Doctors are asking for more money, more autonomy. Americans: ‘No.’

Thanks to the wonders of medicine, newly vaccinated Americans are coming back to life normally and celebrating like in 2019. Doctors, emerging from the pandemic as national heroes, would like to turn back time even more – until the heyday of the 20 . -th century medicine.

But doctors, unlike their maskless and coasting patients, will be disappointed with what the future holds.

Trying to go back in time

Doctors have had a difficult century so far. In addition to battling Covid-19, doctors have spent the past two decades fighting the fiercest players in the healthcare industry and losing hard.

Power in the industry now rests with health insurance companies, major drug makers and hospital tycoons. Doctors feel beaten up, exhausted and abused by a system so overrun with regulations that clinicians now spend more time filling out paperwork than helping patients.

Doctors aspire to the last century. Back then, they were well paid, revered by everyone, and largely left on their own to practice as they pleased. As the war on Covid-19 draws to a close, doctors believe the time has come to demand a return to the glory days when doctors ruled medicine. To get there, doctors want more money, respect and autonomy. They won’t get any of this because our nation cannot afford to give it to them.

A cruel reality

Almost half of Americans are struggling with financial difficulties amid the economic fallout from the pandemic. The country’s uneven recovery has 35% of small businesses worried about surviving the summer. Meanwhile, the federal government now owes foreign lenders $ 28 trillion ($ 85,000 per American).

Soon the reality will set in for physicians: Any solution that involves giving physicians more money or less responsibility will fail. Twentieth century medicine is dead, and with this loss physicians will experience the five stages of mourning.

Doctors and the five stages of grief

The first step is denial, a coping mechanism that is ingrained in the minds of every physician. It is a necessary and sometimes useful tool in dealing with the often horrific, tragic and painful realities of the practice of medicine.

But this same psychological defense leads doctors to dismiss the role they play in the growing inaccessibility and declining quality of health care in the United States.

Examples abound. American doctors prescribe 99% percent of the world’s hydrocodone, contributing to more than 500,000 opioid-related deaths in the 21st century. In addition, 200,000 Americans die of medical errors each year, 500,000 families go bankrupt because of medical bills, and 30% of all medical treatments are found to add little or no clinical value.

Research shows that the United States has the most expensive and least effective healthcare in the developed world. To reverse the trend, doctors will need to follow evidence-based guidelines more closely and adhere to safety checklists (giving them even less autonomy than they currently have, not more).

Anger in the medical profession, it’s pain backwards. This is how doctors exteriorize feelings of fear, hurt, or guilt.

All over social media, doctors are posting indictments in capital letters against the failed U.S. healthcare industry. “Doctors didn’t create the dumb system, nor the management that fuels the dysfunction !!!” said a medical commentator.

Doctors are suffering from everything they have lost. But like the American tourist shouting louder and louder at non-English speaking locals, doctors act as if repeating the same words at higher decibels would change the responses of insurers and hospital administrators.

This is not the case because the problem is not the volume. It is that the doctors speak a different language. No matter how much doctors cry out for higher wages and fewer patients per day, their demands don’t make economic sense to those who receive them.

Negotiation is an attempt to negotiate a better outcome. Some doctors have already started this step.

During Covid-19, a survey revealed 53% of physicians practicing independently feared their practices would not survive COVID-19. As solo practices struggle to survive, more than 70% of all physicians working for a hospital or medical group — a way to gain bargaining power with insurers and increase financial security. But as economic pressures intensify in the post-pandemic era, all physicians will feel the effects.

Small and medium-sized businesses cannot afford 5.5% annual increase in health spending. State governments, which must balance their budgets, will not be able to increase Medicaid payments. These days, politicians on both sides of the aisle see the futility of pushing for any health care plan that would raise taxes.

So rather than negotiating for a bigger slice of the pie like they did before the pandemic, doctors will find themselves negotiating for less. a reduction.

Depression follows unsuccessful attempts at negotiation and is a sentiment increasingly familiar to physicians. According to national studies, around 15% of doctors struggle with depression while 20% report having had thoughts of suicide.

The causes of depression and suicide among physicians are multifactorial and stem from stress at work, unhealthy coping mechanisms, and systemic barriers that make their jobs difficult to accomplish.

In the face of the country’s continuing economic problems and the continued tightening of the health industry belt, these anxieties will only increase in prevalence and severity. Doctors are trained to hide emotions and suppress pain. Therefore, the coming increased period of depression will be the most dangerous part of the grieving process for doctors.

Acceptance of the need for systemic and cultural change is the ultimate destination for physicians. Like the twin snakes that wrap around the caduceus staff, the systemic and cultural problems of medicine are inextricably linked – neither function independently of the other.

After decades of fighting and blaming the healthcare system, physicians will find it difficult to accept that they must play a critical role in solving the problems of cost and quality of medicine. In the culture of doctors, it will look like giving up.

But acceptance isn’t about feeling good about the loss. It is about recognizing the reality and deciding to move forward, despite the discomfort. Acceptance will require physicians to adopt new standards and more realistic expectations.

They will have to abandon the fee-for-service reimbursement model, which pushes them to over-test, overtreat and overcharge patients. They will need to collaborate and coordinate patient care to improve medical outcomes and reduce costs. And they will need to adopt more efficient and effective approaches to delivering health care.

Unlike the other stages of grief, acceptance is a choice. A painful one. But thanks to it, doctors can improve the health of patients, reduce the cost of medical care and begin to treat themselves.


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