THCB

Actually, It’s a Great Time to Be a Doctor

Is this a good time to be a physician? Absolutely! In fact, I believe there has never been a better time to practice medicine. I hold this belief despite the barrage of negative comments and predictions from doomsayers remarking on the sorry state of health care in its current state.

Before I tell you why I’m so optimistic, I’d like to acknowledge one fact: practicing medicine is more complex and difficult than ever, however, this fact doesn’t dampen my enthusiasm. There is no doubt that over the past two decades a great many changes in the health care environment have consumed doctors’ time, distracted us from our core task of providing care, and impacted our incomes.

Meanwhile, patients’ expectations of the health care industry and of their physicians are changing. An increasing number of people want more involvement in their own health care and want to partner with their physician. So it is not hard to understand how practicing medicine can feel more challenging than ever.

For example: results from a national survey reported in the Archives of Internal Medicine in 2012 indicated that US physicians suffer from more burnout than other American workers.

Burnout, in this report, was defined by “loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment”; 45.8% of responding physicians had at least 1 of these symptoms.

So why am I so optimistic?

Because when I read these survey results, and others like them, bureaucracy and complexity are often cited as the reasons why physicians are unhappy. Not patient care.

While these factors (bureaucracy and complexity) can momentarily take physicians away from their passion of practicing medicine, it is the passion of a physician, precisely, that fuels my optimism for the state of health care today.

The multitude of opportunities that currently exist for a physician to take an active, positive role in shaping the delivery of health care – while at the same time developing the best potential to positively impact their lives as physicians and the lives of their patients – are astounding and deserve to be explored.

Twenty years ago, who would have believed that doctors today operate in a world where they can quickly detect life-or health-threatening changes in a patient’s condition through home-based monitoring? Or that a physician who has never seen a particular patient can view her entire medical record before treating her for an emergency condition?

The advances in technology and knowledge based systems not only provide ample opportunity for physicians to become better practitioners, they also allow physicians to ask bigger questions and provide a reliable framework for sharing our collective knowledge with one another. This is but one example of why I think now is a good time to be a physician.

Here’s another reason. In my thirty years with Kaiser Permanente, both as a practicing physician in internal medicine, hematology and oncology, and over eight years in senior leadership roles, I have seen first-hand the positive transformation in the lives of physicians who craft and own the systems they work in.

Physicians at Kaiser Permanente who led the charge in integrating patient-centered care with technology, who combined evidence-based practice with accountability, and who fostered innovation and teamwork all had one thing in common: what they were really embracing was leadership.

Some might say that we can’t learn from Kaiser Permanente’s experience because it is so unique to KP.

I disagree.

Physicians everywhere today have a central leadership role to play in the transformation of a health care system that aligns incentives, relies on evidence-based medicine and delivers coordinated, patient-centered care.

So how can physicians everywhere embrace a leadership role when they are mired in the various bureaucracies that often lead to burn out as cited in the above survey?

My answer to this question is two-fold: First, and always, is to recognize that when we, as physicians, put on our white coats we are already assuming a leadership role given our immense responsibility to care for and improve the health and well-being of our patients as we uphold the Hippocratic Oath.

I am suggesting that we expand our thinking about what it means to be a physician leader, both inside and outside the examination room. Second is to recognize that patients under our care not only depend on our medical experience and knowledge, but also rely on our ability to work together as physician leaders to provide an entire health care system that works in their best interest, and fosters the greater good for society at large.

Physicians are leading a paradigm shift with our patients; instead of the costly approach of treating illness, we are now focusing on preventing illness. Physicians must shift our own thinking as well; instead of the costly route of reacting to physician burnout, we must step in – and up – and take measures to prevent it.

Who better to lead the transformation of our health care system to one that improves core qualities, service and access – while at the same time reducing costs – than physicians and their dedicated teams?

It is my belief that the trusted physician axiom of “do no harm” must be partnered with “do great benefit”, led by physicians who passionately embrace the tools and resources available to them. This is, indeed, an exciting time to be a physician and I can hardly wait to see what we do next.

Jeffrey A. Weisz, MD is president and executive medical director for the Northwest Permanente Medical Group which includes 1,300 Permanente physicians and clinicians who provide care to nearly 480,000 members of Kaiser Permanente. He is the author of It’s a Great Time to be a Physician: Building a Health Care System That Works.

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8 replies »

  1. Thank you for the comments, feedback, and challenges to the notion that it is a great time to be a physician. I am always humbled by the passion and experiences of my colleagues.

    Regrettably, many of the challenges I faced during 25 years of practice as a hematologist/oncologist caring for some of the sickest patients, still exist today. And evidenced by some of the comments, has gotten worse. It is easy to hear the pain and frustration behind some the comments. They come from a desire to do the right thing, practice great medicine, and provide patients with superb care. And yet for some in our community of physicians, not everyone feels able or supported to practice medicine in the manner you desire. That is why a health system, predicated on the continual health and well-being of patients, needs to be led by the very people who care for patients.

    I agree that what physicians experience at Kaiser Permanente can be very different from those who might practice outside of an integrated delivery system. We put all of our energy and resources into supporting our physicians so they have the freedom, tools, community of experts, cutting edge technology, and an entire system behind them so we can achieve the very best health outcomes and patient care experience possible.

    There is a reason why Kaiser Permanente has been thriving for more than 60 years and is poised for another 60 years. It is a great time to be physician because our country and our citizens need us to lead. The opportunities to improve the system are tremendous and the time is now.

    If physicians are interested in seeing a different approach–and in many ways a better approach— then I invite you to come visit us.

  2. If you are in admin, it probably is a great time to be a doctor. Otherwise, you have a severe case of cranial-rectal intromission.

  3. As an addendum here, I googled “criticism of Kaiser Permanente” and found this old NY Times article from a year ago, but hope readers will note this in the article:

    http://www.nytimes.com/2013/03/21/business/kaiser-permanente-is-seen-as-face-of-future-health-care.html

    “Yet even with all of its effort, its chairman and chief executive, George C. Halvorson, acknowledges Kaiser has yet to achieve the holy grail of delivering that care at a low enough cost. He says he and other health systems must fundamentally rethink what they do or risk having cost controls imposed on them either by the government or by employers, who are absorbing the bulk of health insurance costs. “We think the future of health care is going to be rationing or re-engineering,” he said.

    Mr. Halvorson is convinced that Kaiser’s improvements in the quality of care save money. But he also says that the way to get costs lower is to move care farther and farther from the hospital setting — and even out of doctors’ offices. Kaiser is experimenting with ways to provide care at home or over the Internet, without the need for a physical office visit at all. He also argues that lower costs are going to be about finding ways to get people to take more responsibility for their health — for losing weight, for example, or bringing their blood pressure down.”

    Gotta love organizations that want to get patients OUT of the doctor’s offices and hospitals and give care at home and over the Net. I am sure there are examples that might be actually somewhat appropriate, but, when cost trumps care, and an organization like KP is focused on money per what I have read at other links compromises their care options, you can bet (pun intended) the push to make patients accept care away from care provider arenas will be maximized.

    I would assume KP has been the biggest insurer supporter of Obamacare of all of them, hands down! Just follow the money, who were the biggest donators to elections both Obama and Democrats?

  4. I stopped reading here: “Some might say that we can’t learn from Kaiser Permanente’s experience because it is so unique to KP.”

    Why? Certainly one can learn from the KP model, but that does not mean that the KP model is generalizable, and this piece purported to address the state of the physician experience writ large.

    I like the KP model and I believe that the KP model is one of the few functional niches of our current healthcare ecosystem. But as the other commenters have pointed out, to claim — or worse, to believe — the the physician experience as experienced within KP is anything like the physician experience in the broader third-party-payor system is absurd, and more than a touch insulting.

  5. Another example of the agenda by THCB at the end of the day. Another mark/partisan salesman to sell agendas, not principles or public needs.

    Ever watch this show on Showtime called “Shameless”? Well, you don’t have to, the equivalent read are these blog posts over half the time.

    And now yet another delay of mandates. Truly shameless what the creators of this pathetic legislation propagate weekly.

    My bet is the author of this above post sees patients no more than 20% of his daily time. That is why times are great now to him!

  6. If you have any doubts about how doctors are feeling these days, read the comments on an article in Medscape titled “Are Doctors Being Exploited?”.
    Also read articles and responses on doctor’s feelings about EHR.

    Go on to the AAFP website and read responses to our great government oversight of medical care.

    It is a great time to be a physician if you are well off enough to retire. But then, it’s not a great time to be a patient in my opinion.

  7. Forgive me, I’m not usually one to throw flames on this site. But every once in a while, someone says a series of things that are just so ignorant, I can’t help but comment.

    We actually have a member – nay, an Executive Medical Director – of the borg known as Kaiser Permanente talking about their experiences in the ‘real life’ of medical practice. As one of my friends from residency told me about his job in KP…”I’m so happy I got this job, I make great money, and am totally protected from all of the issues I see my peers struggling with in private practice and academics”.

    It speaks to the borgness of the organization that one of its ‘physician leaders ‘has drank the kool aid so completely that he isn’t even aware of the real world that the rest of the doctors live in.

  8. “Jeffrey A. Weisz, MD is president and executive medical director for the Northwest Permanente Medical Group”

    Congrats Jeff. Seems the “great times” might not be with direct patient care though, but rather graduation to administration of the little people. No doubt it’s a lucrative gig, too.

    I mean, what’s not to like?

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