Original article published in medium by the author
My recent article on corruption in the medical industry promoted by trade unions such as the texas medical association is just one side of the coin.
The latest casualty of corrupt trade unions colluding with the insurance industry is doctors. Ask any practicing physician who is willing to talk about their challenges will list the following.
- Redtape, Insurance Paperwork & ability to provide care
- Burnout & Debt
- Uncaring Medical Unions
Challenge 1
It’s a common opinion among patients that their doctor does not spend enough time. A deeper dive into this will shine a light on many issues plaguing the industry. Contradictory to many beliefs, doctors are not free to practice medicine. If what I say looks contradictory, Pay close attention during your next checkup with your primary care doctor. You will see a pattern emerge.
Doctors have to constantly balance your care with what the insurance industry accepts as approved care. Doctors have to ensure that the medicine prescribed for a condition is covered. This is especially true in HMOs. Insurance providers have specific deals with the drug industry and formularies. These deals are a source of constant churn resulting in drug coverage changes. For the patient, this means medicine and dosage change. No wonder adherence to medicine consumption is a challenge in our country.
Procedures are another source of paperwork. To increase their profit, the insurance industry has effectively outsourced their paperwork to individual doctor’s offices. It falls on the staff to do the work on network providers.
The most horrible fact is that doctors are forced to decide what is practical vs. what is best for the patient. This is where the myth of our high-quality care starts evaporating. Pharmacies are not helping either. In a bid to keep the sales machine rolling, they hound doctors with refill requests.
There is only so much time left after the insurance paperwork, keeping track of churns in practicality, and dealing with testing providers/pharmacies.
With so much red tape, process and pressure, it’s clear why it is so hard for physicians to provide care.
Challenge 2 Debt and Burnout
Now let’s take a look at the economics behind this—an average student graduate medical school with at least 200,000 dollars in debt. This is at the time of graduation, but this does not even guarantee an income that can service the debt at a minimum.
Students who do not get to go through a residency often carry their medical and undergraduate debt longer, ranging from $200,000 to $500,000.
They end up working in other roles such as physician assistants, nurse practitioners, and midwives. In light of this, the Texas Medical association’s argument that nurse practitioners should not practice look shaky at best.
Challenge 3 Uncaring Medical Associations
Medical unions have been apathetic to the plight of their members. If we look at the role of medical associations in the regulating health industry, it is clear that they are effectively colluding with the insurance sector. We are yet to see regulations or proposals/efforts to address any of these issues. Instead, we see these trade unions, such as Texas medical association, actively campaign against progress. For example, reducing the paperwork burden alone can significantly improve the burnout rate.
Based on 430 hours of observation, 49% of physicians’ office hours were spent on EHR and desk work while 27% was spent directly with patients. When meeting with patients, physicians spent 37% of their time on EHR and desk work. After office hours, physicians worked a mean of 1.5 hours per day, with most of that time dedicated to EHR tasks.
At this point, one has to suspect that these medical associations are corporations that need these problems to exist to justify their continued presence. They are putting up regulatory obstacles instead of advancing their communities.
Outcome
Doctors are fleeing the medical field in droves. The Association of American Medical Colleges (AAMC) reports that the United States is likely to need an additional 42,600 to 121,300 doctors by 2030. AAMC also projects an even more significant shortage of primary care physicians. Data indicates a shortfall of 14,800 to 49,300 of these doctors by 2030. Despite all these, there is zero effort on fixing the underlying market manipulations
Something needs to be done. We need to bring the free market forces to bear and break the monopoly that’s destroying our healthcare workforce physically, mentally, and financially.
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Notes & References
- https://www.nerdwallet.com/article/loans/student-loans/average-medical-school-debt
- https://www.kevinmd.com/ is an excellent source from a physician’s perspective
- https://www.health.harvard.edu/blog/physicians-paperwork-and-paying-attention-to-patients-2016103110558
- https://www.jwatch.org/fw111995/2016/09/06/half-physician-time-spent-ehrs-and-paperwork
- https://educationdata.org/average-medical-school-debt
Parvathy Sukumaran 
