THE BLOG
08/28/2009 05:12 am ET Updated Nov 17, 2011

Is Health Care Reform Possible Without Caring For The Providers?

There is much talk about health care reform. Insurance for all. Better care for everyone. More available care. Cost control. The ideals on the agenda should make any American proud. Yet, there is an underlying erosion of the spirit of doctors that is not being noticed, and it should be. Because if it is not, then the "ideal" reform program will be provided by burned out doctors and algorithm slaves who have to cave to time and money pressures to provide "evidence-based" solutions that have little applicability to real-life situations. Everyone wants doctors to bear the economic and social brunt of the health care disaster that currently exists, but I would caution against that. There are conversations that are too controversial to be currently aired that will likely lead to a brain drain and an influx of "yes-men" who are corporate America's dream, and health care's nightmares. Here are some of these conversations.

Firstly, most people do not ask relevant questions when it comes to "evidence-based medicine." In principle, and in general, this is a great start to explore how people should be medically treated, but it is rarely the best solution for any given person. "Evidence-based practices" are derived at their "best" from double-blind placebo controlled trials that usually relate to a specific kind of person. For example, people who are excluded from the trial may not represent the general population. In fact, one study found that less than half of the patients undergoing treatment in a general practice would have been included in the hypertension trials. So when Joe Schmo enters your office, you often have little "actual" evidence and have to "overlook" this to think of his particular case. Add to this the time pressures of doctors and nurses -- being paid less, being regulated more -- and no matter how angry you are about doctors needing to care more and think more carefully about a case, it will simply not be possible. I have found this to be the case in many of my referrals to standard medical practices, and many of my colleagues would concur.

Another conversation that idealists like to have about socialized medicine is that doctors should feel obligated to provide great care. And I concur that this is the best ideal and one we should all strive toward. But what happens when we lower the bar for great care? What happens when we ignore physician and nurse burnout and expect health care workers to "suck it up?" What you're left with is a less than competent doctor who is a psychological victim of burnout. A recent article in the Archives of Surgery reported that as many as 38 percent of surgeons are burned out. When will it be time to pay attention to statistics like this? And why does reform not address rewarding doctors more explicitly? "Delayed gratification" is one of the most prominent reasons for burnout. Simply cutting costs and payment to doctors is shortsighted, idealistic, ignoring a real problem, and not going to actually improve the health care crisis we are in. Those doctors who are willing to "suck it up" may themselves be burned out, so that is who will be caring for you. In addition, they may not actually see other solutions for they what to do for a career and settle for what they can get. Trust me: you do not want a person who feels this way treating you, let alone cutting into you. But if we continue to ignore the value and needs of doctors, this is the person you will meet as your doctor.

Doctors are expected to care less about finances than many other professionals. Somehow lawyers, hedge-fund managers, and most other professions face less of a wagging finger when they care about the amount of money they make. Doctors, on the other hand, are expected to be philanthropic and caring and by inference, less concerned about their bank accounts. I can tell you that there are a significant number of extremely well-trained doctors who care a lot about their bank accounts, and they are also very caring and good about what they offer. But I can also tell you that there are an increasing number of doctors who have an eye out for any exit that will get them out of what often feels like an unfair trade-off for the number of years of education, emotional drain, intensity and amount of time spent on any given day at work. Not everybody feels this way. But the current mentality of socialized medicine will usher in a new kind of doctor and usher out many talented, gifted and important physicians who could have made amazing contributions to health care. You simply cannot treat health care staff as "manpower" without recognizing the kind of talent and thinking that we need to grow. Blind health care reform without considering physician financial needs is therefore very shortsighted.

If these burnout facts seem inconsequential to you, then consider the following: "The overall physician suicide rate cited by most studies has been between 28 and 40 per 100,000, compared with the overall rate in the general population of 12.3 per 100,000 Overall, then, physicians are more than twice as likely as the general population to kill themselves. Each year, it would take the equivalent of 1 to 2 average-sized graduating classes of medical school to replace the number of physicians who kill themselves. This rate appears higher than among other professionals... Female physicians appear to be especially vulnerable. Suicide rates for women physicians are approximately four times that of women in the general population..." (http://www.medscape.com/viewarticle/410643_2)

We do need a better health care system. And the ideals for which we strive are very worthwhile. Still, I think that striving for these ideals without considering the humanity of health care workers and their need for rewards is short-sighted and will lead to less innovative "yes-men" who suffer from a lack of drive and motivation to care about the people under their medical care, in large part, because they will be unable to care for themselves.