Physicians' biggest threats

Physicians are plagued by increasing administrative duties and burnout exacerbated by the COVID-19 pandemic. 

Seven physician leaders joined Becker's ASC Review to discuss what they see as physicians biggest threats. 

Editor's note: These responses have been edited lightly for clarity and brevity. 

Peter Nalin, MD. Co-interim regional campus dean of the University of Minnesota Medical School (Duluth): 

​​1. With the responsibility to document patient care comes the need for more time-saving technology to facilitate the documenting. While encouraged by advancing technology, physicians would welcome documenting less in order to care more.

2. Physicians need more colleagues, and patients need more doctors, so another increase in U.S. medical school positions and residency positions can prevent the looming shortage. If half the expansion resulted in more family physicians and half the expansion toward the specialties, more patients would be served across the entire continuum of care.

3. The profession of medicine responded admirably to the latest pandemic, yet physicians are not immune from the disruption, exhaustion and human suffering encountered for two years. It's important for physicians to experience healing and renewal along with our society as we emerge on the other side of this pandemic. 

4. For our aspiring youth and other workers considering healthcare careers, the role of physician opens many pathways to care for patients and advance health by discovering, delivering and improving care through innovation and continuing education.

Stephen Brotherton, MD. Orthopedic surgeon at the Texas Health Care Bone and Joint Clinic (Fort Worth): I think that the biggest threat to physicians currently is the inexorable separation of physicians from their status as professionals. The regulation of our profession has gone beyond externally controlling what we charge for our time and expertise. As more physicians become employed by entities (usually hospital systems), with goals divergent from ours, these doctors find they are confronting, not hospital bylaws, but employment contracts. In short, the ability of a physician to freely exercise his conscience and exist as an independent moral entity is disappearing. This is a threat to their humanity and to society as a whole. Since physicians define themselves by what they do for others, this is a threat to society.

James Bradley, MD. Orthopedic surgeon at University of Pittsburgh Medical Center: The devaluing of the physician with extensive clinical experience and wisdom because of increasing administrative burden to treat our patients, thereby causing early burnout, is the biggest danger to our profession today. 

Ajay Israni, MD. Nephrologist at Hennepin Healthcare (Minneapolis): I feel the biggest threat is burnout from dealing with angry patients or patients not willing to adhere to medical recommendations.

Vikas Patel. Executive Vice Chair of University of Colorado Medicine (Denver): The biggest threat facing physicians right now is the business of medicine. Medical care for physicians has become much more of a business from every aspect compared with what used to be the "art" of medicine. Physicians are now pressured to see more patients in the clinics and document more irrelevant aspects of the visit, far more than spending time getting to know their patients and understanding their patients' problems. Office procedures, such as injections, add to this, as injections garner more reimbursement than just an office visit, not to mention the "ancillaries" of imaging, physician therapy, etc. All of this pressure comes from decreased reimbursements and a need to cover the "overhead" costs of a practice. So if costs go up, physicians are pressured to increase throughput and find other ways to cover the cost of patient care.

What’s even worse is the increasing trend of hospitals employing physicians. This, then really becomes a business employment and the primary goal of any business (even nonprofits) is to generate revenue. Physicians are then the focus to see more patients and pressured to do more procedures and surgeries. This becomes even more of a factory mentality with a tremendous focus on throughput. 

Kian Eftekhari, MD. Oculofacial plastic surgeon at the Eyelid Center of Utah (Salt Lake City): As an independent physician, I think the biggest threats right now are scope of practice expansion efforts in optometry, nursing and physician assistants, which would allow state legislatures to make medical school, residency training and clinical experience an "unnecessary burden" for anyone who wants to practice medicine and surgery. Without appropriate input from physicians about how this will affect patient safety, I worry we will worsen clinical care for future generations, including when I need a doctor one day.

Gary Mathern, MD. Director of Epilepsy Surgery at UCLA: From the individual physician point of view, the biggest threat is burnout because physicians are being asked to do more with fewer resources and finances because nobody wants to pay for healthcare (people assume healthcare should be free no matter the cost). From the profession point of view, the largest threat is lack of physicians being trained and the debt most incur to become a doctor. 

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