Wednesday, October 7, 2009

Doctors should lead healthcare reform

Medicine is in a time of change. Hopefully we can create a healthcare system that provides rapid access to quality medicine for all of us. The details will be difficult to work out, but there is no question that physicians should be involved in helping to craft the new plan.

After all, physicians ultimately know what the day-to-day care of patients entails and what issues contribute to making the delivery of quality healthcare efficient. Of course the creation of a plan will also require the input of other groups including politicians, various industries, and patients, but without physicians, there will be no healthcare, and it is important to hear their voices.

So what do physicians think? Who represents their opinions? What do physicians want in the new healthcare plan?

The AMA, founded in 1847, has typically been perceived as the "voice of physicians", yet physician enrollment in the AMA has waned to a current level of 245,000 members representing about eighteen percent of American physicians. I don't think it can be said any longer that what the AMA says is what physicians believe.

Recently, an organization called Sermo, the Latin word for conversation, has become active politically and has engaged in debates with the AMA on national television. Sermo has about 100,000 physicians in its community and it's CEO is Dr. Daniel Palestrant. Membership is for physicians only. Their relationship with the AMA is antagonistic at best.

These societies may be the only exposure the public has to the opinions of large numbers of physicians as a group, and the message sent by these societies greatly impacts how physicians are viewed and whether their message affects policy decision making.

So, how does the public know what physicians think? Upon visiting the website of the AMA, there is a section for physicians as well as one for patients. The section for patients presents resources on healthcare as well as the AMA's vision of healthcare reform.

Although they do not offer membership to non-physicians, Sermo does maintain a blog , accessible from their website and available to the public, which purports to represent the Sermo physician community's perspective on select issues, presumable issues selected by Dr. Palestrant. The blog is heavy reading and focuses mostly on physician discontent with the current healthcare system, rather than presenting to patients a discussion on how fixing these problems would improve healthcare for patients, ultimately what the public wants to know. Unfortunately it sounded like doctors complaining, rather than doctors working for a better healthcare system.

I posted a message on the Sermo message board suggesting that a section be created for patients, on which Sermo could explain the issues facing medicine, doctors, and what doctors think should be done to help our healthcare system. The responses reminded me of something I learned in college psychology. A rat was randomly shocked in order to create a stressful environment. A stuffed animal was placed in the cage and the rat attacked it. On the Sermo message board, I was the stuffed animal.

Although I explained carefully that I thought a physician-only organization was great, Sermo had an obligation to present a face to the public once they had entered the debate on healthcare. The Sermo blog does this in a sense, but is difficult to read. I suggested a simple link from the homepage to a site where the public could read about the realities of medical practice from the people on the front line, not from politicians and insurance companies. The response to my suggestion was unanimously negative.  Doctors have become so stressed that they need a place where they feel safe. The sad thing is that doctors could help make the whole healthcare system a safer place for doctors and patients.

Medicine is an honorable field. I can think of nothing that feels more rewarding than making another person stop hurting, or fixing them when they are broken. Many years of training go into becoming a physician, typically at least eight years following college, and often several additional years. Physicians usually leave their training in enormous debt, and having sacrificed much of their youth to serve fellow humans. It used to be a sure bet that one would be successful as a physician, and physicians were a happy lot.  Most physicians would not want their children to go into medicine. This is troubling. 

In crafting a new healthcare plan we must not neglect the needs of physicians, but it is up to physicians to make their needs known. Both the public and doctors want the same thing and they need to be working together against the enormous political clout of the insurance and pharmaceutical industries that fear a loss of profits. Most doctors are in favor of a single payor system that would eliminate for-profit insurers and curb the power of big provider chains, thus allowing more dollars to go to patient care. This is similar to the 67% of the general public who support a single payor system. Doctors want healthcare decisions to be made by doctors, not by insurance companies. The New York Times reported that between 2000 and 2005 the number of Americans with private health insurance fell by 1 percent, while employment at health insurance companies rose 32 percent. The implication is that the insurance companies are working harder to decide who does and does not deserve healthcare. Denial of care is often a decision made by an insurance clerk with high a school education. The result is a burden on doctors to deal with the insurance companies when they could be taking care of patients and the need to see more patients in less time. Doctors views are really pretty much in sync with that of the public. Doctors can't be perceived as an isolated group of fat-cats that don't care about their patients and don't want to interact with patients except to make money. In general, physicians are people who want to help people, and they have chosen this path as a living. It's time for physicians to become the strongest unified voice for healthcare reform and I think the public will support them.In searching the internet for public opinion of physicians I found almost all positive reports. People seem to still trust their doctors. Doctors should stop complaining among themselves and lead the way to a better system.  A good indicator would be when doctors want their children to be doctors again.


  1. So many excellent points!!

    I am really sorry you were the stuffed animal, because you had an especially good idea. Physicians and patients must be partners in healthcare. The arrogant exclusion of patients is such a disservice to them! Patients have so much to share and teach their healthcare providers. Doctors who think they have nothing more to learn are doomed to ignorance.

    I do have to make one small correction regarding managed care denials. That is almost an urban legend, that denials are made by uneducated clerks. Every state in the country has laws in place mandating any clinical denial must be made by a physician.

    BTW,I am happy to sign up as your first follower. We all need minions. :)

  2. Hi Marie,
    Thank you for your comments as well as your correction. I hear different things from doctors and it may depend upon the specialty. I think that some specialties deal with more rejected services than others. I don't know who does the rejections and I trust you are correct that there is a doctor involved, but I still see that as a doctor who has a conflict of interest and has never seen or examined the patient.
    I am honored to have you as a follower. Thank you.

  3. I almost left a long comment about managed care, but you have inspired me to write something for Dr. Kevin's blog instead. :)

    I understand how doctors get frustrated. In my years in managed care, I have worked with many doctors who were compassionate and truly concerned about the patients we served. They always reached out to the ordering physician to try to get additional information before denying anything. A denial for them was a last resort.

    But you are right, there are the other kind, including one I worked with who I called Dr. Evil behind his back (I also called him Dr. No, lol; I am so immature). Unfortunately it got back to him, which did my career no good but gave me enormous personal satisfaction.

  4. That's funny! I'm sure you're right about the different types, but it's a slippery slope.