by James D. Veltmeyer, MD
Do you know that America faces a physician shortage of up to 100,000 by the year 2030, according to the American Association of American Medical Colleges?
Are you aware that the majority of physicians would not recommend medicine as a career? Almost two-thirds are pessimistic about the future of their profession and 46% surveyed by the Physicians Foundation plan to change careers. One doctor, Ernest Brown of Washington, D.C., says there’s no “heart and soul” in medicine. “It’s all commodities and profit.”
A 2018 survey of over 8,000 physicians reported that 78% feel “burned out” and 40% screen positive for depression, according to the AMA. Even more alarming is the fact that one doctor commits suicide every day – the highest suicide rate of any profession. That’s 28 to 40 per 100,000 – more than twice the rate in th general population.
These are disturbing statistics and indicative of the deeper crisis facing American health care today. A great and noble profession—perhaps the noblest of all—is clearly on the ropes.
Physicians are trained to heal and cure, but, increasingly, that role is being overshadowed by government and insurance company rules, regulations, and red tape that take us away from our patients. Corporate health care – dominated by a handful of powerful and politically-connected hospital chains—has replaced the traditional doctor-patient centered practice. Doctors face countless hours buried in paperwork that heals no one and endless hours on the telephone, begging for the approval of medically-necessary treatment from faceless insurance company operatives. They are working longer days and nights and because of pathetically-low reimbursement rates ( especially from Medicare and Medicaid ) are forced to see more patients but spend less time with them.
They are saddled with huge medical school debts, the need to pay for malpractice insurance, high office rents, and bill collectors while insurance companies and hospitals siphon away more and more of their income. Unlike nurses, they have no union to fight for their interests.
One study in the American Journal of Emergency Medicine found that emergency room doctors spend 43% of their time entering electronic records, but only 28% with patients. The Direct Primary Care Coalition estimates that 40% of all primary care revenue goes to claims processing and profit for insurance companies. It certainly isn’t going to doctors, contrary to popular belief. Incredible as it may sound, the average salary for physicians doesn’t break $60,000 a year until after their fifth year of practice!
The problem has become so serious that thousands of doctors are leaving or considering leaving the profession. This has worsened since the arrival of Obamacare with its mandated Electronic Health Records ( EHR ) requirement.
With a pricetag of $27 billion, the EHR mandate has resulted in many small medical practices closing up and physicians either taking early retirements or selling out to corporate medical or hospital groups in order to afford the cost of converting to electronic records. Doctors are literally extorted to go “paperless”by having their Medicare payments cut if they do not. 66% of physicians say EHR has reduced the amount of time they can be with their patients.
That’s just one example.
Let’s take a look at the coding monstrosity. In the 1980s, Medicare imposed price controls ( i.e., socialism ) on doctors who treated the elderly. The controls forced us to use complicated coding classifications to submit our claims to the government. The codes were tied to a fee schedule. Hospitals were required to submit to a similar coding system. This process has not only forced doctors to try to fit round pegs into square holes, consuming vast amounts of time that could be better dedicated to patients, but it incentivized hospitals to submit as many diagnostic codes as possible to the government in order to increase the “Medicare payday.”
Private insurers soon followed the Medicare example and imposed coding regulations on physicians. By making their income dependent on how much they could bill the insurance companies, many doctors were forced to focus an inordinate amount of time on navigating codes to generate revenue for their practices. Many medical practices actually employ coding specialists and maximizing profits from codes has become something of a cottage industry in some places.
Next, we had the rise of HMOs, PPOs, and various sorts of networks which the insurance companies designed to ration care. Physicians, their staffs, and patients run in circles trying to figure out if a certain doctor or hospital is “within the network” or not, often receiving contradictory information from theinsurance company and the medical provider. Often, a patient will be assured that a doctor is “in network” only to find out later that wasn’t the case when a big unexpected bill arrives in the mail.
Then we have the “protocols,” certain pre-determined treatment standards that often do not apply to the distinct health needs of a specific individual. Again, another example of a government-imposed “one-size fits all” approach that treats us as groups, not individuals with unique needs and requirements. Doctors can face financial retribution if they don’t follow the “protocols,” even if their medical judgment dictates another form of treatment. And, of course, any deviation from the “diktat” must be thoroughly documented to the appropriate health care overlord.
Facing this type of straight-jacket regulatory burden imposed by government and private insurers, is it any wonder almost half of physicians nationwide are actively looking to retire still in their prime or leave the medical field altogether?
A recent poll showed that two-thirds of doctors said “government involvement is most to blame for current problems.” And, once the exodus starts, the physician shortage matched with the increased demand triggered by schemes like Bernie Sanders’ “Medicare for All” single-payer system ( as well as health care for illegal immigrants ) will lead to galloping increases in health care costs and taxes which will make today’s levels look tame by comparison. Worst of all, it will lead to rationing and long lines to see your doctor or receive a medical procedure.
The crisis of American health care is at hand. If we don’t want to face a dire future of medicine without doctors, we must free physicians from the strangling octopus of government and corporate control so that we can get back to doing the job we were trained to do: healing the sick and saving lives. No government bureaucrat or insurance company executive can do that.
Dr. James Veltmeyer is a prominent La Jolla physician voted “Top Doctor” in San Diego County in 2012, 2014, 2016 and 2017. Dr. Veltmeyer can be reached at firstname.lastname@example.org