I feel a similar foreboding. Thank you for expressing this so well. I have always struggled to understand how healing the sick became a "for profit" business with a few reaping huge $$ rewards while so many suffer because of a shortage of "money".
Highly recommend Ultra-Processed People by Chris van Tulleken which has an excellent discussion of the financial pressures on food companies and the food choices we now have.
Thank you for the recommendation! By the way WSJ has a series of articles on how private equity has dramatically increased the cost of healthcare. I'd link but all are behind a paywall. The system has become immoral.
Thank you for the great comments! I plan to respond to everyone individually but I've had a very busy couple of weeks of work and travel. For what it's worth, this post has had nearly 6500 views and has led to many new subscribers. In fact, this has had more initial views than anything I've written since starting on Substack. So I appreciate the fact that you take time to read what I write, and that you share my posts. And for new subscribers, thank you so much for giving me some of your precious time (and for the paid subscribers, money). Your kindness and interest encourage me to continue writing. And I have a lot of new things to write about, so more on the way. Edwin
Beautifully written. You've put words to something I have struggled to. In addition to all of the social and cultural forces we contend with, the mental and emotional state of providers will magnify those problems. We weren't in great shape before the pandemic and, for me, at least the pandemic did significant damage to the point that, at 42, I'm not sure I can go back. I think there are many of us who are heartbroken.
Amy, you're so right. I'll be 60 in July. I love what I do, but it gets particularly difficult to muster the courage and energy to do nights, or to go into those shifts where we have more holds than new patients and everything feels hopeless. Heartbroken is a great description. Thank you for all you have done over your career! And thank you for your comment.
The medical profession is the only one which has allowed non-professionals to take over diagnosis and care of patients in the form of denials of care. The AMA agreed to allow the government to set Medicare fees and it's been a slide into the red tide you so aptly describe since that copout by the AMA in the 60s. No other profession allows those outside their profession to set their fees. Elizabeth Rosenthal in her book An American Sickness believes the only way out of this mess is for patients to demand their legislators fix the problem. Those in control of medical costs are not going to let go of their profits voluntarily. The U.S. is the only developed country with no national healthcare. Yes, one hears complaints about the universal healthcare programs in other countries, but clearly the U.S. lack of universal heathcare is a far greater problem.
Alan, we really handed over the keys to the kingdom, didn't we? And in the process we hurt our profession and by extension all of the patients who depended on us. Thanks as always for commenting!
I started out as a PA in 1975 when health care planners were taking about the shortage and maldistribution of primary care doctors in America. PAs and nurse practitioners were supposed to become "physician extenders" as more docs were minted and somehow induced to work in rural areas and inner cities. I remember thinking it odd that medical insurance reimbursement was about the same for freezing a wart (a 5-minute procedure) as it was for doing an hour-long complete history and physical...and with a lot less paperwork. Since then, the old GPs were replaced by board certified family physicians, but the shortage remains. Patients who lack a primary care provider do not receive comprehensive care or continuity of care. They are forced to seek medical care at urgent care centers and emergency rooms. Add in the socioeconomic ills of our time and the shortage of hospital beds, staffing, medications and governmental dithering, and we have a huge problem which you define so well as a "red tide" that is becoming a tsunami. Great article!
Jon, thanks for your comment. I hadn't thought about it but the old GPs were work-horses. And many of them had done only an internship before settling in and caring for an entire community! I think that the system expects that of the PAs and NPs but without the same education and with higher expectations for perfection. I fear it's going to be bleak. Always appreciate your comments friend.
Not a health care professional but intelligent enough to see these problems trundling along and wondering where the health care professionals were. They are best positioned to call the issues as they see them rather than to go along to get along.
Not a health care professional but intelligent enough to see these problems trundling along and wondering where the health care professionals were. They are best positioned to call the issues as they see them rather than to go along to get along.
RJ, I think that professionals (as Rural Doc Alan references) made our mistake by letting the government and then administrators take over. We thought we were going to be able to focus on patient care but instead we were just made into worker bees intended to generate profits. Fortunately there are some great things happening now in terms of pushback against corporate medicine! Thank!
Bob, thank you for your comment about our people. It's a tough time. On another note though, the prescription opioid issue is partly our problem and partly an issue of industry creating and marketing dangerous products, very intentionally, resulting in death and devastation. It's certainly a complicated problem.
Dr. Leap this is SO profound!
Thank you my friend! I hope you're well!
I feel a similar foreboding. Thank you for expressing this so well. I have always struggled to understand how healing the sick became a "for profit" business with a few reaping huge $$ rewards while so many suffer because of a shortage of "money".
Highly recommend Ultra-Processed People by Chris van Tulleken which has an excellent discussion of the financial pressures on food companies and the food choices we now have.
Thank you for the recommendation! By the way WSJ has a series of articles on how private equity has dramatically increased the cost of healthcare. I'd link but all are behind a paywall. The system has become immoral.
Thank you for the great comments! I plan to respond to everyone individually but I've had a very busy couple of weeks of work and travel. For what it's worth, this post has had nearly 6500 views and has led to many new subscribers. In fact, this has had more initial views than anything I've written since starting on Substack. So I appreciate the fact that you take time to read what I write, and that you share my posts. And for new subscribers, thank you so much for giving me some of your precious time (and for the paid subscribers, money). Your kindness and interest encourage me to continue writing. And I have a lot of new things to write about, so more on the way. Edwin
Beautifully written. You've put words to something I have struggled to. In addition to all of the social and cultural forces we contend with, the mental and emotional state of providers will magnify those problems. We weren't in great shape before the pandemic and, for me, at least the pandemic did significant damage to the point that, at 42, I'm not sure I can go back. I think there are many of us who are heartbroken.
Amy, you're so right. I'll be 60 in July. I love what I do, but it gets particularly difficult to muster the courage and energy to do nights, or to go into those shifts where we have more holds than new patients and everything feels hopeless. Heartbroken is a great description. Thank you for all you have done over your career! And thank you for your comment.
The medical profession is the only one which has allowed non-professionals to take over diagnosis and care of patients in the form of denials of care. The AMA agreed to allow the government to set Medicare fees and it's been a slide into the red tide you so aptly describe since that copout by the AMA in the 60s. No other profession allows those outside their profession to set their fees. Elizabeth Rosenthal in her book An American Sickness believes the only way out of this mess is for patients to demand their legislators fix the problem. Those in control of medical costs are not going to let go of their profits voluntarily. The U.S. is the only developed country with no national healthcare. Yes, one hears complaints about the universal healthcare programs in other countries, but clearly the U.S. lack of universal heathcare is a far greater problem.
Alan, we really handed over the keys to the kingdom, didn't we? And in the process we hurt our profession and by extension all of the patients who depended on us. Thanks as always for commenting!
I started out as a PA in 1975 when health care planners were taking about the shortage and maldistribution of primary care doctors in America. PAs and nurse practitioners were supposed to become "physician extenders" as more docs were minted and somehow induced to work in rural areas and inner cities. I remember thinking it odd that medical insurance reimbursement was about the same for freezing a wart (a 5-minute procedure) as it was for doing an hour-long complete history and physical...and with a lot less paperwork. Since then, the old GPs were replaced by board certified family physicians, but the shortage remains. Patients who lack a primary care provider do not receive comprehensive care or continuity of care. They are forced to seek medical care at urgent care centers and emergency rooms. Add in the socioeconomic ills of our time and the shortage of hospital beds, staffing, medications and governmental dithering, and we have a huge problem which you define so well as a "red tide" that is becoming a tsunami. Great article!
Jon, thanks for your comment. I hadn't thought about it but the old GPs were work-horses. And many of them had done only an internship before settling in and caring for an entire community! I think that the system expects that of the PAs and NPs but without the same education and with higher expectations for perfection. I fear it's going to be bleak. Always appreciate your comments friend.
Not a health care professional but intelligent enough to see these problems trundling along and wondering where the health care professionals were. They are best positioned to call the issues as they see them rather than to go along to get along.
Not a health care professional but intelligent enough to see these problems trundling along and wondering where the health care professionals were. They are best positioned to call the issues as they see them rather than to go along to get along.
RJ, I think that professionals (as Rural Doc Alan references) made our mistake by letting the government and then administrators take over. We thought we were going to be able to focus on patient care but instead we were just made into worker bees intended to generate profits. Fortunately there are some great things happening now in terms of pushback against corporate medicine! Thank!
You’re right. All this can be fixed with a couple neck cracks and a few alfalfa pills. Silly physicians……
Bob, thank you for your comment about our people. It's a tough time. On another note though, the prescription opioid issue is partly our problem and partly an issue of industry creating and marketing dangerous products, very intentionally, resulting in death and devastation. It's certainly a complicated problem.