Sean Khozin, MD, MPH

In the past few weeks, CNN has done a great job presenting the real views of physicians about the healthcare system. In fact, today I was on CNN with Heidi Collins speaking about my medical practice and healthcare reform (will post the video when it’s up).

One of the recent commentaries on CNN is an interesting account of Dr. Vance Harris’s frustrations as a primary care physician. I had published an earlier piece by Dr. Harris on my blog last year called “Not in a Million Years.”

After venting out a bit, Dr. Harris ends his commentary with:

Good luck recruiting primary care specialists when we are projected to be short 39,000 by 2020, according to the American Academy of Family Physicians. And nearly half of all doctors surveyed by the Physicians’ Foundation have said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.

I know this is true because I am struggling to find a primary care doctor to take care of my wife and myself. Now that is ironic. Anyone know who is taking new patients in California?

Dr. Harris initially posted his commentary on Sermo and was met with great words of moral support from his colleagues.

“Some people regard private enterprise as a predatory tiger to be shot. Others look on it as a cow they can milk. Not enough people see it as a healthy horse, pulling a sturdy wagon. Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy, its inherent virtue is the equal sharing of misery.”

Sir Winston Leonard Spencer Churchill

Matthias G. Muenzer, MD, a gynecologist in Boston, recently presented the following 3 items as a poll to a group of physicians on Sermo about what all physicians have in common, regardless of their political or personal views. Within a few days, 304 physicians responded, 95% of whom strongly agreed with his vivid assessment:

• We want to serve our patients, not insurance companies nor the government
• We want to practice medicine independently according to our knowledge and judgment, and not be told what to do by insurance companies nor by the government
• We want to make a living on our own, we do not want to be given what insurance companies and government deem “appropriate” for us

The New Yorker; May 5, 2008

The following is a wonderfully written and refreshingly honest essay by Vance Harris, MD; an excellent and dedicated family physician with 20 years of clinical experience.

Not in a million years would I have anticipated regretting my career choice. At an alarming rate our physicians are being burned out by a system which cares little for their hardships and continues to impose impossible regulations and layered puzzles upon those physicians who still care enough to try.

Physicians are just about ready to throw in the towel. There is a tremendous sense of betrayal as we see the results of years of giving in to government bureaucrats and CEO’s of health insurance companies, so that the national budget might somehow be balanced and private industry might be able to pass on the savings to the consumer. Needless to say, the national debt is not balanced. Big Blues have not passed on large savings to customers but they do increase bonuses for management.

I finish up 20 years in family practice. I care for 3200 patients. Over the last 19 of my 20 years of practice I cheerfully answered questions about whether I would do it again. Still enjoying the wonder of constantly learning along with the opportunity to help people, I always answered yes in the most affirmative manner. Never in the last 20 years have I seriously thought that I could have made another decision.

It saddens me now that my lifelong enjoyment and enthusiasm has all but died. Don’t get me wrong, I still think it a great blessing to help people. I take great personal satisfaction in providing excellent care to patients. I consider it a great honor and a sacred obligation.

I never chose medicine to make a lot of money. Now that I’ve been in practice for over 20 years, I look back with a sense of betrayal. I have watched reimbursement shrink to levels of 15 years ago. Overhead has more than doubled. Providers of equipment and supplies think it their right to charge more money each year. Apparently they didn’t get the memo from Medicare or Blue Shield.

When fees shrunk, most of us took shorter lunch periods and extended our day an hour. What followed were shorter vacations as we struggled to keep up with paperwork. Having stretched the day to our physical limit most of us were forced to take on more patients per hour. Even with all of these variables being tuned in, we now find ourselves unable to continue. I am exhausted all the time. I work 12 to 14 hour days and come in on weekends 4-6 hours.

Arriving to an age where your own mortality is staring back in the mirror, you reflect. I have worked 12-14 hour days my whole career. I haven’t liked working those hours. My motivation for long days has ended up being an economical necessity. One of the unintended benefits of a system that leaves me so little time is that I have few interests outside medicine. I use to have many.

Now I find myself a bit bitter, having worked the bulk of my life providing care for others only to find that I will have very little left at the end of my career to provide for my needs. I am angry that government has tried to solve budget problems on the backs of the providers. We are not going to solve the nation’s health-care problems by working for free.

I think it only fair to inform America that they might want to plan ahead. Plan for a time when the bulk of your medical care will come from foreign graduate and foreign trained doctors living in this country, willing to work lower wages. Plan on less time with your doctor. Plan on five minutes to get one problem taken care of, returning many times as you address others individually. Plan on few prior authorizations as your physician will not have time. Plan on filling out most of those forms yourself and then waiting for the physician. Plan on calling the office only to find people who have been overworked and overstressed by hundreds of patients who have little patience or understanding of how difficult this job is. Plan on not getting the most understanding people on the other end of the line as you call for medications before you go on vacation.

It saddens me to say that I regret my decision at becoming a doctor. For the first time in 20 years I note this statement to be true. There is a cold storm brewing. For 20 years I’ve never felt this way. I wonder with whom we will fill the need for future physicians. Plan not to have the kind of understanding and sympathy and empathy that you have felt in years past. Plan ahead for a very impersonal and rushed visit during which time the true nature of your problems will probably never be addressed and issues just under the surface will never be explored.

Like all of you tomorrow I will head off to work helping to heal others, listening to and empathizing with many wonderful people. This is still the most amazing job in the world.

“The significant problems we face cannot be solved at the same level of thinking we were at when we created them”
Albert Einstein

We need an innovative paradigm, a disruptive attitude, and a new way of thinking to heal our ailing healthcare system.