Take This Job and Shove It
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Happy Tuesday Advocates
I would like to encourage comments and suggestions from you if you have time. Please use the comment button below. Thanks to Heather (physician) and Gary (psychologist) for suggesting today’s topic
Provider Burnout - Take This Job and Shove It
Here is a link to Johnny Paycheck’s song. There has been a lot of press lately about physician burnout. A recent American Medical Association article identifies burnout as a long term stress reaction whose symptoms include emotional exhaustion, depersonalization (i.e. lack of empathy for or negative attitudes toward patients), and feelings of decreased personal achievement. They found 63% of doctors are there now.
People have been measuring this for years. In 2013 a Temple University study found that 62% of ER doctors were burned out, largely because ERs had been outsourced and the doctors were being pressured to provide lesser quality care (cheaper), and to bill for unneeded tests to increase profits for the corporate ER. Here is a link to the NY Times source.
This is serious and is causing a crisis in medicine. Here is another article that found that 20% of doctors want to quit within the next year.
The system is so broken that doctors and nurses and other healthcare providers suffer under its weight.
Here is a list of what snuffs out the spark all of these professionals that were so eager to help heal people.
Complicated additional record keeping to satisfy insurance companies
Complicated coding of treatment that varies between insurance companies - there are over 900 of them
Corporate micromanagement of the provider (you must order this test first, you must upcode the service, work faster, see more patients, bill more, etc.)
Insurance company micromanagement of the provider (order the x-ray first, then we will let you order the MRI, no ,your patient can’t take that drug, they must be prescribed these other two first and if they don’t work then then maybe we will cover the one that the patient really needs).
Denials and resubmission of insurance claims for payment- remember on average 17% of all claims are denied but some companies are as high as 49% and that 80% of all denials are reversed on appeal - what a waste!!!
Insurance companies denying sufficient reimbursement to those that treat behavioral issues.
Political interference. Let’s not forget the 25 states that have banned abortion. In those states doctors are forced by law to let women suffer - unto death - until they act and many doctors are quitting or moving because of it.
Of course, doctors aren’t unique. Nurses suffer the same way. They are given too many patients to manage and insufficient resources to do it. Here is a link to National Nurses United (a union). You can read more about it there. In my area the nurses at Providence Medical are on strike.
These doctors and nurses and other healthcare providers are placed in a system where their ability to help patients in the way they were trained is taken away from them by corporations interested in how much they make instead of how well the patient is cared for or by ignorant legislators.
If you’re a provider, the AMA has some recommendations to cut down on stupid stuff done at work that may help a little. Here is the link. But these are band aids not solutions.
The corporatization, monetization, and politicization of healthcare is screwing everyone. When politics prevents doctors from acting in their patients best interest both patient and doctor suffer. When fee for service is the norm, the more patients you see, the more you make and the lower quality the patient can expect. Doctors and other healthcare providers are encouraged by management to move patients along as quickly and cheaply as possible or to take care of as many patients as possible. The result is that the quality of care for the patient suffers, and the providers suffer because they are pushed so hard to deliver what they were not trained to deliver, money instead of health.
Universal healthcare is not a panacea, but it will address many of these issues. I have read in HR 3421 that nurse/patient ratios will be a key quality metric, Many facilities will be financed with global budgets instead fee for service (still available if necessary) and that the system will reward patient health, not the volume of patients run through. All of this for far less than we pay today.
ACTION
Use RESISTBOT (text SIGN PPMOST to 50409) or call or email your Congressional Representative and Senators and the President (their contact info is in the References Section) and tell them something like:
“My name is [name] and I live in [zipcode] and I am your constituent. I am very concerned about just how many doctors and nurses and other healthcare professionals are burned out. 20% of doctors will be leaving the profession next year because they are not allowed to provide the care they were trained to provide. Corporations are pushing them to bring in more money, instead of provide suitable care and there is excess interference from insurance companies that stands in the way of patients receiving that care in the form of pre authorizations, excess record keeping, and denials of needed service. And let’s not forget the stress doctors in anti abortion states feel because they have to let women be near death before they can act.
You have it in your hand to fix this for all of us and I want you to act. I want you to cosponsor and loudly support either HR 3421 or S 1655 Improved Medicare for All which will simplify insurance and halt the corporate micromanagement of healthcare with global budgets and regional oversight to insure that there are sufficient providers to care for the number of residents in their region.
And while I have your attention, I want you to support the Women’s Health Protection Act and make sure we have national reproductive healthcare in ALL the states.”
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
https://www.commoncause.org/find-your-representative/addr/
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Organizations to Contact
NARAL - Pro Choice America
Planned Parenthood
Physicians for a National Health Plan
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water Resistbot write up
Thanks for writing. I appreciate hearing your viewpoint and I agree with you about remuneration. I have a relative (young) who is a doctor and has worked under both fee for service and as a salaried physician and he much prefers being on a salary. The pressure to see too many patients and not provide sufficient care was overwhelming.
Regarding the NHS and money, it seems that that is a regular issue in a number of countries with universal healthcare. I recall, not so long ago that French doctors went out on strike during negotiations with the government. Of course they came to terms quickly.
One province in Canada had that issue of not enough money in the fund for healthcare, I think it was Ontario, and they people just decided we will tax ourselves a little more to get what we want. I know that's hard in England as the VAT is pretty high now.
Anyway thank you, I poke my nose into how the UK is doing a little more frequently....Be well...
As a Brit who grew up post 1950 and benefitted from the Welfare State and the creation of the NHS and who now lives in US, I would normally be jumping all over this! I absolutely support universal healthcare and find the existing system in the US to be frighteningly complex and dangerously obscure to the point that I tend to just hope that I never need to use it! However, many do, as will I at some point, so the ostrich approach is no approach at all. Nevertheless, I hate to report that the much-vaulted NHS in the UK is also sadly broken and suffering, ironically from many of the same woes that beset the US system-overworked doctors and nurses, cumbersome bureaucracy, too much demand and not enough money(although the latter is not the case overall in US, I know, unless you are unlucky enough to live in one of the health deserts in this country.) Healthcare is a basic right and tying it to profit and loss inevitably will lead to inequality of care, but it is also true that doctors and nurses deserve decent remuneration in acknowledgement of the years of studying and continuing education they are required to pursue. Obama had a shot at it, but a lot of folks in this country are so biased against anything that smacks of a socialist agenda that I fear the US will never achieve anything like healthcare for all.