From loss of autonomy to artificial intelligence, six physicians joined Becker's to discuss the biggest threats to the physician workforce.
Editor's note: These responses were edited lightly for clarity and length.
Richard Goldstein, MD. Colon and Rectal Surgeon at Center for Colon and Rectal Health (Langhorne, Pa.): The biggest threat to physicians is the corporatization of healthcare. There is essentially no practical difference, from the physician's perspective, between private equity groups or hospital chains, whether for-profit or non-profit. For a few physicians the pay is extraordinary, for most it is not. The pressure to continually see more patients, or perform more procedures, is never-ending.
This was a Faustian bargain. Physicians have lost their authority, their autonomy, and their prestige, becoming widgets in a machine.Yet, they still retain personal liability for outcomes. They are also usually bound by outrageous restrictive covenants that force a geographic relocation in order to change employers. Some physicians are even ignorant enough to sign a restrictive covenant that goes into effect even when their employer lays them off or fires them. Physicians often stay in a poor employment situation so as not to uproot their families.
Michael Gomez, MD. NICU Medical Director of Pediatrix Medical Group (Long Branch, N.J.): Lack of control and autonomy.
- High standards of performance raising costs, creating shortages of qualified clinicians, risks, administrative burdens, time practicing versus being regulated, rapidly evolving changes all contributing to the feeling of no control and autonomy
- Not being properly trained to manage all the 'strains' of medicine leading to disaffection and burnout
- Health policies evolving without significant input from physicians making physicians feel inconsequential
Roger Kaldaway, MD. Owner and CEO of Milford-Franklin Eye Center (Milford, Mass.): Physicians are facing a crisis of burnout fueled by an overwhelming administrative burden. The ever-increasing demands of documentation, regulatory compliance and EHR management are pulling them away from what they love most: patient care. The pressures of maintaining high patient satisfaction, navigating complex insurance systems and the constant threat of litigation only exacerbate the problem. To make matters worse, Medicare's declining reimbursement rates, coupled with rising inflation, are making it increasingly difficult for physicians to sustain their practices.
Javier Marull, MD. Associate Professor in the Department of Anesthesiology and Pain Management at UT Southwestern Medical Center (Dallas): Medicine has always been about patients, doctors and the relationships between them. For physicians, the ability to make decisions based on their knowledge of each patient has always been important to the profession. However, the landscape of healthcare is shifting. While the main mission of helping patients remains the same, the way physicians work is changing, especially in large academic centers where collaboration, protocols, and metrics play an increasingly important role.
Many physicians have experienced these changes firsthand. We have moved from a more independent practice of medicine to one that relies on teamwork and system based care. This shift has brought many benefits, mainly when it comes to improving patient outcomes. Working together with a diverse team, nurses, specialists, and administrators allows us to provide more comprehensive, coordinated care. And the use of evidence based protocols helps ensure that patients receive the best possible treatment. However, these changes also come with challenges, particularly when it comes to maintaining a sense of autonomy. As physicians, we have been trained to trust our clinical judgment, to make decisions based on our expertise and our understanding of each individual patient’s needs. But now, we are also expected to work within a framework of protocols and metrics that guide our practice.
David Rosenfield, MD. Anesthesiologist at Alliance Spine & Pain ( Peachtree, Ga.): Many physicians face the challenge of effectively managing their practice’s financial aspects. This includes dealing with insurance reimbursements, understanding complex billing codes, and controlling operational costs. Every year, many of us find ourselves working harder and longer hours just to maintain our incomes. The costs of practicing medicine (rent, equipment, employee costs) continue to rise, while reimbursement often declines year over year.
Sheldon Taub, MD.Gastroenterologist at Jupiter (Fla.) Medical Center: The biggest threat to physicians right now is losing autonomy and decision making. In spite of extensive training, they are told by nonmedical personnel how to manage patients. If you don’t follow the algorithm that the insurance companies outline, you have to justify through a peer-to-peer discussion the rationale for doing the particular test you want. Often this is with someone with an entirely different medical background. This can be labor-intensive and non-reimbursable.