No Doctor in the House

The art of medicine doesn't matter anymore. All that matters is checking the right boxes and attaining some minimum customer satisfaction score.
The art of medicine doesn't matter anymore. All that matters is checking the right boxes and attaining some minimum customer satisfaction score.

I used to be a doctor.

Now I'm an Interchangeable Provider Unit.

And honestly, being one sucks.

After undergoing the rigors of medical school and a family medicine residency, I eagerly anticipated walking as a respected professional through the hallowed halls of medicine.

Instead, I find myself swimming in a tank with great white sharks. Which is how I became an Interchangeable Provider Unit.

Here's the pathogenesis of my transformation.

First, came the EMR system. I learned that if I checked all the right boxes, I was a good doctor. Conversely, if I didn't check all the right boxes I was a bad doctor.

Then there were the “metrics” that had to be met—such as achieving effective serum glucose control in diabetic patients, convincing patients who smoked to quit, and encouraging other patients to have colonoscopies.

Of course, these metrics don't count unless they're entered into the EMR—even though they're things I had already been doing every day of my life as a physician.

Next came the impossibly—and obnoxiously—unrealistic workload. I am given far more work to complete per week than I can manage in 80 hours, let alone 40 hours—with a compensation based on 40 hours.

And the work has to be done. If it isn't, management sends me nasty memos, along with my dreaded 'score sheet' showing me exactly how I compare to all the other doctors in the organization.

Trying to fulfill these impossible goals, I run from exam room to exam room, seeing as many patients per time unit as I possibly can. Patients get herded in and out like cattle, with management wielding the prod and not hesitating to use it on my “gluteus maximus” if I don't keep up.

No other doctors have been hired to help me out. I have no colleagues I can consult with on a difficult case, or who can provide moral support on particularly bad days.

You see, management discovered another way to save money—hiring more physician assistants and nurse practitioners instead of doctors. In the past, these people were physician extenders. But gradually they have become just another way to process more “cattle” through the clinic and maximize profit.

These physician extenders certainly don't help me with my heavy patient load. They have their own patient loads. In fact, I have to sign things for them that only a “doctor” can sign.

Many patients even call the PAs and NPs “doctor”—because they don't understand the very significant differences in our education and training. But, ironically, I'm not referred to as a “doctor” any more. Medical assistants and front office personnel regularly refer to me as a “provider.” So it's no surprise to see that's also what I'm called by health insurance companies and the government.

And now I am what it seems they all wanted me to be—a pithed, decerebrated and docile Interchangeable Provider Unit. Very much like Jack Nicholson at the end of the movie One Flew Over the Cuckoo's Nest.

Some people in medicine talk about being burnt out. I am so far beyond burnt out that I could star in the movie sequel, Toast 2.

All vestiges of my individuality as a doctor are gone. The doctor-patient relationship, once considered sacrosanct and inviolable, has been replaced by a computer that I type on while “seeing” the patient—frequently with no eye contact whatsoever.

The art of medicine doesn't matter anymore. All that matters is checking the right boxes and attaining some minimum customer satisfaction score.

I harbor no illusions. I know full well that I can be replaced at any moment by another generic-but-equivalent “provider unit.”

So now, when someone walks into the clinic asking if there's a doctor available, I just point to my badge and tell him or her that there's no doctor in the house—just an Interchangeable Provider Unit.

 

Dr. Joel R. Cooper, a board certified family physician in the Phoenix, AZ area, is a contributing writer for The Medical Bag.

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