Physicians' biggest enemy in providing patient care

From increased administrative duties to powerful private payers, the obstacles to administering top-notch patient care are many for physicians. 

Nine physicians spoke with Becker's ASC Review about their biggest "enemy" in providing the best patient care. 

Editor's note: Responses were lightly edited for clarity and length.

Alok Sharan, MD. Spine surgeon at NJ Spine and Wellness (East Brunswick): I think physicians’ biggest enemy in providing great patient care is physicians themselves. Over the years, for a variety of different reasons, physicians have outsourced a lot of responsibilities to other stakeholders. Increasingly as they have done this, physicians have lost a lot of their independence. Practicing medicine and giving high quality care is very challenging, even in the best of situations. Ultimately, a well-trained, knowledgeable physician working on the front-line knows what is best for a patient. The fundamental unit is the doctor and patient. Unfortunately, physicians have allowed administrators, government regulations and business people to interfere in that relationship, which has led to the downward spiral of costs and quality. The modern physician has to learn more about nonclinical skills so as not to lose their independence and minimize the interference from other stakeholders in the delivery of high quality care.

Cory Calendine, MD. Orthopedic surgeon at the Bone and Joint Institute of Tennessee (Franklin): The patient care path is complicated, but one antagonist bears mention: private payers. Insurance companies are essentially financial vehicles. They provide no actual patient care. While insurance companies are seeing epic profits — in the tens of billions for 2021 — those same companies are narrowing the list of covered services and increasing denials for physician-directed patient care. This produces, at worst, less care for the patient, and at best, more burden to those delivering the care. I applaud a free-market system, even in healthcare, but to be sustainable, every stakeholder must be involved in solving the system's greatest challenges, such as the indigent care burden, fragmentation of information due to lack of interoperability and the removal of the physician's role in direct patient care. These are three areas ripe for collaboration and cure.

Judith Gorelick, MD. Assistant clinical professor of neurosurgery at Quinnipiac University's Frank H. Netter School of Medicine (North Haven, Conn.): The biggest challenge to providers in providing exceptional and timely patient care today is largely the commercial insurers whose policies and protocols often lead to unnecessary delays and denials. This is frustrating both to the patients, who don’t understand the issues and simply want treatment and to feel better, as well as to providers who have their hands tied in providing appropriate and efficient treatment. With all the paperwork already required in clinical practice, most providers do not have the time, resources or personnel to advocate for every single patient who has had their imaging study or procedure denied.  

Ian Armstrong, MD. Neurosurgical spine specialist at Centric Health (Bakersfield, Calif.):Our biggest enemy that we must overcome is complicated, but simply stated, it is 'time' — more precisely the lack of time. First, time to listen to our patients and understand their medical issues. If you want to make a diagnosis in a complicated medical situation, listen to the patient. In their own way, they will tell you what the diagnosis is if you just listen. Second, time to  spend with our patients listening to them, getting to know them, understanding them and their  life circumstances. It’s difficult to make the right medical decision for the patient in front of you if you don’t truly know and understand them. Third, time to educate our patients. My father was a physician, and he always taught me that one of our main roles as a physician was to educate our patients to what the medical problems are and then inform and educate patients about what all the treatment options are. What really are the risks, benefits and alternatives? Patients' compliance is so much higher if they understand what is going on, and they are charged with the responsibility of their outcome through education. 

Jeff Clode, MD. Internal medicine specialist in Spokane, Wash.: Time, or lack of it, is the biggest enemy to providing excellent patient care. This comes from the pressure to produce, either from a health care system or admittedly self imposed, and needs to be solvent and profitable in a private practice. Second, the ungodly amount of time sucked up by doing an adequate job on the EMR. Only a Luddite would deny the value of computerized medical records when properly done. However, no one has cracked that nut yet. Third, bureaucratic demands from payers — totally understandable in our profit-driven, fee-for-service, capitalistic healthcare system but the result is a horrible time sink because the process is so inefficient, cumbersome, and, dare I say, designed to be confrontational. 

Jae Jung, MD. Physician medicine and rehabilitation physician at UCLA Spine Center (Santa Monica, Calif): The insurance companies. It’s difficult to get appropriate care in a timely fashion to provide the best patient care without some kind of hurdle set by them. 

Frank Hromas, MD. Family medicine specialist in Amarillo, Texas: The biggest enemy is greed! Greedy middlemen — pharmacy benefit managers, insurance companies, medical system executives and investors, physicians who forget that you can’t replace lost margin by increasing throughput and the pharmaceutical companies in cahoots with sleazy politicians.

Brad White, MD. Orthopedic surgeon in New York City: For-profit free enterprise medical care is the biggest enemy of the availability of quality healthcare in this county. The second big problem is malpractice and other medico-legal litigation. Lastly, lobby groups pushing these first two items. Reform all three, and we might have a chance of medical care not bankrupting this country. Above alll is public education stressing that the primary responsibility for healthcare rests with each individual and begins at home.

Grace Onimoe, MD. Pediatric hematologist-oncologist in Cleveland: First is insurance — many limitations on drug approvals and tests needed to secure an accurate diagnosis. Many insurance denials and peer-to-peer medical reviews are required, which may not even be successful on the first try. Even lifesaving drugs are denied, and many times we have to search for coupons or ask drug companies to consider providing the drugs free on a compassionate basis. Lastly, administration needs to work closer with physicians to see what works best for patient care.

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