show me the money

The delivery of healthcare is a business in the United States. Healthcare costs consume 18% of our GDP. This is projected to increase to 20% by 2026. Despite this, our health outcomes rank 37th in the world.

Hospital systems are either for profit, not-for-profit or funded by the government. For profit hospitals earn money for their investors, not-for-profit hospitals earn money which is funneled back into the operating expenses of the hospital, government funded hospitals rely on tax revenues for operating expenses. But the bottom line is the bottom line, regardless of the financial structure of the hospital. 

Why is healthcare so expensive in the United States? 

What can be done to improve this situation which is frankly not sustainable?

Simple answer to a complex question: all stakeholders in the healthcare system need to be less greedy.

Less greed on the part of insurance companies (the CEO of one insurance company earns a reported $15M+ annual total compensation). Less greed on the part of hospital systems (why are C-suite executives earning more than physicians who provide the services from which the hospital profits?). Less greed on the part of pharmaceutical companies (rising drug costs are leading patients to stop taking necessary medications and tap into retirement savings to pay for out-of-pocket treatments). Less greed on the part of physicians (should we really be offering non-evidence based treatments to our patients for cash?). And yes, less greed on the part of patients who insist that their physicians order expensive unnecessary tests.

Everyone needs to do their part.

Together, let’s redirect the focus away from the bottom line and towards improving health outcomes.

Isn’t that what healthcare should be all about?

We really should be #1 not 37th.

au-ton-o-my

Autonomy: from the Greek roots: autos = self and nomos = law. Oxford English Dictionary definition "freedom from external control or influence; independence".  In childhood, autonomy is when one understands oneself as a self-governing individual.

A world-wide epidemic of physician burnout exists according to an editorial published in The Lancet (Physician burnout: a global crisis, The Lancet, July 13, 2019). Doctors are retiring earlier than planned. Suicide rates for physicians are higher than for any other profession. Not only does burnout affect physicians' personal lives, but also affects patients' care and safety. Why is this happening? Rising educational debt, increasing administrative tasks, long hours, professional competition, demanding patients, erosion of physician autonomy...

There is a sentiment brewing that our country's healthcare crisis may be aided by establishing a system modeled after the NHS in the UK where physicians are employed by the government. According to The Lancet article, 80% of doctors in a British Medical Association 2019 survey were at high or very high risk of burnout. Is this really the only practice model that should exist for our physicians?

I have worked under almost every practice model available to a physician: multi specialty group practice, hospital employed, academic medicine, small group private practice, locum tenens, solo private practice, full time, part time and for two brief periods in my career, I didn't work at all! Each model has its strengths and weaknesses and I chose each model for a particular reason (work-life balance, financial, benefits...) at a specific time in my career. But none has afforded me as much autonomy as solo private practice.

I realize that not every physician desires to be a solo practitioner, but feel that preservation of physician autonomy is essential to combating burnout. By encouraging a variety of practice models to co-exist, physicians' professional longevity as well as patient care and safety will be improved.

epiphany

Isn’t life funny?

The “retrospectoscope” allows one to see things more clearly than when we’re in that moment of cloudiness.

Crying without reason.

Time pressure.

Misdirected anger at patients and colleagues.

Broken relationships.

Unhealthy choices.

Stress.

Fear.

Perseverance and survival mode thinking led me to cast many lines in the water.

Many nibbles.

Few bites.

Then one day the cloud was lifted.

Joy has returned to my professional life.

Balancing solo private practice with locum tenens work in rural underserved areas.

Oceans and mountains.

Financial security.

Feeling appreciated.

Ready to share my story.

I didn’t realize I was burned out until I wasn’t...