The Battlefields of Medical Care
As a family physician who has been in medical practice in America for nearly twenty two years, I can’t help but wonder about how medicine has drastically changed in the last two decades since I finished residency and started my medical practice. The best way I can describe how medicine used to be like when I first started private medical practice in the late nineties, and how it is now is with the word coup d’état. Medical practice in general has undergone multiple revolutionary changes that remind me of the many sudden and unsettling coup d’états that I’ve experienced as a child growing up in Northeast Africa.
I still recall during my early childhood days in Africa how each coup d’état brought drastic changes in the fabric of our society and led to many unwelcome consequences. And depending on which group initiated the coup, properties were confiscated, harsher and stricter religious laws were legislated, and new limitations on rights and freedoms were instituted. First, changes were made here and there by a new regime, then new limitations and restrictions by the leaders of the coups that followed were placed and enforced.
I can’t help but see some resemblance between those coup d’états that I’ve experienced during my childhood and the new revolutionary changes that occurred to the practice of medicine in America today. There are multiple new changes, limitations, restrictions and roles that physicians are now expected to follow. There’s definitely a new non-physician sheriff in town, and physicians who once used their power and talents for the most part to do good are no longer in charge. And that’s the new reality of medical practice in America.
There is no doubt that the scientific and technological advances in medicine, fueled by research and brilliant scientific minds have made America the world’s leader in medical advancement. And this is truly a blessing not only for Americans but for the whole world that benefits greatly from America’s medical technology and know-how.
It seems that the coup d’états that have befallen the practice of medicine in America and pauses a great threat to the amazing wealth of medical knowledge in the U.S. is the gradual transformation of medicine from Patient-Care centered model into a hugely profitable business enterprise. I saw in my many years of medical practice the gradual infusion of business managers and business savvy, intelligent administrators who have skillfully transformed medical care into an extremely profitable business.
For many generations in America, medical care has always been demanding and consuming but yet prestigious, independent, honorable, and rewarding to physicians. I recall the trend of how aggressively large non-profit hospitals and newly formed health systems gradually began to buy independent physicians practices. I’ve seen how dramatically that has changed the landscape of medical care as the strongly independent physicians whose main concern was their patients became contracted employees of big businesses with a main goal of maximizing profits and minimizing expenses.
Enterprising business minds whose primary interest is to make money from patient care (including a supermarket manager that I knew about who was hired by a business company that owns a chain of independent medical clinics to manage all the physicians and clinic operations) were now deciding on how physicians ought to deliver medical care. Revolutionary profit generating changes, akin to a coup d’état, such as increasing the number of patients per hour physicians must see, reducing and replacing higher paid physicians and registered nurses with less costly medical providers, and instituting complex and costly Electronic Medical Records (EMR) became the new norm.
According to The Guardian in an article dated March 13, 2018
“The United States spends twice as much on healthcare as 10 other high-income nations, driven by the high price of everything from prescription drugs to doctors’ salaries, a new study in the Journal of the American Medical Association finds.”
“The US also spends more on
administrative costs. Other nations spend between 1%-3% to administer their
health plans. Administrative costs are 8% of total health spending in the US.
This results in US health costs that, as a percentage of gross domestic
product, are nearly double that of other nations. In 2016, the US spent 17.8%
of GDP, compared to 9.6%-12.4% in other countries.
At the same time, America often had the worst population health outcomes, and
worst overall health coverage. The US ranked last in life expectancy; had the
worst maternal mortality rates (nearly triple that of the United Kingdom); more
infant deaths than any other country, and a high rate of low birth weight
babies.”
There is no doubt that few are profiting a lot from healthcare in America, but primary care physicians with their mounting medical school loans (a medical student graduates with an average debt of $170 to 180,000 according to the US News), work hours that can be up to 80 hrs a week for some, and a mountain of administrative burdens are definitely not one of them.
All the seismic changes in medicine has not been without serious and deadly consequences. According to a 2018 Medscape survey the rate of physicians burnout (variation is found between specialties) is at 42%, and up to 14 % are reporting both depression and burnout.
Medscape Family Medicine also reports in an article dated May 07, 2018:
“With one completed suicide every day, US physicians have the highest suicide rate of any profession… more than twice that of the general population” and adds “ A systematic literature review of physician suicide shows that the suicide rate among physicians is 28 to 40 per 100,000, more than double that in the general population.”
So indeed, the state of medical knowledge in America is excellent but the current state of the practice of medicine after a series of coup d’états is not as good. Sadly, often times it’s becoming mentally unhealthy, dangerous, and at times deadly to many great physicians.
Please reach out to friends and loved ones and seek the advise of a mental health professional if you experience distress or suicidal thoughts.
The National Suicide Prevention Lifeline ( 1-800-273-8255 https://suicidepreventionlifeline.org/ can be reached 24/7 and offers “… free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.”
Adel G. Hanna, M.D.