MD Whistleblower

Increasingly, physicians today are employed and most of them willingly so.  The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals.  In addition, the alternatives to direct employment are scarce, although they do exist.  Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings.  Another practice model is gaining ground rapidly on the medical landscape.   Private equity (PE) firms have   been purchasing medical practices who are in need of capital and management oversight.   PE can provide services efficiently as they may be serving multiple practices and have economies of scale.   While these physicians technically have authority over all medical decisions, the PE partners can exert behavioral influences on physicians which can be ethically problematic. For example, if the PE folks reduce non-medical overhead, this may very directly affe

As promised in a prior post , here’s a sampling of issues that are grinding down doctors.  Physician burnout is no mystery illness; we know the causes.   Electronic Medical Records (EMR) .   This modernization of medical data recording has been a true gamechanger for billers and medical coders.   For doctors, it continues to be a source of great angst and frustration.   A few years ago, I was using 4 different EMR systems all at once.   Sound like fun?   It wasn’t.   EMR, despite its advantages, has been a potent force threatening doctor-patient relationships.   How do patients feel watching their doctors pecking away at keyboards throughout most of the visit with hardly any eye contact?   EMR also spews forth hours and hours of tasks and communications (previously known as paperwork)  which are hard for doctors to keep up with.   Readers are referred to the EMR Quality category on this blog for additional rants, I mean commentary. Demand for volume over quality.   When any worker

We celebrate Independence Day this year at a time when the country is fracturing deeply along political, ideological, moral and religious lines.   The nation hasn’t been this divided since the turbulent 1960’s when we were rising in anger over the lies of Vietnam, the boiling over of the civil rights movement, the heated struggle for racial equality, the assassination of political and moral leaders and the women’s liberation movement.   But we managed to get through all of this even though many elements of these struggles are ongoing.   Important progress has been made and must be acknowledged.   Hate and anger today are omnipresent.   Yesterday’s heroes -police officers, judges, the FBI, public health leaders, news anchors, college professors – are now demonized.   How did we allow this to happen?   Are we supporting these darker forces or pushing back?   Is there a way out? I believe there is but enough of us will have to decide that comity, civility and serving the greater good

For most of my life, there has been a tipping disorder in this country.  Too many of us were undertipping those who served us and depended upon tips for their livelihoods.   At times, servers in restaurants would be fully stiffed, or received a paltry tip when they deserved more.  In general terms, increasing a tip from 15 to 20% means much more to the server than it does to the patron. Other occupations such has hotel workers, airport porters, cab drivers, tour guides, bartenders, valets and food deliverers – to name a few – depend upon the generosity of their customers.   Traditionally, a tip was a reward for good service.   Indeed, this provided an incentive for workers to perform well.   Better service led to better tips. We now have an entirely new strain of tip dysfunction in this country.   Tipping is no longer tied to service and has become an expected surcharge from classes of workers who heretofore would never have been eligible for a tip.   A few years ago, would a tip

I have not personally suffered an addiction and I have no expertise in addiction medicine.   But I have treated large numbers of individuals with gastrointestinal issues who also are in the midst of an addiction or are recovering from this illness.   I have tremendous admiration for a person who has – with the help of professionals – unshackled himself from the suffocating tentacles of addiction.   As I have not faced this challenge,   I cannot begin to contemplate the journey. This nation has not settled on a coherent strategy to battle this plague.   Is it a medical issue?   Is it a law enforcement issue?   Which treatments are evidence based?     Should insurance coverage for treatment be required as are other benefits such as preventive care?   Can treatment be compelled on an unwilling addict?   I read a poignant opinion piece recently in The New York Times by David Sheff whose son ultimately prevailed against his addiction.   The article refers to a study that concluded that

We live in an era now when workers have leverage over their employers.  Nearly every establishment is struggling to hire employees.  It’s mysterious, not only why so many folks have chosen not to return to work, but also how they are paying their living expenses.   Remote work, particularly for younger workers, has become a non-negotiable red line.  If you are an employer who expects full time in person presence, then good luck finding willing candidates.  Telemedicine has also permeated the medical profession.   Ten years ago, physicians would have howled that there could never be a replacement to the in person visit when doctors could read body language and engage in the age-old hands-on physical examination.   That was then.   Now, many physicians prefer to offer virtual care and many patients demand it. I’ve given up virtual visits, but not for the reasons that you may think. During the early months of the pandemic, when I first entered the virtual visit arena, I found the ex

Studies consistently show that more than half of American physicians are suffering symptoms of burnout.  Consider that astonishing statistic.  What if half the country or half of your own profession were suffering from a disease?  Wouldn’t you expect- or demand - that every available resource be devoted to crush it and rescue the afflicted? Is the medical profession and society at large attacking the physician burnout plague?   Not as I see it.   Indeed, the statistics are all trending in the wrong direction. Physicians and their families, their employers, other medical professionals, the government, and the public are all aware of this epidemic.   I often read expressions of deep concern for doctors’ plight, but the concern is not a treatment. We know the various forces and pressures that are pushing doctors toward the precipice.   There’s no mystery here.   Yet, why won’t anyone pull these doctors back from the edge? What are we waiting for?   A burnout pandemic? We have to put thi