… if banking or consulting jobs (arbitrary examples) offer the same satisfaction but more pay, why shouldn’t the best and brightest hop on that bandwagon?

That there is a “patient” implies that there is a “doctor” (or some other “health care provider,” but I’ll stick with physicians for the moment).  Presumably the goal of recent efforts in the US to expand health insurance coverage was motivated, in part, by a desire to increase aggregate access to healthcare, a large part of which is access to a physician in some setting.  There’s no shame in pointing out that factors that reduce the supply of physicians will reduce access to physicians.  There’s no shame in saying that future generations will not flock to medical schools to join a profession that cannot give them the autonomy and job satisfaction commensurate to their ability and years of training (I’m deliberately leaving the question of pay out of this).

I, for one, believe that physicians do have immense value to add to patients’ health… to put it mildly.  I wouldn’t be going to medical school if I felt otherwise.  I agree wholeheartedly with those suggestions for healthcare delivery reform that are focused on strengthening the doctor-patient relationship.  Focusing on this relationship, and not just the physician, would be a powerful way to convince the public that physician sentiment does matter.

I’ve said before that doctors should be strong, effective advocates and thought leaders in health policy conversations.  This starts with being strong, effective advocates for their own profession.  At the end of the day it’s the patient’s welfare that is the goal of medical activity; that doesn’t mean that doctors should be afraid to take a clear, unambiguous stand on their own behalf.  If your job is to help the patient, then there’s nothing wrong with advocating for changes that improve how you do your job, and that ensure that future generations of physicians will come forth to do it in the future.  It’s hard to convince anyone when you spend as much time on the caveats as you do the case.  When even the former heads of CMS agree that you’ve been largely ignored in the recent reform conversations, you know you can afford to be — that you should be — a lot louder.

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