Growing up, I knew I wanted to be a doctor. I was enthralled with the idea that I might be called upon at a beckoning moment to perform a life-saving surgery for a child devastated in a car accident, or have the privilege of counseling members of my community about how best to deal with that nagging back pain or shed those extra pounds. To me, medicine presented the ultimate sacrifice: doctors made a profession out of putting others first.
When then candidate Barack Obama campaigned on the promise to extend health coverage to over 90 percent of Americans in 2008, the budding doctor in me was thrilled! This would mean that fewer patients would be denied care because they were unable to pay. I was no stranger to the horror stories. As a medical student, I had volunteered in a non-profit clinic that saw the very patients that other doctors would cast away. I didn't blame those doctors: after all, a doctor's gotta eat, right? I justified their decisions as the unfortunate circumstances of a flawed health system.
But when President Barack Obama began the odyssey of turning candidate Obama's campaign plans into reality, I was forced to think again. I was stunned when the American Medical Association -- the organization that was supposed to represent me as a young physician-in-training, and the voice of American doctors -- attempted to sabotage the plans early last June. A five-minute consultation with Wikipedia taught me that the AMA has long been a great defender of the "status quo" in health care, even credited with inventing the term "socialized medicine" in the early 1900s.
While the AMA eventually ended up supporting a watered-down version of health reform, a recent poll commissioned by Investors Business Daily taken before the passing of the law found that 65 percent of American physicians were opposed to the legislation, and a whopping 45 percent of doctors would consider quitting if reform passed. And since its passing, many doctors have publicly announced that they will leave their practices when the bulwark of reform policy takes effect in 2014. Several, including Dr. David Janda, a renowned orthopedic surgeon argue that they cannot practice under the new system and maintain the Hippocratic oath that every doctor takes upon graduating medical school, especially the clause, "and first, do no harm."
Honestly, Dr. Janda? You're a smart guy: when you oppose a transformation that would extend access to care to 32 million Americans, aren't you doing harm?
We need to be honest with ourselves: what are we afraid of? Are we afraid that perhaps some sort of "government panel" is going to tell us how to do our jobs? In the old regime, health insurance companies did that already by arbitrarily disallowing Americans with pre-existing conditions access to care and by prohibiting physicians from billing certain procedures and treatments depending on a patient's particular coverage. Were we afraid of change in general? Perhaps, but most doctors agreed that some change was needed.
And what about the money? As of May of 2009, according to Forbes magazine, the top nine highest paying jobs in America all belonged to doctors (incidentally, rounding out the top 10 was "chief executive"; I haven't heard anyone barking about doctors' bonuses), and that's not going to change anytime soon.Tthis new bill is forecasted to add 32 million more patients to our roles. Even if it did take a surgeon's average salary down a notch from $206,000 plus per year, s/he'd still have enough for the necessities, like, say, healthcare, right?
It's time that doctors got with the diagnosis. According to a Gallup poll taken soon after the passing of health reform, the American people, our patients whose interests we've sworn to serve, (see Hippocratic Oath: "That I will exercise my art solely for the good of my patients") wanted change. If medicine presents the ultimate sacrifice, and doctors make a profession out of putting others first, it's time we step up and give it to them.
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Many docs also have a chronic stress problem. We should draw more doctors into primary care by focusing on quality of life rather than just salary (of course you still need a decent base salary). Regular time off, a set annual salary with bonuses for good outcomes (instead of the old fee-for-service treadmill), flexible hours (as far as possible), learning and outreach opportunities, seamlessly integrated technology for case notes and patient records, even excellent on-site food or places to take a break and go for a walk between rounds or cases... I'd wager that quality of life and work environment perks like these would help catch quite a few new primary care physicians.
"A five-minute consultation with Wikipedia taught me that the AMA has long been a great defender of the "status quo" in health care, even credited with inventing the term "socialized medicine" in the early 1900s."
Spend a few hours reading Overtreated: Why Too Much Medicine is Making Us Sicker, Who Killed Healthcare, Market Driven Health Care, and Worried Sick and you will be able to expand the list of those holding the status quo.
Do we really have the courage to change the system beyond the framework bill passes a couple weeks ago?