“Physician, heal thyself” is a proverb that has been used in literary texts from at least the 6th century B.C. The moral of the proverb is that physicians should care for themselves in order to better care for the illnesses of others.

Unfortunately for all of us, more and more doctors and nurses are doing just that – but by leaving the profession. And worse according to Wendell Potter of Healthcare – Uncovered, “Many are going to work for Big Insurance. UnitedHealth Group is now the country’s biggest employer of doctors, with around 70,000 at last count.”

How ironic – flocking to the very industry that doctors say mainly drove them out of their profession. And in what capacity I have to wonder – to provide the M.D. stamp on the denial of services and claims?

“Last year, more than 300,000 doctors, nurses, and other clinicians left their jobs, far more than entered the workforce,” according to Potter. “Many of them have cited burnout from having to deal with insurance company demands and the way insurers and investors have inserted themselves between them and their patients. Physicians also have a higher suicide rate now than any other profession in America.”

It’s not entirely about the money and the long hours.

The Primary Care Physician

The primary care physician (PCP) is usually your first medical contact point. It is also where the greatest shortage of physicians is occurring; projected to reach 48,000 by 2034. Why is that?

Medical school debt and future income. The average medical student is graduating with over $200,000 in debt. Paying this debt can be expedited by making an immediate good salary. A PCP’s annual compensation averages between $250,000 and $275,000. By contrast, many specialists make more than twice that: plastic surgeons – $619,000, orthopedists – $573,000, and cardiologists – $507,000. According to Dr. Russ Phillips, director of the Harvard Medical School Center for Primary Care, “You have to really want to be a PCP when that student will make one-third of what students going into dermatology will make.”

Workload. The lower annual income plus the punishing workload and long hours typically faced by primary care physicians are causing more medical students to choose a specialty.

Value to patients. Primary care is considered the foundation of our health care system, linked to better population health and more equitable outcomes. It is where more serious underlying medical conditions are identified at early stages.

And yet, while we need more PCPs, the U.S. has underinvested in primary care, spending less than 5% of health care dollars in 2020 compared to many other countries.

Insurance payment imbalance. Medicare covers 65 million people and finances more than one-fifth of all health care spending. The Medicare payment schedule is too complex for this post, but the system rewards specialties that emphasize procedures more than primary care, where the focus is on annual wellness exams, chronic disease maintenance, and referrals to specialists.

Selling themselves to the highest bidder. Even if your doctor’s office is in the same location, usually a medical building filled with colleagues, everything else has probably changed. He or she is part of a large group, often owned by a hospital, private investors, or worse – venture capitalist entities. Or they are attached to a larger network – for-profit or nonprofit.     

The autonomy of the physician is now at the mercy of a number of agencies. These usually include the larger organization’s financial goals, and the reimbursement schedules of both private insurers and federal programs like Medicare and Medicaid. During the pandemic doctors were often given financial bonuses for the number of patients they vaccinated, including several rounds of boosters. They regularly receive bonuses by pharma companies for prescribing their advertised drugs rather than a lower-priced equivalent.

Increasingly, AI technology is being adapted to automate approvals, procedures, billing, claims, and their denial. Patient satisfaction, patient loads, and other measures keep the majority of the once in-charge doctor under the supervision of a host of examiners.

This is how author and public-hospital physician Dr. Ricardo Nuila describes his chosen profession. “Let’s call it Medicine Inc., this amalgam of healthcare suppliers in America, for its level of sheer conscience-less competition.” He defines Medicine Inc. as “a growing patchwork of doctors, hospitals, pharma and insurance companies that greatly influence state and federal policy makers. This powerful patchwork of corporate interests works together to keep the idea and implementation of a functioning national health system seem impossible or threatening to the American people.”

Doctors unionize.

According to Harold Meyerson, writing in The American Prospect (August 4, 2023), there is a “surge in doctor unionizations, but largely confined to interns and residents. They spend more of their time sharing the same workplace and working conditions than older attending physicians. Doctors in mid-career have more at stake than younger doctors; they come from a less diverse and progressive generation of physicians than today’s interns and residents. For the time being, it seems clear that the doctors seeking to unionize, and succeeding at it, will most likely be interns and residents. To date, there are only 10,000 members of two unions representing attending physicians.

What do they want?

? Representation and greater presence of their voices in the institution’s decision making process. “Not enough of the people who see patients are involved,” said several doctors. “We need people who see the problems firsthand. If the rate of doctor and nurse retention is to rise, as it needs to, if patient care is to get better, that’s what we need.”

? A greater voice when it comes to safety and working conditions that put patients and physicians at unneccesary risk.

? A more humane and patient-centered healthcare system.

“Most doctors,” says Meyerson, “are cognizant of how many of the basics of American health are deteriorating, with whole segments of the population experiencing shorter life expectancies, rising rates of maternal mortality, and deaths of despair. Winning back a share of the control over what they can do for patients is clearly not a sufficient remedy to what ails American medicine. But it’s a necessary one, and one for which a growing number of doctors are prepared to fight.”

And imagine this! If nurses can strike and get better working conditions, why can’t doctors strike and get their profession back?

Note: Dr. Ricardo Nuila’s most recent book is: The People’s Hospital: Hope and Peril in American Medicine.

Photo credits: Doctor – online-marketing, money – giorgio-trovato, union – tatiana rodriguez.