As a physician leader, I recognize the public needs to be educated as to what's happening in healthcare, for the crisis we're experiencing impacts everyone. For instance, there are now ten non-clinical administrators for every physician in this country. This means a greater portion of every healthcare dollar goes to paying for staff who have
nothing to do with direct patient care. Yet, these administrators dictate and control much of what physicians can and must do (from time spent with each patient to supervisory responsibilities for others in the healthcare team with an unfair burden of liability). Physicians are forced to see more patients in less time, many of whom are sicker than ten years ago and on more medications. Despite mounting and exhausting obstacles to excellent, compassionate care, physicians strive to care for people every day according to our high standards,
placing patients first.
As medical care becomes increasingly complex with the epidemic of obesity, diabetes, cancer, and many other chronic illnesses, the
standard of care has been dropping, with an explosion of non-physician team members with significantly less training than physicians being given clinical responsibilities for which they are not adequately trained. Although they have an important role to play as valued members of the healthcare team, in many settings they simply don't have adequate supervision. And while the growth in physician numbers has been stunted for over forty years (
see graph below) and there are not enough residency spots for every graduating, well-trained medical student, the numbers of non-clinical (
and very expensive!) administrators and non-physician team members continue to rise exponentially.
In 2017, physicians have less and less control with more responsibility and liability. No wonder physician burnout is at an all-time high.
What's truly remarkable is that it isn't higher, and I believe that is due to our high levels of resilience, commitment, and dedication to our profession and to our patients. Although this poem is different from most of what I typically post here, I was inspired to write it after becoming a patient and experiencing the "other side" of healthcare. Like most physicians I know, I long for the day when healthcare returns to
placing patient care at the center of all we do, with the
high standards of care that are
a foundational part of physician training in medical school, medical residency training, and medical fellowships.
Here's my poem, written to inspire my colleagues to say, enough is enough, and stand up for patients and a high standard of care. Yes, this takes courage, and it is precisely what's needed. (An explanation of the many acronyms is included below.)
A New Lexicon for
Physicians
by: Amaryllis Sánchez Wohlever, MD
Imagine if PQRS
and ICD-10,
EHRs and the looming MACRA,
MIPS and APMs
all stood for something else,
like measures of meaning and care
aligned with what patients need
and with who we are:
true servants at heart.
These sly abbreviations
champion some other dream
that hijacked our profession
and disrupts the healthcare team.
But we refuse to abbreviate care,
cut corners, detach,
and forget who we are.
I dream of autonomy
and its friend, common sense,
and that sacred relationship we all still defend.
I dream of scaling that fence
built by faceless EHRs
that split
my vocation … from … the human person
I vowed to assist.
So why not rename
the despised click-click-clicker
that keeps us a
– u – t – o – m – a – t – e - d
and every misnomer that traps us
‘til we’re duly subordinated.
Here’s a new dictionary of medical terms
born of our noble dream — not theirs.
Physician, Arise! This is my earnest plea.
Quit playing someone else’s maddening game.
Rules that hinder, intrude, disrespect, and inflame.
Success is, now, L I S T E N — up to you and me.
Mandates and regulations keep choking.
Administrators blindly add more stress.
Care suffers while we smolder, too busy to voice our distress.
Remember your Hippocratic Oath?
Anyone else take that pledge?
We know what matters most.
Our patients are first.
Make another vow, for the future’s at stake.
It’s time to stand up; we must stay wide awake.
Patients deserve much less haste, something better.
Sacred relationships front and center — forever.
I believe in you,
Colleague. You’re ready!
Dare to speak your truth and to STAND!
10 thousand more voices all over this land.
A new future requires a return to the basics.
Practice your craft. We cannot be complacent.
Make everything count for you and your patient.
It is time to heal our profession.
Let’s scrub in and start healing our nation.
Let us all work together to see
Everyone’s
Health
Restored.
Including our own.
Physician colleagues, stand up!
Dr Mari
PQRS: Physician Quality Reporting System
ICD-10: International Classification of Diseases and Related Health Problems
EHR: electronic health records
MACRA: Medicare Access and CHIP Reauthorization Act of 2015
CHIP: Children's Health Insurance Program
MIPS: Merit-based Payment Incentive System
APM: Advance Payment Model
