Tuesday, April 15, 2014

Physicians Under Siege

According to physicians, the medical profession is breaking down. Obamacare is addressing a real problem, but it has not solved it. It is making it worse.

We might end up living in a nation where everyone has substandard health insurance, without enough physicians to treat them.

Some medical specialists—like cosmetic surgeons—are doing just fine, and most physicians are earning a good living, but primary care physicians are fleeing the profession.

Outlining the problem on the Daily Beast (via Maggie’s Farm), internist Daniela Drake explains that 90% of physicians advise young people against joining the field. She adds that physicians are especially prone to commit suicide.

In her words:


Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retire as quickly as possible. Physician MBA programs—that promise doctors a way into management—are flourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.

Why would there be a war on physicians? Perhaps, it’s part of the war on privilege and the war on success. We can’t allow any single group of individuals to do that much better than the rest… unless, of course, they funnel large amounts of money to the right politicians.

Physicians feel that they are drowning in insurance forms and regulatory burdens. So many different insurance forms means that physicians or their staff must spend an inordinate amount of time doing administrative work.

It’s not just that patients pay through higher insurance premiums, but they also pay when physicians do not have the time or the energy to do their best work for each of them.

Of course, Obamacare has not solved the problem. It has not mandated a unified insurance system, but, as Drake points out: “has codified this broken system into law.”

Drake is too kind to point out that Obamacare also does not rein in the threat of malpractice.

If you were a physician, how would you feel if you knew that your decisions were going to be second-guessed by trial lawyers? Does the word “demoralized” come to mind?

How bad is it? Drake explains:

But the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” list continues to lengthen. A stunning and unmanageable number of forms—often illegible—show up daily on a physician’s desk needing to be signed. Reams of lab results, refill requests, emails, and callbacks pop up continually on the computer screen. Calls to plead with insurance companies are peppered throughout the day. Every decision carries with it an implied threat of malpractice litigation. Failing to attend to these things brings prompt disciplining or patient complaint. And mercilessly, all of these tasks have to be done on the exhausted doctor’s personal time.

In many ways, physicians have lost the battle to the trial lawyers. The threat of malpractice, the need to placate patients so that they do not sue, has contributed mightily to the problem.  Yet, Drake does not mention the role of lawyers in producing the current state of affairs.

But, how else to explain the fact that the leaders of the profession believe that physicians need to be subjected to extra testing, to place their professional competence beyond question.

If the medical profession has seen itself defined by a media narrative that portrays doctors as corrupt, a threat to everyone’s health, who benefits from that narrative?  Trial lawyers. If the nation believes that physicians are error-prone, juries are more likely to reward the victims of such supposed errors.

Drake explains how the narrative has been crafted:

Certainly, the relentlessly negative press coverage of physicians sets the tone. “There’s a media narrative that blames physicians for things the doctor has no control over,” says Kevin Pho, MD, an internist with a popular blog where physicians often vent their frustrations. Indeed, in the popular press recently doctors have been held responsible for everything from the wheelchair-unfriendly furniture to lab fees for pap smears.

The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations. Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands.

Medicine is over-regulated because some people believe that physicians cannot be truly caring if they are in it for profit. If their interests are venal, not godly, they need to be punished for doing so well.

Considering how bad it is and how much worse it’s going to get, it’s becoming more and more difficult to deny the fact that Obamacare is merely a prelude to a government take-over of the medical system.

Of course, the proponents of a single-payer system now have to explain the looming failure of Obamacare. They will have to explain whether bureaucrats, not being motivated by profit, can ever get anything right.


Sam L. said...


And their explanations will be lies.

Dennis said...

I think we need an Affordable Litigation Act. This because we have become a very litigious society where citizens can suffer all kinds of legal inequities and there are so many laws, some informed and others not, that no one can help from breaking the law.
Fees should be tightly controlled. All lawyers offices should have to file a myriad of forms with the federal government. Lawyer's actions should be administered by a board that controls whether or nor they can take a case or not. Any lawyer that does not meet the government's directives loses their license.
The same stricture that we now have placed on doctors should be levied on lawyers and anyone associated with the legal system. Everyone in the legal profession needs to subjected to malpractice.
I suspect that if we subjected the legal system to what the legal systems wants to subject everyone else we would see a quick change in the government and the size of that government. The ALA would make for a better legal profession.

Stuart Schneiderman said...

I agree entirely. Unfortunately, lawyers make the laws and they make them to advantage lawyers. Or, as the old saying goes, the inmates are running the asylum.

Anonymous said...

Why does this country keep voting for and empowering leftists? How do we get a Biden, Obama, Pelosi, Boxer, and all the others. It just depresses me no end and it seems we cannot stop it. My neighbor's wife told me after the election that she could not vote for Republicans because they wanted to "ban contraception". I wanted to hit my head against the nearest wall. What hope is there with more and more people like this? If they cannot understand that issue what is the chance they can understand the statist attack on doctors?

Lastango said...

I imagine the Left and its associated centralizers in government will explain the failure of nationalized health care the same way they viewed the fall of the Soviet Union: as communism done wrong. The cure would have been more, better, purer Marxism, imposed over a much longer period to give it a chance to work.

Anonymous said...

Dennis: Spot on. And the reason it won't happen is in Stuart's response. Lawyers are out of control in America. The ACA could've created some relief, but didn't. Nary a word. It's frightening.

As for the subject if the original post, I'm not sure I have a ton of sympathy. We've been talking about gluts and shortages of medical professionals for decades. Yet I also remember one of Milton Friedman's famous lines: "The American a Medical Association is perhaps the strongest trade union in the United States" by controlling admissions to medical schools through approval and accreditation (Capitalism and a Freedom, Chapter 9, 1962).


Dennis said...

Lastango, Both the Plymouth Plantation and the Jamestown settlements almost failed because of a form of communism, communalism ergo the commonality of the term "commonwealth." It was only when property rights were recognized and implemented that they began to prosper. Sadly, we will always have people who believe they are better people and if only they can control everyone it will all work out despite centuries of failures.

I wrote much of that "tongue in cheek." There is no profession more dangerous to the freedom and liberty of a nation than the legal profession. Doctors may make mistakes, in many cases because we are unique individuals, but they are not likely to enslave us under the guise of the "rule of law."
There is not one dictatorship that does not function under the "rule of Law." One can always tell when the "rule of law" has lost its importance when the main law enforcement organization is actively not enforcing some laws and enforcing those that fit their agenda. Hitler, Mao and Stalin all used the "rule of law."
Once a country and its leaders begin to believe that the law is what they make it then we are on our way to dictatorship. "Due Process quickly becomes the money due in the process and a way to punish those in opposition.
The agencies of government that were established to aid its citizens is now used as a political tool to destroy those very same citizens.
If those citizens begin to realize how truly dangerous the legal profession has become and doesn't start electing people who will severely limit lawyers then we are doomed to death by a government that is of, for and by the lawyer. There are some in the legal profession that are starting to recognize that danger, but whether it is soon enough to stop our slide into dictatorship remains to be seen.