Monthly Archives: October 2013

Sex, Lies and Healthcare Reform: The Current (Sad) State Of The (Un)Affordable Healthcare Act

This week, the US House of Representatives finally got the opportunity to question Secretary Kathleen Sebelius and examine the debacle that is the Affordable Care Act.  Unfortunately, the Secretary of Health and Human Services spent most of the 3 hour session skirting around the issues and tossing blame to other government agency bureaucrats, government contractors and of course the GOP.  When repeatedly pressed, she did in fact admit responsibility for the failed rollout but stopped short of admitting that the ultimate responsibility falls upon the Commander in Chief, President Barack Obama.  Like any good soldier in a politically appointed job, she protected her boss from the fallout of the TRUTH.  However, in spite of the Secretary’s claims of ignorance during her testimony, Lawmakers on the House committee as well as the American people were able to begin to better understand why the ACA has been such a disaster:

1. A complete lack of leadership on the part of the President and his appointees.

2. A complete lack of understanding of the law by the very people who drafted and now champion the legislation.

3. A complete lack of understanding of process of healthcare delivery in the US today

For example, numerous provisions have already been delayed and many more are likely to be postponed in the future.  The mandates on some businesses, the out of pocket expense caps, and now the individual mandate–just to name a few.  Throughout the process there have been many misleading statements made by the President and his political colleagues both in the White House and on Capitol Hill.  No less than 6 different statements were made by Mr Obama forcefully claiming in 2009 while addressing the American Medical Association:

If you like your doctor, you will be able to keep your doctor, period, If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.”

Obviously the hundreds of thousands of insured that are now being dropped by their insurance plans and forced into the exchanges are proof that these statements are in fact not true.  In addition, there is mounting evidence that the White House as well as Secretary Sebelius knew about these issues with potential coverage loss for quite some time.  An IRS document from 2010 (during the time in which the President was making such bold statements about coverage) suggested that this may in fact not be the case.  This document clearly states that an estimated 40-60% of individual policyholders would be dropped from their plans due to the ACA.  An article in yesterday’s Washington Post awards the administration with “Four Pinocchios” for making untrue claims about his cherished ACA.

We are a nation built on certain guaranteed Freedoms–in particular freedom of choice, freedom of religion and freedom of speech–we are slowly losing our way in the healthcare debate.  Those with a particularly stringent religious beliefs concerning premartial sex and birth control practices are now forced to purchase products that supply contraception.  The Catholic Church–whose believers practice natural family planning–are being forced to provide their employees with funding for birth control.  Our government has clearly overstepped its bounds.  Those who are healthy and have little need of expensive insurance policies are now forced to pay for benefits they may not really need.   The entire success of the ACA system requires that those who don’t need medical care pay for those who do–a unique system for transferring wealth.

Ultimately, costs will  continue to rise.  As evidenced by a report filed by Sebelius’s very own HHS in September 2013, most will see a significant premium increase.  The average male in the US today who enters the exchange will see a 99% increase–the average female will see a 67% increase.  In some states such as North Carolina where I reside, the average man will pay a 350% increase in premium.  Rather than closing the wealth gap in the US, the ACA will actually result in the development of two divergent classes of Americans with respect to healthcare–Those with wealth will be able to pay out of pocket for concierge medicine–they will have access to whatever they need, whenever they need it as long as they can continue to pay.  The rest of America will be lumped into the dysfunctional and bureaucratic Obamacare system.

I am sadly disappointed by my government–those in charge have slowly chipped away at my noble profession–Medicine is in jeopardy of no longer being a form of art–soon medical care will be an automated system carried out by a group of mindless lemmings.  The doctor-patient relationship which has been the core of good medical care is in danger of extinction.  I am a firm supporter of providing healthcare to those who cannot afford it–just not at the cost of Freedom.  I can only hope that those in power in Washington will respect the basic tenets of our democracy and, most importantly, put legacy and ego aside and do what we do best as doctors–put patients first.

Finding Success AND Happiness in Medicine? Where Is The Holy Grail?

Medicine is a very rewarding career.  However, recent changes in the healthcare system have made the practice of business much more cumbersome and job satisfaction rates among physicians is at an all time low.  Fear over the unknown and how Obamacare may affect our ability to effectively and efficiently care for out patients has significantly contributed to the general unease in the medical community.  Most physicians are highly driven, highly successful individuals.  Much of my professional happiness (and I expect other healthcare providers feel the same way) is derived from developing relationships with my patients and achieving excellent clinical outcomes.  However, balancing success and happiness in medicine is now more challenging than ever.  More time is now devoted to additional government mandated paperwork, arguing with insurers and managing escalating overhead costs.  All told, these tasks begin to take away time normally devoted to patient care.

This week, in the online magazine Inc.com, I read an article discussing tips for ensuring BOTH happiness and success.  As I read through the piece, I began to reflect on my own balance of success and happiness–How can these two goals can be readily achieved TOGETHER?  Although primarily directed at the executive/business professional, much of the content is very applicable to medicine.  In today’s medical landscape, the most successful physicians have embraced the concept of the Physician Executive–developing a business skill set that allows one to be fastidious with a spreadsheet while also providing exceptional patient care.  I have addressed this concept in several previous blogs–now more than ever, it is critical for physicians to think like business people in order to navigate the changes that are being implemented on a daily basis.  Although much of our new executive-like tasks certainly take time away from patients, if we are able to find the right balance we can still find happiness and fulfillment in our jobs.  As stated in the Inc.com piece, in order to achieve both goals we must think in unique ways–try to do things differently and find out work works best for YOU.

In the article, author Steve Tobak explores six unique ways that one can develop BOTH a successful career and enjoy a happy life–believe it or not, they do not have to be mutually exclusive.  Here is my take on how each of these suggestions (that were created by Mr Tobak) can apply to those of us who have made our careers in medicine and healthcare:

1. Develop real relationships:  In the end, relationships matter.  In medicine, the most important relationship is that with our patients.  Understanding patients feelings, their families and their preferences improves our ability to care for them.  Celebrating their successes and their family milestones provides me with great happiness.

2. Groom yourself:  No, I don’t mean comb your hair–Try new things.  Engage in other activities as time allows.  Make sure that you make time for family outings and that you try skydiving–or horseback riding–whatever it is that interests you–give it a whirl.  It may change the way you look at your work and your life.  Ultimately, exposure to new things can make us all better leaders and provide more opportunities for success at work.

3. Do Nothing:  Medicine can be incredibly hectic.  Running between hospitals and clinics.  Hustling to see a new consult or dictate another note–all of this “noise” can take away from happiness.  Every single day, just take a few minutes to do nothing.  Sit quietly and listen to your own thoughts…meditate.  Even a brief respite can make you more effective and ultimately improve your mood.

4. Work for a great company:  Whether you own your own practice (a rarity in today’s medical world) or work for a university or hospital, make sure you believe in the mission of the organization.  Be involved and try to influence policy.  If you work in an organization that recognizes and appreciates your efforts, your job satisfaction will improve.  If you do not, you may need to consider taking a risk and making a change.

5. Do one thing at a time:  This seems like an impossibility for physicians today (guilty as charged).  However, if you are able to make a list and prioritize–focus on one or two tasks at a time–you will see the fruits of your labor.  Crossing a task off the list gives us a feeling of accomplishment and completion which can add to overall happiness and satisfaction.  Trying to chip away at several things at once can often result in no task done well.  In medicine, it may be that you spend a half day a week on administrative work–take time to separate yourself from clinical work and catch up on the rest.

6.  Be good to yourself:  As physicians we expect nothing but the best out of ourselves–we are often very critical of our own decisions and clinical outcomes.  In the current healthcare market  (world of Obamacare reform) there is much we cannot control.  We must remember to remain centered and remain “in the present” in order to achieve happiness.  Although providing perfect care is a noble goal–it is not attainable.  Be reasonable with expectations–always provide the very best of yourself to your patients and be satisfied with the fact that you do.

Happiness is critical to a successful and fulfilling career.  With sweeping changes in healthcare, many physicians are finding it more difficult to balance both success and happiness.  By applying these 6 unique principles and looking at the “big picture” it is my hope that all of us can continue to serve our patients, continue productive successful careers and remain satisfied and happy throughout our professional and personal lives.  If we are able to achieve the right balance then everyone–patients, family and YOU–will ultimately reap the benefits of a long and HAPPY career in healthcare.

Are You “Top Brain” or “Bottom Brain”? Implications for Healthcare Reform

Recent evidence suggests that they way in which we think and behave may be controlled by how well we use different systems within our brains.  In the past, the concept of “left-brain” versus “right-brain” has been accepted as a way to explain the differences in which people perceive and attack problems.  This theory is actually based on very little real science.  New evidence backed by years of neuropsychiatric research now suggests a completely different paradigm for how individuals process stimuli, respond to events and ultimately make choices and execute plans (aka behavior).  Certainly, no “system” in the brain functions completely in isolation from the others–but how we use them relative to each other significantly impacts how we may function as leaders and as members of a team.  Understanding the neuropsychiatric basis of thought and behavior can help us identify those destined to lead, those with creative minds for designing concepts, those that can see the “big picture”, those who can interpret and respond to emotion effectively and those who are adept at execution of tasks.  As we examine the current state of healthcare reform, it is evident that a more effective team must be assembled in order to achieve success.  Currently, the efforts in Washington are beginning to fall apart–the rollout of the ACA Exchanges has been a debacle.  The politicization  of healthcare has limited our ability to effect real reform.  Effective teams are diverse in composition and complementary in talents–they should not be based on political party affiliation.  As we develop a new healthcare system,the ability to place people in the positions best suited to their strengths is paramount in order to achieve the best possible patient outcomes.

This past week in the Wall Street Journal, authors Kosslyn and Miller, explore the way in which the brain processes information and how this process impacts our behavior and our ability to lead others.  Dr Kosslyn, a neuroscientist at Harvard, describes the new way in which higher brain functions are now thought to occur.  Rather than “right brain” and “left brain” cognition, new research divides brain functions into “top brain” and “bottom brain”.  Anatomically, the “top brain” contains the parietal lobe and the larger part of the frontal lobe.  The parietal lobe is known to manage input from many different sensory modalities and is essential in determining spatial sense and navigation.  The upper part of the frontal lobe is known to be associated with planning, recognizing consequences of actions, and short term memory actions.  In essence the frontal lobe is all about reward, attention and motivation.  In contrast the “bottom brain” consists of the occipital and temporal lobes (with a bit of the lower portion of the frontal lobe included).  The temporal lobe is important in storing visual memories, comparing incoming sensory input with stored information and processing emotion and language.  The occipital lobe is important in processing visual input.  Together, these “bottom brain” functions are utilized to compare new information with old and to apply meaning to our experiences and the world around us.

These two “brain systems” do not function independently–they work in concert and to differing degrees in different people.  The ways in which these two systems interact and function together may very well explain how some are effective leaders, others are creative thinkers and still others are more interpretive and can better understand and deal with emotion.  The authors theorize that the way in which we combine the “top brain” and “bottom brain” functions falls into 4 categories.  I found that these categories are very applicable to business and to medicine–many of the important functions of business committees and medical teams can be represented by each of these four cognition types.  However, it is important to note that although each type is different–none are better or more desirable than others.  That being said, each category of cognition may be more likely to succeed at a particular job or in a particular role on a team.  Successful reform of our current healthcare system will require the assemblage of a competent team of experts that will address the most pressing issues in healthcare today–each member should have different talents in order to bring new ideas to the table.  Ultimately, our job is to provide high quality, effective, compassionate care to our patients every single day–no matter what political party we endorse.  We must create a system that allows doctors to do what we do best–diagnose, care and treat.  I believe that by putting people in positions that play to their strengths and creating groups with complementary talents (by applying this new neuropsychiatric theory) we have a chance of actually achieving successful and sustainable healthcare reform.

According to Dr Kosslyn’s research individuals may be separated into distinct groups based on the ways in which they use the “top” and “bottom” brain systems: (Here are my thoughts as to how each cognition type may impact a team assembled to fix the issues with healthcare reform)

1. Mover:  According to the top/bottom brain theory, a mover typically uses both top and bottom brain in complementary ways.  Based on the situation presented, the Mover is able to combine input from both systems and respond to situations as they evolve by integrating inputs from both systems to varying degrees.  These people are well suited to lead others because much of what they do involves planning and then responding to the consequences of their actions and choices.  They learn from their mistakes and take calculated risks.  In our current healthcare crisis, Movers will be essential in crafting a system that will provide essential healthcare benefits for patients in a way that will not bankrupt the system nor deprive some of care.  Movers will adjust to issues with the website rollout and adjust plans (or delay individual mandates)  as the situation dictates (rather than press on with systems that do not work).  Movers will ensure that care will be based on good outcomes data supported by  randomized controlled trials. (rather than arbitrary government requirements for box checking).   These people excel at weighing the risks and benefits of a particular therapy and organizing others to execute the plan.  Movers in medicine are insightful and self aware–they work hard to improve outcomes and are able to adapt when things do not go as planned.

2. Perceiver:  These individuals tend to utilize the bottom brain in more diverse ways and do not rely as much on the top.  These people are adept at making sense of what they perceive and try to place their understanding of emotions or situations in context.  These people are essential in medicine and provide a broad view of the issues at hand–think “the 10,000 foot view”.  These team members do not usually create or execute plans–rather they provide insight and perspective.  They serve as essential advisors for leaders in healthcare reform.  They can provide candid feedback and help others see mistakes and shortcomings so that they can be corrected.  For example, “maybe we should delay the rollout of the exchanges given the fact that our software is not yet ready to meet the needs of those that will try to register this month”  Often these are the wisest members on the team.  The Perceiver will be essential to the success of any healthcare reform–the Perceiver will focus on success of implementation rather than meeting arbitrary deadlines and building a legacy.

3. Stimulator:  These people typically use the top brain a great deal but utilize bottom brain functions very little if at all.  These people are great at creating and implementing plans but are unable to learn from their mistakes.  They do not incorporate the consequences of their current actions into future plans.  However, these people are highly creative and think about problems in very different ways that others–in healthcare reform these people will come up with the ideas that ultimately may result in success.  The status quo and the “tried and true” will not suffice.  Healthcare reform is a daunting task and will take the efforts of those who think in extraordinary ways.  These people can be effective but MUST be held in check by a strong leader who can help to curb their enthusiasm at times.  However, thinkers of this type often produce innovative ideas that change the course of history.

4. Adaptor:  These people utilize neither the top or bottom brain systems in complex or analytical ways.  These individuals tend to be impulsive and respond to the situation at hand.  As the authors of the Wall Street Journal article state, they “go with the flow”.  They are, however, responsive and action oriented.  These types can be essential members of the team.  They are effective as “worker bees” and can accomplish a long list of tasks.  In healthcare reform we must have  these cognitive types–they are the workhorses that make the plans happen and accomplish the much needed day to day implementation.  (think website design and rollout)

How our brains function has much to do with how we behave in groups and how effective we can be in the care of patients.  In the past, we have separated thinkers into right and left brain–now, we have a better way to think about cognition.  The degree to which individuals utilize the top and bottom brain functions can determine the best role for them on a team.  A team cannot exist with just one type of thinker–all must play a role and all complement one another.  As we continue to struggle with healthcare reform, we must assemble talented teams of individuals in order to be successful.  Although it remains a highly political issue, we must rise above the politics and focus on the patients that we claim to serve.   We must utilize individuals from all four groups of cognitive types in order to improve care and create real reform.    Identifying the best people to serve on a particular team is critical–putting each individual in the best role for success is essential.

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The Power of the Pronoun (and Perception): Impacting Patients Through Building Effective Teams

Have you ever taken note of how much you or a colleague says “I” versus other pronouns?  The pronoun that you choose in conversation may very well provide insight into your psyche and may determine your effectiveness as a leader.  Current research has indicated that the frequency at which an individual uses the pronoun “I” speaks volumes about their self confidence, level of empathy and perceived status within an organization or group.  As physicians and members of teams of providers we function in groups in order to provide care to our patients on a daily basis.  How effectively we interact with patients, nurses, technicians and other providers may significantly impact the outcomes for our patients.  This research, which was published in Journal of Language and Social Psychology in the last month may provide important insight into how we can better function as physicians, team members and leaders in medicine.

The Wall Street Journal‘s Elizabeth Bernstein explored the potential impact of the newly published studies on pronoun use in her column just this week.  Researchers tested subjects in five separate studies and examined the way in which status or relative rank was reflected in the frequency at which subjects used the pronoun “I”.  The findings were quite interesting—those who used the pronoun “I” often felt subordinate or less sure of themselves.  In addition, those that used frequent “I’s” were more introspective, self conscious or in emotional or physical pain.  Surprisingly, those that were “full of themselves” and even narcissistic did not use “I” nearly as much.  In contrast, those that were more self assured, and possessed higher job status used the word “I” with much less frequency.  In a separate study, the use of the word “I” was also associated with those who were telling the truth–those who avoided the using it were found to be less genuine and were often hiding something.  When resolving conflict, psychologists have often encouraged those in group therapy to use the pronoun “I” when discussing conflicts and feelings.  For years, marriage counselors have advocated the use of the word “I” rather than the word “you” during feedback sessions as “you” is often perceived as more accusatory.

Confusing?  “I” think so.  But, as study author Dr James Pennebaker mentions there is an enormous misconception about the use of “I”– those in power or positions of authority do not use it more.  In fact, those that are in power were found to use it less because they seem to be more interested in looking out at the world and figuring out their next strategic move– while those in more subordinate positions were found to be  simply looking inward and trying to please others.

In today’s medical world, the focus on care is on the team (the “We”) rather than the “I.”  A major shift in approach to patient care has occurred in the last decade –individual disease states are managed by teams of caregivers composed of varying job titles, provider roles, and medical specialties.  Even physicians from varying specialties such as radiology and cardiology are working together to provide multidisciplinary approaches to disease management.  Discussions of best practice and hybrid approaches across specialities are now commonplace and are resulting in improved outcomes.  For example, at the University of North Carolina at Chapel Hill, we have created a Heart and Vascular Center where radiologists, cardiologists, vascular surgeons, cardiothoracic surgeons and heart failure specialists see patients together and develop care plans in concert–no longer are different specialties competing for cases and arguing over alternative approaches to management.  In our institution, care is becoming more streamlined and through cooperation and academic discussions amongst providers,  patients are receiving the best treatment options available essentially tailored to their particular clinical situation.

So, what exactly do we as healthcare providers do with this information from the pronoun study?  Admittedly, much of it is confusing (except to the Psychologists) but the bottom line is that we must pay careful attention to the pronouns that we use and how we may be perceived by both those we lead and those whom we follow.  As leaders and as team members, how we are perceived by others may be a critical factor in our ability to function most effectively and care for our patients at the highest levels.  High level, effective communication with patients, nurses and other healthcare providers is essential.  In addition, we must also take note of the ways in which others communicate in order to maximize everyone’s contribution.

What is the  bottom line?  Dr Pennebaker recommends that we all try to use “I” a bit more.  According to his work, it makes you appear more humble as well as more genuine and more engaged.  Using “I” allows others on the team to see humanness and vulnerability in their respected leader–this fact alone may provide more connection and more inspiration among those with whom you work.

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Exploring The Leadership Potential of Three Little Words: Applying “I Don’t Know” To Medicine

Recently I read an interesting article on leadership published at Inc.com.  Although most of the journal is focused on those in business, many of the pieces on leadership are very applicable to those of us in Medicine.  In this article author Curt Hanke writes about the inspiration and leadership positives found in the three simple words:  “I Don’t Know.”   On first blush, we may think that a leader speaking these words may no longer inspire confidence and may lose the support of his or her troops.  However, as Mr Hanke goes on to detail, the words “I Don’t Know” may provide inspiration and motivate teams to perform even better.

As physicians, we are leaders–we lead teams, we lead students and other trainees, and most importantly we lead patients.  There are times when we lead and guide patients and families on very challenging journeys through brutal, sometimes devastating diseases.  Often, being a good leader is the most important part of our job.  With leadership comes many responsibilities– and those whom we lead look to us to show confidence as we provide guidance in uncertain times.

As physicians are leadership roles are two fold:

1. We lead teams of caregivers with a common goal–the best outcome for our patients.  Our teams look to us for confident judgements during crisis (such as during a code blue) and guidance when making day to day clinical decisions.  Our teams are bright and capable.  Our team members are diverse both in training, ability and in education–nurses, physical therapists, pharmacists and other physicians–all working in concert to achieve clinical success.

2. We lead patients and families.  We are the experts in a complex field that is foreign to many–we are relied on as guides, as advisors as well as generals on the field of battle.  We must inspire confidence and show kindness at all times.  Our patients are often frightened and uncertain.  We must help them learn, grow and adapt to changing medical and clinical scenarios.

To lead in this way can be very challenging but is not terribly dissimilar from leading in the business world.  We must be prepared–with knowledge of disease and the best available therapies.  We must be aware of the strengths and weaknesses of each individual on our medical team (including our own) and we must be able to motivate those in very different roles to band together for common good.  We must lead patients and families with compassion–we must understand things from their perspective and apply their needs into the equations we use to make clinical decisions.  We must lead both groups with honesty.  We must be willing to say “I Don’t Know” when appropriate.

Then we must harness the power of “I Don’t Know” in four distinct ways (according to Mr Henke):

1. Creates Possibilities--As a leader, saying “I Don’t Know” in medicine, may create an opportunity to bond with patients, families and team members.  Having the courage to articulate your shortcomings as the leader may actually garner more respect and tighten bonds through your honesty.

2. Inspires Engagement–As a leader, saying “I Don’t Know” in medicine may provide opportunities for others to take center stage and bring forward ideas that they may have otherwise kept to themselves.  It allows others to think more creatively and inspires team members to find “ownership” in working to solve a particular clinical mystery or treatment problem.

3. Avoids Complacency–As a leader, saying “I Don’t Know” in medicine provides me with the motivation to learn more and to be better.  Not knowing the answer right away drives me to reflect on my particular skill set and take stock in what I can do better both as a leader and as a team member.  When the leader works to improve, it often inspires growth among team members as well.

4.  Inspires “Fun” During Difficult Times–As a leader, saying “I Don’t Know” rather than a positive effect on morale–A culture of “I Don’t Know” produces engaged team members and these engaged team members are more productive.  Ultimately a more productive medical team results in more positive patient outcomes.

Effective leadership is vital to success in both business and in medicine.  The most effective leaders know their own limitations and are not afraid to share that with the team that is inspired to follow them.  Courage to say “I Don’t Know” may be the difference in discovering the most accurate diagnosis and prescribing the most effective treatment plan for a patient and their family.  Be willing to admit when you fall short–as Socrates stated “The only true wisdom is in knowing [what] you don’t know”

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Obamacare Fuels Burnout: Running for Cover and Finding Nowhere Left to Hide

As the Affordable Care Act (ACA) is implemented this week, many physicians are beginning to take stock in their own professional and personal lives.  The practice of medicine is a privilege but it is also an occupation that can consume nearly all aspects of a physician’s life.  In the past I have struggled with my own “work-life balance” and I have shared my thoughts on burnout in my previous blogs.  As a healthcare provider, I am absolutely dedicated to my patients and their well being–However, with the new demands that the ACA places on physicians, it may be difficult for many healthcare providers (including myself) to continue to find balance. Loss of balance will ultimately increase physician burnout rates and place an already burdened healthcare system under even greater stress.

Physician burnout rates are currently at all time highs.  Symptoms of burnout include emotional exhaustion, feelings of depersonalization and a low sense of personal accomplishment.  According to a 2012 publication in the Archives of Internal Medicine, physician burnout occurs at much higher rates than other occupations.  In fact, American Medical News reported that nearly 50% of all physicians suffer from the symptoms of burnout.  Decreasing reimbursement, increased workloads and loss of autonomy have fueled much of the current discontent.  Now, the ACA will add millions of newly insured patients to the system along with more paperwork, restrictions and mandates/benchmarks in order to obtain better reimbursement levels.  I am afraid that many providers may be so focused on “checking boxes” for the government that they forget about the patients. Additionally, physicians will be asked to see more patients in less time.  As I mentioned earlier, reimbursement levels continue to fall and overhead costs continue to rise.  Many private practices have given up their autonomy and “sold out” or integrated with large health systems in order to survive.  Now, with the ACA, there are going to be more patients and thus more efficient throughput required in physician’s offices.  There will be a consistent need for additional staff to manage the increased patient volumes as well as the government mandated paperwork.  However, most practices are finding it financially non viable to hire additional workers. Ultimately, the shortfalls in staff affect the very people the ACA is established to protect–our patients.

In preparation for the implementation of the ACA, many practitioners are already making changes.  As reported on FoxNews.com yesterday, many internists are considering giving up their primary care practice in favor of boutique like practices that focus on hormonal therapies or weight loss.  As reported in Forbes in January 2013, one in ten physicians are moving into concierge medicine where they charge a limited number of patients an annual fee up front for 24-7 access to care.  One of the basic principles of Obamacare is access to care–unfortunately, many primary care physicians are leaving the marketplace just as demand is increasing to an all time high.  Physicians that leave traditional practice cite numerous reasons for their exit and many suffer from burnout.  Most of us who have chosen a career in medicine do so because of an interest in serving others–selfless behavior throughout one’s career.  Service to others in our daily practice provides enormous fulfillment and improves job satisfaction.  But now, with the ACA in effect, we are no longer able to spend as much time in the service of our patients–we spend more time with government forms, rules and regulations and are paid little or nothing for the increased administrative duties.  The ACA is now one of the primary drivers of healthcare provider burnout and will ultimately result in a physician shortage in the US.

The idea of providing affordable healthcare to all citizens is an important goal.  However, haphazard planning and rushed rollout will most certainly doom the ACA to failure.  Unfortunately for all of the uninsured, lawmakers (including our President) have focused more on legacy (and what the history books may say about their time in office) rather than on producing real healthcare reform that has a chance to succeed and serve those who need it most.  Key components of an effective healthcare system reform include provisions that satisfy the needs of patients, payors/insurers, hospitals (and other centers for care), as well as physicians.  Physicians and other healthcare providers are key components to the delivery of quality care–although it appears that our current reform has not accounted for nor planned for physician attrition due to burnout.  Failure to provide adequate resources and support for care providers will not only result in quality providers leaving medicine but may also discourage bright young college students from entering the noble profession of medicine in the first place.  As many physicians continue to “run for cover” there appears to be nowhere left to hide….

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