The Forgotten Physician
Debates about health care tend to revolve around how to get the most affordable care to the most people. But in determining what is best for patients, the well-being of physicians matters too.
Note: Below is the first post in the section “Longform Side Effects,” which features longer policy briefings. This one is excerpted from a Summer 2019 piece published in National Affairs. It traces the ways in which doctors have been eclipsed and, in some ways, crushed by insurers, EHR manufacturers, and the federal government. It also proposes a series of policy solutions.
America's doctors are in a bind. A variety of policy changes in recent decades have created new pressures for the profession…Nearly 80% report symptoms of "physician burnout," a problem that has become a catchphrase in medical journals, and 62% are pessimistic about the future of medicine. The profession has one of the highest rates of suicide in the U.S. (at an average of up to 400 a year, it's more than double the rate of the general population), and multiple studies have demonstrated that doctors suffering from burnout are far more likely to make major medical errors.
While drug companies, insurers, and lawmakers all have a voice in the policymaking process, groups representing doctors and medical schools attract far less attention, at least in part because doctors are still doing well by many measures (though their incomes have steadily declined or stagnated for decades). Though their work can be draining, their plight might not seem especially wretched when compared to that of low-income patients. But high-quality health services depend upon high-quality providers, and in discussions of quality and value in medicine, it is vital to remember that both quality and value are grounded in the doctor-patient relationship. Our policies should reflect that, when determining what is best for patients, the health and well-being of physicians matter too.
Ronald Dworkin has written in these pages about the evolving identity of the American physician, from gentleman-doctor to benefactor to technician to scientist. In recent years, a combination of new laws and technologies have again redefined the doctor, this time as a sort of data-entry clerk. As Dr. Robert Wachter and health-policy consultant Jeff Goldsmith put it in the Harvard Business Review, "Only in health care, it seems, could we find a way to 'automate' that ended up adding staff and costs!"
Read more at National Affairs.