Dear American Physician,
The changes in the landscape of the American healthcare system have called for some drastic changes in thought, process and execution over the past 10 or so years. We have seen the invasion of computers into the medical landscape, the loss of autonomy as insurance companies require us to ask them for permission to provide care to our patients and a drastic change in who works for whom and how the American healthcare worker is paid.
In the middle of all of this, many Physicians are choosing to retire, leaving a significant shortage of physician providers to care for the masses in this country. Emerging onto this landscape in the past 40 years is the "Mid-Level Provider". The Physician Assistant and the Nurse Practitioner are poised for growth's in their fields unprecedented in the history of healthcare. With this advent, the American Physician is concerned about how their jobs are going to change. Will the Doctors act as team leaders, managing groups of Mid-Levels. Will they act as consultants for the more difficult cases while the Mid-Levels focus their visits on "Healthcare Maintenance", or something else? In short, the American Physician is wondering if they are going to be "replaced" by someone who has less education and makes less money, making them more attractive to business.
I hate to let the cat out of the bag, but the biggest elephant in the room no one is talking about is that you have already been replaced! A physician preceptor once told me that some day, the actual practice of medicine would become the easiest part of my day. I have found this to be true. The place you have been replaced is not by lessor trained providers seeing your patients.
YOU HAVE BEEN REPLACED FROM ABOVE, NOT BELOW! You were in a unique position to guide healthcare organizations into this next century. Instead, you have given up that job to less trained Healthcare Business Managers! That's right. The CEO of your local hospital, The CFO of the local insurance. The business management staff of the medical group YOU own part of. This has reduced the leaders of American Healthcare to "EMPLOYEES". In a recent article in Medical Economics Magazine, the recommendation was made that Healthcare Organizations NOT hire physicians to the business management staff. The reasoning was that they will think too much about patient care and not fiscal responsibility!
Yes it's true. You have been replaced. The CEO used to respect the Medical Chief of Staff. Not anymore. It's all about business and acceptable risks. Is it worth risking a lawsuit so that you can save $100,000 by denying a life saving procedure? What's the likelihood of a law suit? Can we settle for less than the procedure would cost us? These are the questions a Healthcare Business Administrator asks that a physician would never consider!
So the next time you feel like a "Mid-Level Provider" is stepping on your toes, remember, if we wanted to be Physicians, we would have gone to Medical School. (Every Nurse Practitioner or Physician Assistant I have ever met would have been more than capable of graduating from Medical School). Remember, we are on your side! We want the best for the patients in our clinics just like you do. You need to fight to reclaim your role as the Director of the American Medical landscape. We need you to set corporate policy, work with politicians to insure that the patients of this country are being cared for in the manner that is correct and proper.
We need to return management of healthcare to Physicians! Remove the decision making from those that only care about the health of the corporate finances! YOU need to return to your rightful positions as the leaders of this field!
And when you look around, we will be right there, supporting you in your efforts to provide high quality medical care the OUR patients!
Sincerely, your colleagues, your local PA/NP
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