Affording medical school, impossible, paying back college loans, impossible, paying all the administrative/paperwork labor costs in practice, impossible, relying on prompt payments from government on Medicare, impossible, care by government compliance standards, impossible.
Burnout = Probable
Blame Obamacare and Congress for the coming drought of doctors
When you go to the Internet or phone book today, there are hundreds of physicians listed in most urban areas. But in the next two decades, you can expect more difficulty finding a physician in your hometown — a major physician shortage is looming, thanks to Obamacare and Congress.
In the last year, I have seen many mid-career physicians leaving the practice of medicine. While the growth of mid-level hospital administrators has ballooned by nearly 3,000 percent in the last 30 years, fewer students are entering medical school. In fact, according to Compdata surveys, hospital administrators now account for a large proportion of the costs of healthcare.
The pending physician shortage will affect both primary care as well as numerous essential subspecialties. When I was in medical school, I was told that specialists, such as cardiologists, would be in abundance and I would not be able to get a job. My classmates and I were pushed towards jobs in primary care.
However, many of us chose to pursue our passions — for me, it was cardiovascular medicine. I have been a practicing cardiologist for almost 17 years now — I never had any issue with finding a job in my chosen field.
Based on a new report from the Association of American Medical Colleges, it is expected that we will see a shortfall of nearly 100,000 doctors by the year 2030. A closer look at the predictions show that we will have a shortage of 40,000 primary care physicians, as well as a shortage of nearly 60,000 physicians in specialties such as allergy and immunology, cardiology, gastroenterology, and infectious disease. In general surgery, the report predicts that there will be 30,000 fewer surgeons than are needed to provide care to those who need it.
Why Are Doctors Leaving Medicine?
A 2016 report from the Physicians Foundation found an alarming growth in burnout and dissatisfaction among practicing physicians — 47 percent of respondents in the survey indicated plans to “accelerate” their retirement and move into areas outside of clinical medicine.
The most common reason for leaving medicine included regulatory burdens and electronic health records. Nearly 63 percent indicated that they have negative feelings about the future of healthcare and only half of all physicians would actually recommend a career in medicine to their children. Many of my colleagues feel they have no voice and have no way to impact healthcare policy — even in their own institution.
As regulatory requirements and non-clinical tasks continue to mount, physicians are finding themselves spending less and less time with patients. According to 2016 research from the Annals of Internal Medicine, most doctors only spend 25 percent of their day engaging with patients — the bulk of the time is spent on non-clinical electronic and regulatory paperwork. In fact, for every hour of direct patient contact, physicians have an additional 2 hours of electronic paperwork.
Most of this is due to either mandatory electronic medical record coding (to help the hospital systems bill at the maximal levels) or due to government-mandated documentation (such as asking about gun use during office visits — most of which has never shown a survival or outcome benefit).
What Is the Solution?
These statistics should be incredibly troubling for all Americans seeking healthcare. With access already an issue in the healthcare system for many and more reforms on the way, we must do more to entice bright young minds to medicine—and retain those that are currently delivering care to millions of patients.
While the AAMC argues that the answer to averting a shortage lies in creating more training spots and allowing advanced practice nurses and physician assistants to do the work of trained physicians, the real answer to the pending crisis lies in Washington.
Congress must act to save healthcare. Years of Obamacare and the resulting increase in regulations applied to physicians have begun to erode the very core of medical care — the doctor-patient relationship. Physicians are now tasked with checking boxes and filling out forms rather than bonding with patients.
Congress has spent the first 6 months of this year simply posturing and grandstanding about healthcare rather than actually working on meaningful reform. Once again, no real physician input into the creation of a workable healthcare reform bill has been sought by those in Washington (reminiscent of how Obamacare was created). Those in Congress must listen and act now:
1. Limit Meaningless Electronic Paperwork
Currently doctors spend far too much time with electronic medical records. Electronic records, while touted to be a patient safety tool, are nothing more than a way for hospitals and healthcare systems to ensure that they are billing patients at the highest levels — capturing all possible charges. Physicians are forced to click through myriad pathways in the record in order to document their care and work and all of these pathways are carefully designed to maximize billing codes. Most doctors take home two or more hours of electronic documentation nightly in order to keep up with patient care loads.
We must streamline paperwork and balance documentation with patient care. Doctors should not be billers and coders for the healthcare system.
2. Remove Hospital Administrators from the Care Equation
In some institutions, there are more mid-level managers than physicians. These executives are not physicians and are not trained in the practice of medicine. Their primary focus is to increase market share for the healthcare system and to “manage” healthcare professionals by creating algorithms of care and regulations. Administrators will claim that their activities will help with quality improvement and patient safety. However, most of these individuals are highly compensated and I am not aware of any data that suggests their activities have ever been shown to improve patient outcomes. For most physicians, administrators are a mechanism for increasing cost of care.
Physicians should be part of the decision-making process in any healthcare system and should have a voice — currently there are very few physicians in the C-suite.
3. Remove Barriers to Patient Care
Nothing frustrates doctors more than not being able to provide care to patients. We must make healthcare more accessible and provide physicians with the resources they need to efficiently provide high-quality affordable care. We must promote the use of telemedicine and digital tools to enhance the doctor-patient interaction.
We must allow physicians and patients to build long term relationships and facilitate and promote engagement. No longer can we allow networks and insurers to dictate which doctor a patient can see — “If you like your doctor, you can keep your doctor.”
4. No Longer Allow Insurance Companies to Dictate Care
As a practicing physician, I spend a great deal of time battling with insurance companies over appropriate care for my patients. I find myself spending hours each week on the phone with an insurance company bureaucrat arguing that a particular test or therapy is indicated (even though these are supported by clinical guidelines) rather than caring for patients. We must not allow insurers to dictate how highly-trained physicians should care for their patients.
Insurers must abide by the practice guidelines and indications for tests and procedures that have been approved by major national organizations, such as the American College of Cardiology, for example.
UNODC
Interfima
In Russia, this is called ‘active measures’ and there have been several panels before congress providing testimony highlighting with evidence all the methods used by Russia. This type of political intrusion is part of the Russian hybrid warfare not only against the United States but other countries in Europe, Eastern Europe and NATO.
