(Opinion) Retrieving the joy in medicine
Our current healthcare system benefits hospitals and corporations at the expense of physicians and patients
Opening the door to one of my exam rooms, a 4-year-old girl stood before me beaming with excitement, having just heard her baby sister’s heartbeat. As I measured her mom’s belly, I said to her, “I sure hope your sister comes out as healthy and as strong and as smart and as kind as you.” To which she responded, “And, and, and … no cavities,” pulling back her lips to show me her white teeth. My days in the office were filled with these light moments.
In recent years, it concerns me doctors are working in a healthcare system that does not allow for these special moments; a system that too often benefits hospitals, health insurance companies, pharmaceutical and device corporations at the expense of physicians and patients. This has happened with the rise of a huge new industry that provides healthcare at a profit.
Healthcare delivery and physician practices have always been based on a devotion to public good. Services were provided by nonprofit institutions and individual practitioners.
In 2020, for the first time ever, less than half of doctors work in physician-owned settings. More than 300,000 U.S. practicing physi cians are employed by hospitals and 122,000 are employed by corporations.
My private OB-GYN practice finally joined the Concord Hospital Medical Group 10 years ago when we could no longer pay our expenses. Our annual medical malpractice insurance premiums rose to $75,000 per physician, although we had not been sued in over 25 years. We struggled to meet the costs of full benefits for our office staff as health insurance increased.
As physicians, we were not making enough money to recruit a young, well-trained OB-GYN surgeon to our practice to replace our older partner who was retiring. Finally, we were forced to comply with a federal regulation which required that our practice adopt electronic medical records. The initial cost would be $35,000 per provider. At the time, we had six physicians, two nurse practitioners and two physician assistants, which would have resulted in a cost of $350,000.
There is a sacred unwritten social contract between physicians and society. We sacrifice a good part of our youth and young adulthood to train and learn the skills to provide for the health needs of patients and society. For that sacrifice, we hope to work in a supportive healthcare system that is not distorted by its own entrepreneurial ends.
This social contract appears to have been violated by the “corporatization” of American healthcare.
Today, most managers and decision-makers in healthcare are not physicians. They have never cared for a patient or a community. Success for these non-physicians is profit measured in revenue produced per visit, procedure or clinical encounter. Many do not know the importance of the patient-physician relationship.
Administrative tasks for providers have proliferated. They are faced with insurance authorizations, a 20-minute patient visit schedule and documentation of the encounter on a slow, clumsy electronic medical record. Many go home with their laptops to record patient visits at night after putting their children to bed.
Physicians know electronic medical records do not improve patient care, do not make us better providers. Computerized medical records only make us better at billing, resulting in greater revenue for the healthcare system. Physician stress and burnout is coming from a lack of joy in the dysfunction of our health system.
Remarkably, the U.S. is the only developed country in the world that has not determined that healthcare is a fundamental human right. In 13 other highly developed countries, universal healthcare exists at half the cost of healthcare in our country. Healthcare has be come the largest industry in the U.S. — $4.3 trillion in 2021, which is 18.8 percent of the GDP, yet life expectancy is only 76.1 years, lower than the 13 other developed countries. Our population has a higher prevalence of chronic conditions, and we have insufficient access to care.
The corporatization of American medicine has resulted in a lucrative consolidated system of hospitals with administrators making two to five times what physicians are paid. We have highly profitable insurance companies, pharmaceutical corporations raking in billions of dollars and many wealthy consultants.
A few years ago, a very bright, redheaded 6-year-old girl accompanying her mom in my office announced that she was planning to become a doctor just like me because she wanted to deliver babies. I told her that would be wonderful, that maybe she would come back and practice with me. She replied, “I don’t think so. I think you will be dead!”
No doubt, she is right. My hope is that she and her young physician colleagues might re-create a healthcare system in which the joy of caring and being cared for remain alive.
Dr. Oge Young is a retired obstetrician and gynecologist who practiced in Concord for 35 years. He is the past president of the NH Medical Society.