Standardization May Not Provide the Best Patient Care

Physicians seem to be losing their professional status. As we become pushed to the side by non-physician administrators and government regulations that make little sense in real-world clinical medicine we are losing an important aspect of what makes physicians vital to healthcare. In a time when the economics of medicine has reclassified physicians as mere providers and relegated patients to being clients, the language now used to describe the physician-patient relation is full of business terms and increasingly lacks language related to meaningful medical care.

When physicians had private practices, they maintained control over the care they provided. Physicians could care for patients in ways that were not compelled by arbitrary quality markers put in place by lawmakers who had never stepped foot in medical school. They could refer to the specialist or facility that made the most sense for the patient in front of them, without being compelled to send patients to whatever provider the hospital system will make the most money from.

Patients rarely understand the complexity of the medical world; it's complicated and confusing. The system becomes more overwhelming when a patient is in the middle of a serious illness. As more and more physicians lose control over how they can take care of patients, it is the health of the patients that suffer. Insurance companies dictate medication choices, decide which imaging a patient can have, and which specialist may be seen. Large, faceless, multispecialty groups pour money into whatever venture will bring in the most dollars, whether or not that venture will provide a tangible benefit to patient populations.

Physicians have become cogs in the system. Calling us providers, we are suddenly interchangeable with midlevels with less education and less training. I appreciate the services offered by my physician assistants and nurse practitioners, but we are not the same. Legislature pushing for independent practice by midlevels shows how little law makers understand the complexity of medicine. A family medicine physician has eight years of schooling and then over 10,000 hours of residency training before she can become board certified; yet some states are willing to let nurse practitioners practice independently with only 3,600 hours of experience. Few patients understand this difference in training and no one steps up to explain it to them because it is less expensive if they don't know.

More than ever physicians are closing their private office doors and joining the ranks of employed providers. The flexibility of having vacation coverage, no longer having to manage the business aspect of an office, and more regular hours all play into that decision. Additionally, the time and economic costs associated with meaningful use, EHR maintenance, and administrative work are beyond what most solo or small group practices can manage.

I doubt the wave of employed physicians will reverse in the near future, but all physicians need to take back the practice of medicine. We need to pull together for the health of our patients. Until we take on the leadership and decision-making roles in our institutions, we will be plagued by the onslaught of restrictive regulations, impractical protocols, and intrusion of nonmedical administrators dictating what occurs in our exam rooms. Our patients deserve better than that. They deserve doctors who can practice the best medicine for them. We know that even patients with the same condition may need somewhat different treatment depending on other variables and the one-size-fits-all medical protocols prevent physicians from using our hard-earned education and training as it was meant to be.

I have been always been an employed physician. I see the struggle each day as my larger institution attempts to regulate multiple offices. They are looking for ways to make the offices identical products, without understanding that each office cares for a unique population and what works in one office may be impractical or useless to the patients in another office. While we should continue to encourage collaboration and sharing of ideas to improve all offices, in the end, we also need to accept that identical offices with rigid protocols may not serve our individual patient populations.

Ultimately physicians need to be at the helm of healthcare. We are trained for patient care. Our experience on the floors, in our offices, and with our patients is vital. When we are pushed around by executives looking only at the bottom line our patients end up with facilities that may not meet their health needs, and frustrated physicians having to explain to families that the appropriate treatment cannot be provided. We are the ones liable, but we are no longer the ones in control - and this needs to change. Anybody can check boxes on an EHR and do whatever the built-in clinical decision-making software says. Physicians have the training and experience to know that the software doesn't understand all the intricacies of patient care and most patients do not fit in those boxes anyway.