Where is the joy in medicine?
Oge Young, MD, is the past NHMS president and general board member representing New Hampshire obstetricians for 20 years.
Opening the door to one of my exam rooms, a 4-year-old girl stood before me, beaming with excitement, having just heard her little sister’s heartbeat. As I was measuring her mother’s belly, I said to her, “I really hope your sister comes out of this as healthy and as strong and as smart and as kind as you are. To which she replied, “And, and, and… no cavities,” pulling her lips to show me her white teeth. My days at the office were filled with these lighthearted moments.
In recent years, it worries me that doctors work in a healthcare system that does not allow for these special moments, a system that too often benefits hospitals, health insurance companies and pharmaceutical and device companies, the detriment to physicians and patients. This has happened with the rise of a huge new industry that provides health care for profit.
The organization of health care delivery and the practice of physicians have always been based on concern for the public good. Services were provided by non-profit institutions and individual practitioners. In 2020, for the first time, less than half of physicians work in physician-owned facilities. More … than 300,000 practicing physicians in the United States are employed by hospitals and 122,000 are employed by companies.
My private obstetrics and gynecology practice finally joined the medical group at Concord Hospital ten years ago when we could no longer afford our expenses. Our annual medical malpractice premiums have increased to $75,000/doctor, although we haven’t been sued in over 25 years. We struggled to cover the full benefit costs for our office staff as health insurance increased.
As doctors, we weren’t making enough money to hire a new, young, well-trained obstetrician/gynecologist surgeon into our practice to replace our older partner who was retiring. Finally, we were required to comply with a federal regulation that required our practice to adopt electronic medical records (EMRs). The initial cost would be $35,000 per supplier. At the time, we had six physicians, two nurse practitioners, and two physician assistants, which would have cost $350,000.
There is an unwritten sacred social contract between physicians and society. We sacrifice much of our youth and young adulthood to train and acquire the skills necessary to meet the health needs of patients and society. For this sacrifice, we hope to work in a supportive health system, a system that is not distorted by its own corporate ends. Recently, this social contract seems to have been violated by the “corporatization” of American health care.
Today, most health care managers and decision-makers are not physicians. They have never healed a patient or a community. Success for these non-physicians is profit measured in revenue generated per visit, procedure, or clinical encounter. Many do not know the importance of the patient-doctor relationship.
The administrative tasks of service providers have multiplied. They are faced with insurance clearances, a 20-minute patient visit schedule, and documentation of the encounter on a slow and clumsy electronic medical record. Many go home with their laptops to record patient visits at night after putting their children to bed.
Physicians know that EMRs do not improve patient care or make us better providers. Electronic medical records only make us better at billing, which translates into higher revenues for the health care system. Physician stress and burnout stem from a lack of joy over the dysfunction of our healthcare system.
Remarkably, the United States is the only developed country in the world that has not determined that health care is a basic human right. In 13 other highly developed countries, universal health care exists at half the cost of health care in our country. Health care has become the largest industry in the United States, $4.3 trillion in 2021, or 18.8% of GDP, but life expectancy is only 76.1 years, lower than that of the other 13 developed countries. Our population has a higher prevalence of chronic diseases and we have insufficient access to care.
The corporatization of American medicine has resulted in a consolidated, lucrative system of hospitals with administrators earning 2 to 5 times what doctors are paid. We have highly profitable insurance companies, billion-dollar pharmaceutical companies, and many wealthy consultants.
A few years ago, a very bright, red-haired 6-year-old girl who accompanied her mother to my practice told me that she was considering becoming a doctor like me because she wanted to give birth. I told him that would be wonderful. That maybe she would come back to train with me. She replied, “I don’t think so. I think you’re going to die!”
No doubt, she is right. I hope that she and her young medical colleagues can recreate a healthcare system where the joy of caring and being cared for remains alive.
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