The Business of Medicine

I believe moderation is the key to a healthy, well-balanced life.  Though medicine is a field that touts moderation for our patients, it paradoxically demands excessivity from our physicians- leading to depression, poor work-life balance, frustration, suicide, and burnout.

The relatively more recent increase in employed practices (i.e., owned by a corporation or hospital) means a loss of autonomy for physicians, complete with the “pressure to increase production.”  Protests made by physicians stating that patients cannot be distilled into “production units” are met with consistent pressures to see more patients in less time, double book, and increase the work day.

Many physicians are fed up.  Our work is undervalued, our time becomes less precious, our patients are given less time.  The tides are starting to change; physicians are beginning to speak up in larger numbers (which makes us harder to ignore), but it will take a movement before they listen.  Patient care quality is always more important than quantity.

I have met many physicians who are burned out, spoken with many young people disinterested in medicine, and see the longevity of my field shrinking.  We have got to continue to demand work-life balance, more time with our patients, and improve the quality of life for our colleagues.  The fact that we face a dire physician shortage upcoming dictates that we must start to improve the field now, so that we can attract and retain future physicians to the field.

I strongly believe that this includes improving maternity leave policies, pumping locations and availability, childcare coordination, and acceptance of females in the workplace.  It has been a “boy’s club” of sorts since the institution of the field, yet 2017 was the first year female students outnumbered male students matriculating into medical school.  As a field, we need to start listening to our female colleagues now, to understand what challenges must be overcome in the future for these upcoming female medical students.

We need to unionize; I am under the impression that physicians are not able to unionize in the political sense, but in the sense of coming together to improve quality of life for all physicians.

After all, for many fields, “It’s not personal; it’s business.”  Medicine, however, is inherently personal; we need to change the culture.  We need to advocate for ourselves, which is something not all physicians do well (very much including myself).  There are many CME offerings regarding the business of medicine; I believe this should be taught in medical school and all the way through residency.  If we are to win this game, we first need to learn the rules.

Next, we need to treat each other respectfully, from medical students to attendings, and everything in between.  This is a huge cultural change, but necessary if we expect to retain people in this field.  From my own experience, I can say that a young, blonde female physician never stops fighting for respect- true also for minority physicians (regardless of gender).  If we don’t treat each other with respect, how do we expect our patients and administration to respect us?

Finally (but not lastly), we need to demand quality patient care be rewarded.  I’m not talking about Press-Ganey scores (or other customer-satisfaction surveys), which are easily invalidated.  What I mean is specifically good patient care- which should be determined by us, the physicians.  We need to set the standards for measurement of quality in our field, rather than allowing non-clinical administrators to determine how to define what we do.

Let’s take medicine back.

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