Over the last decade or so doctors have felt their stature steadily slip away. Their significance has of course remained; without doctors healthcare would come to a screeching halt. Newly named “physician extenders” cannot do what most physicians can. They are simply not trained for the task. As important and passionate as they are in healthcare delivery, physician assistants and nurse practitioners possess just a small portion of the training required to become practicing MDs. Doctors often spend more than a decade after college training to a level required to deliver the most sophisticated and complex care. Many laypeople seem oblivious to this fact; some likely have intentionally blinded themselves to it. Physicians are “where the buck stops”. We are the CEOs of our practices, the generals if you will. Yet, the insidious degradation of doctors has led to a variety of deleterious and likely unintended forms of fallout. Most obvious is our title. Once called nothing but “doctor”, we are now dubbed, “health care practitioners”, “health care providers”, and most recently, “EPs, or eligible providers”. This fact may seem trivial, but its reverberations run deep. We have been equated to all others who treat patients – nurses, advanced nurse practitioners, physician assistants, medical assistants, and physical therapists… Our distinction as leaders in patient care is being eroded. Imagine if the same were true in the military – no more generals, colonels, sergeants or the like. Just “military personnel.” Or, what if we applied the same rule to government – no more senators, congressmen, mayors, governors, or even presidents. Simply “public servants.” There is no doubt such an arrangement would be justifiably unacceptable to those involved. These two systems, like the medical system, would crumble absent titular distinctions. But the damage to medicine dives far deeper than this.
We have just witnessed the release of Medicare payment information for each doctor in the US. Soon the “Sunshine Act” will also become a reality. The amount of money paid to highly specialized doctors to deliver educational talks will become fodder for the public to muse. The lunches, coffee, or even requested medical articles brought to offices by pharmaceutical representatives will soon be open for public scrutiny. Total transparency is a beautiful concept for an ideal world. In such a world everyone would love and respect each other; no one would compete with another; and all would be subject to the same laws and regulations. Such is not the case of course. Do you know what your attorney earned last year, or how much money your grocery store pays for its eggs? Of course not! We live in a land that purportedly permits freedom to compete. Competition requires a high degree of privacy. Our country was in fact built upon such a premise. How can one dermatologist fairly compete with another if confidential internal financial records become open access? There are far too many financial ramifications to explore in this short blog, but the adverse fallout from such transparency will be pervasive. And it will most certainly include a drastic decline in the education of practicing doctors. That of course will translate into deteriorating quality of care.
The most consequential outcome of medicine’s recent evolution will undoubtedly be decay in heath care delivery. Marcus Welby, MD was an excellent television show because it depicted a dedicated, diligent, assiduous, committed physician. Dr. Welby captured the hearts of viewers because he loved his patients and they loved him. He was honored, respected, appreciated, and yes, even well compensated. The reality, for better or for worse, is that doctors are human beings. They crave recognition and appreciation for their sacrifices. Absent such recognition, and assuming a continued decline in reimbursement as well as the massive increase in federal regulations, the Marcus Welby, MDs of this nation will become extinct. At times this augury feels inevitable. At other times there is hope. Unfortunately however, until the general population recognizes the physician resource it is rapidly losing, I believe the more pessimistic outlook will prevail. Marcus Welby, MD may truly be unresuscitatable.
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