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“ As a blanket approach in this country , we have deprioritized preventative care and over-prioritized interventional care ,” ( Semuels , 2024 ). Maximizing throughput and RVUs maximize profit for corporations but significantly impact the quality of care in many cases . As a result of this profit-driven assembly line mentality , many physicians have little control over their practices and feel more like warm bodies than professionals who are valued for their training , expertise and concern for their patients .
Moreover , profit-driven insurance companies have far too much control over our practice of medicine , with few repercussions . In a WAVE 3 News exposé regarding insurance company denials , the reporter interviewed University of Louisville law student Francis Beifuss . He wrote a cutting law review article entitled Illusory Remedies : Why Lacking Oversight and Penalties Leave Half the Country with Only A Shadow of Healthcare . Mr . Beifuss ’ own wife was denied care by her insurance company for treatment of a chronic illness , with seemingly no repercussions . He writes : “ Cloaked in the safety of legislation and precedent , insurers can avoid covering claims because the penalties for breaching their duties are far cheaper than performing them … no entity tracks the prevalence of ERISA health plan claims denial . The lack of monitoring makes the prevalence of wrongful claim denial impossible to know with certainty . Worse , the selective reporting that is available is voluntary , making it high risk for cherry-picked data that masks issues ,” ( Beifuss , 2024 , p . 763 ). A physician may know that a patient needs a particular medication , procedure or imaging study to proceed with their care . However , a third party can deny a medically indicated treatment with minimal to no consequences to the insurance company . That is demoralizing for physicians and patients , not to mention time-consuming due to the tedious appeals process .
As a result of these factors ( and more ), patients keep getting sicker and even more reliant on the system . Patients ’ illnesses become more complex and challenging to manage and start at younger ages , oftentimes in childhood . It has become nearly impossible for a primary care physician ( PCP ) to manage multiple medical conditions in a 15-minute follow-up visit , much less get to know our patients as human beings . Fear of litigation , lack of time and resources , increasing case complexity , concern for patient safety and patient expectations lead to more and more subspecialty consultations , further driving up costs and , in some cases , dangerously fragmenting care . This also delays subspecialty care for those who truly need it because the system is so backlogged with consultations . PCPs leave their jobs in droves , leaving patients with a revolving door of PCPs , long waits for new patient visits with PCPs and increasing midlevel-driven primary care ( with arguably similar turnover ). Many patients end up with medication lists so long that they are being prescribed more medications to treat side effects from existing medications . Most of these patients will never have a physician
( PCP or specialist ) delve into the “ nitty-gritty ” of lifestyle factors that are contributing to their “ unhealth ,” nor do they have anyone to help coordinate their complex care . And how could a physician do so when they are constantly running behind , overwhelmed by patient load and administrative tasks , and downright burned out ? Unfortunately , it is the path of least resistance to add / adjust medication or recommend a test or referral rather than spend time investigating the myriad of lifestyle factors that contribute to illness . Make no mistake , there are many times when medications and other interventions are absolutely indicated , but all patients can benefit from improvements in lifestyle factors . Lastly , when chronic disease and lack of access to care go unchecked , emergency departments and hospitals overflow with patients with decompensated illnesses . Most hospitals do not have the resources to address this enormous influx of patients , and as a result , both patients and health care professionals suffer the consequences .
This leads us to the impact of the “ sick system ” on the physician . “ Burnout ” runs rampant among physicians . I believe one of the reasons for this is that many physicians feel trapped in a system that seems too immense and too broken to change . They feel they are spinning their wheels , putting in 110 % effort with minimal returns and have little say in how they use their education and experience to care for patients . At least for me , it often feels like an impossible matchup between David and Goliath , so to speak .
My high school cross country coach always used to say : “ Don ’ t be a ‘ wish I had ’ kind of person ; be a ‘ glad I did ’ kind of person .” This stuck with me throughout my journey to becoming the physician I am today and now it is more meaningful than ever . Now is the time for physicians as a collective to stand up for our profession and patients and work to change our system for the better . This will require self-directed learning ( for example , obtaining Lifestyle Medicine training ), advocacy , collaboration with like-minded colleagues and a collective resolve to do better for our patients and our profession . In my opinion , this will require many physicians to start their own practices . We must emphasize quality of care , time with patients and safe staffing ratios over RVUs , volume , endless administrative tasks and incentivization of costly tests , procedures and pharmaceuticals that generate revenue . We must know our patients as humans , not just their diseases and medication lists . We must get back to our roots as healers . This is a far more meaningful and effective treatment for “ burnout ” than online modules , books or lectures . In October 2024 , physicians and colleagues in Oregon voted to authorize the first doctors ’ strike in history to advocate for more time with patients , safer staffing and more equitable wages and benefits ; we may see more of this in the coming years if our system continues its current trajectory .
On a systemic level , what if doctors were incentivized to de-prescribe medications , when indicated ? What if food companies were penalized for adding addictive , unhealthy additives to food and incentivized to produce affordable , clean , organic food products
24 LOUISVILLE MEDICINE OPINION