Over the last few years much has been written and said about the problems facing physicians within the American Healthcare System. The purpose of this particular post is not simply to further define those problems, but to offer a logical solution. The title of this writing is also the “Mission Statement” of my own practice, and the action being suggested is one I have personally employed.
Throughout the western world, universal healthcare has become a touchstone for the progressive, socialist movement. It is after all, relatively easy to argue that everyone deserves access to medical care when they are sick or injured; it is simply the humane thing for a society to provide. But, once the state defines healthcare as a basic human right, they are then faced with the challenge of allocating adequate resources to ensure that everyone has access.
Proponents of “universal health coverage” argue that there are only two viable choices, either mandate that everyone purchase insurance, as called for under the Patient Protection and Affordable Care Act of 2010, or have a government run single payer system where healthcare is paid for through taxation of the population. But a “one size fits all” healthcare system has proven to be unworkable. Even in mature socialized system such as the National Health Service in Great Britain, a significant private healthcare system has emerged. This is analogous to the rise of private schools in America, despite the fact that public education is available and essentially free to everyone. This is obviously a natural phenomenon based on individual expectations and the will to control one’s own destiny.
Another major challenge to various attempts to manage individual healthcare from the top down is the independent behavior of those who actually provide the care. Government bureaucrats and insurance executives have assumed “providers” can be controlled through financial incentives, corporate directives, or government mandates. What they failed to consider is that physicians will consistently attempt to resist doing or not doing things that are contrary to their training and their professional ethics.
Physicians are by nature inclined to put the interest of individual patients ahead of their own, or those of the payer; a concept that is vital to the establishment and maintenance of a meaningful patient-physician relationship. But in recent years, economic motivations and not so subtle pressures from elements of the “third party payment system” have gradually drawn many physicians away from their most basic obligation, like sailors to a sirens song. Such conflicts have created a loss of practice satisfaction, anger and frustration, and a practice environment where many physicians have opted for an early exit from the profession they spent a lifetime pursuing.
Perhaps the best evidence of this changing paradigm is observed simply by calling a physician’s office to arrange an appointment. The first question you will likely be asked is “What kind of insurance do you have?” Healthcare has become all about payment, yet patients rarely even ask what it costs. The system has insulated patients from the payment process, while at the same time doctors who participate in Medicare and Medicaid, or who work under insurance contracts, have virtually nothing to say about how they are compensated.
So what’s the answer? The only logical solution is for physicians to take the lead by returning to their professional roots. This means independently treating their patients according to their knowledge and training, and then looking to the patient for appropriate payment for those services. The ability to truly serve as the patient’s advocate can only come when the contractual bondage to outside payers is broken. As long as physicians continue to sign contracts with entities other than their patients, their true allegiance will be questioned.
The solution is therefore not an AMA solution, or a legislative solution, or a specialty society solution. It is an individual physician solution, which requires a personal introspective analysis. Such self-examination is certainly difficult and the issues are obviously complex. In the end, each physician must decide for himself or herself whether or not a divided allegiance is being used to “manage” the care they provide.
I’m not so naive as to believe that America’s physicians will suddenly receive a collective epiphany, leading to a mass exodus from the insurance roles. The fact is that most physicians are in one or more business relationships that may prevent them from taking such action. Others will not be willing to risk the loss of their financial security, based on “guaranteed” insurance payment. Thus, for a variety of reasons, truly independent physicians are likely to remain a relatively small minority well into the future. But over time they will differentiate themselves by appealing to those patients who recognize the value and wisdom of controlling their own healthcare decisions.
Some will argue that by opting-out of insurance contracts physicians are actually promoting a two tiered healthcare system. Perhaps that is true, but like it or not some consumers want the opportunity to choose from a group of independent physicians rather than being compelled to accept whomever happens to be “on duty” at the local clinic. Certainly the majority of Americans will continue to accept whatever providers are available through their insurance carrier’s network or government program. But, these two options are indeed complementary in an overarching system which seeks to provide healthcare to everyone according to their own choice.
To meet the expectations of a growing consumer-driven, private healthcare system, independent practitioners must work to re-establish a level of trust that has been undermined in recent years. It is time for a new and more modern independent physician’s pledge; one that considers both the rights of patients and the rights and obligations of physicians. To be relevant, this pledge must address the specific challenges of today’s complex world, while at the same time reaffirm the traditional ethics that made the practice of medicine an honored profession over the centuries.
The Independent Physicians’ Rights and Obligations Pledge outlines a new covenant between physicians and their patients based on “mutual trust, mutual respect and mutual responsibility”. Any physician who is considering breaking the bonds of third party contracts should embrace this pledge as a new contract, entered into directly with each patient whom they are privileged to serve. Each physician should also consider this pledge as their personal commitment to the renewal of their own SPIRIT as they continue to pursue professional excellence.
The Independent Physician’s Rights and Obligations Pledge
As an independent practicing physician I hereby acknowledge my role is central to ensuring quality care for all patients. I further recognize the potentially disruptive nature of outside influences on the patient-physician relationship, including various methods of payment. Through this pledge I hereby reaffirm my unconditional commitment to my patients, my colleagues and my profession, and to maintaining my SPIRIT as a physician.
I pledge, to provide personal healthcare to all those who I am privileged to treat, in accordance with my training and experience with a spirit of Service.
I pledge, to uphold, defend and perpetuate the time-honored ethics of the medical Profession.
I pledge, to conduct my practice with openness, honesty, fairness and personal Integrity.
I pledge, to keep the time-honored patient-physician relationship based on mutual trust, mutual respect and mutual Responsibility.
I pledge, to establish just and appropriate fees for the services I provide, treating all patients fairly and with compassion, free from any third party attempts to influence my professional judgment or Independence.
I pledge to work within the community of physicians to ensure the medical profession remains self-regulating and self-governing with respect to education, training, quality assurance and peer review, according to our time-honored Tradition.
Now, before all who are my witness, I accept and embrace these fundamental rights and obligations freely and without reservation, and declare my willingness to abide by them to the best of my ability.