Shouldn't We Just Accept That Healthcare Isn't Changing Anytime Soon?


Physicians have been frustrated with the healthcare system for years. 

There are many reasons for this frustration - persistent declining reimbursements, loss of physician autonomy, increasing regulations, prior authorizations, denials, failure of the system to put the patient's interests first, malpractice judgements, etc.

Those are just a few of the reasons, and that's a pretty significant list.

Physicians complain on social media. LinkedIn especially has become the place for physicians to air their grievances.

And the grievances are real and substantial.

Some have discussed these issues with members of Congress.  Others have tried to exert influence through state and national medical societies.

And all physicians can relate to these issues.

But, what has any of that frustration, attempted influencing, or complaining accomplished for physicians?

Nothing!

When will physicians stop complaining and take real action?

Just face it, healthcare isn't changing in any meaningful way.

And if any major changes eventually occur, it won't be in our lifetime.

So, in my opinion physicians have only four options.


1.  Switch to a Direct Care model.

Some physicians have done this.

They have opted out of Medicare and stopped taking insurance. 

Most report it being difficult at first, but then generally, most acclimate and like it.  

This doesn't work well for every subspecialty. Especially some of the surgical subspecialties.  It is difficult to be an expert in one or two procedures like a surgical subspecialist while limiting the patients who are willing to see you because you don't take insurance or Medicare.

So, most surgeons who have converted to DPC tend to be generalists who do all types of surgeries in their field and not subspecialist experts in one or two procedures.

The majority of physicians who choose this model are Primary care Physicians.

It is a reasonable option for some.

Usually, your income decreases but so do your expenses, so the net revenue may not be much different from your current revenue. 


2.  Reach financial independence but keep practicing.

The main frustration and complaint of physicians is related to compensation.

They just don't feel adequately reimbursed for the work they do nor the risks they take.

They see the numbers for the revenue they generate, but relatively little makes it to their wallet. 

So, the better option is to create or acquire other streams of revenue outside of your practice. 

The goal is to have enough additional streams of revenue that you don't need the revenue from your practice.

Then, if you choose to keep practicing, you can choose how busy you want to be, which patients you will see, and which procedures you will perform.

Then, you can have the practice you want. 

You can care for patients and not feel rushed.

You can take time off without worrying about your expenses.

You can eliminate burnout.

Whatever you ultimately decide to do about healthcare, you should work aggressively toward financial independence. 

Being financially independent allows you autonomy, more time, and more choices.


3.  Band together and form a union.

There are unions in lots of different industries.

There are even some in healthcare, but these are usually nurses or residents. 

Practicing physicians do all the work in healthcare but have the smallest voice and the least representation.

For many years physician unions weren't considered an option because unions are only for employees and not employers.

However, now that over 70% of physicians work in an employed model, what keeps you from forming a union?

Nothing!

Yet, if you choose to join a union, you have to be prepared to go on strike.

Strikes happen in other industries.  And they are usually successful, because the union members are specially trained and not easily replaced.

Therefore, the owners ultimately have to negotiate and meet demands.

You as a physician are specially trained and not easily replaced. 

Yet you alone or in relatively small groups have no leverage.

So, form a union. 

Exert your influence.

Yet, many physicians worry about actually walking off the job and going on strike.

The concept makes you feel like you aren't being true to the Hippocratic oath, doesn't it?

Most often, just the threat of a strike leads to renegotiated wages and contracts without the workers actually walking off the job.

And, physicians can still staff the ERs and trauma centers, so true emergencies can still be cared for.

So, strikes can occur without patients being abandoned.

And again, most often, just the threat of a strike works without the strike occurring.

Who will lead this movement?

Who will initiate this large scale organization of physicians into a union?

It will work.

Isn't it inevitable?

Then, get started!


4. Quit practicing completely.

Another option some have taken is just to quit practicing completely.

Some have retired sooner than planned because they were fed up with it.

Others were not financially ready for retirement. They were just fed up.

So, they quit, and went to work in another field.

Some have quit practicing but stayed in the healthcare field.

There are lots of nonclinical jobs available for physicians.

You physicians are smart people.

You have skills such as communication abilities, problem solving abilities, writing skills, sales techniques, marketing experience, etc.

You can transition to other types of work.

It isn't what you envisioned when you went to medical school, but it can be done.

For some, it has been the best decision they made.


What will you do?

Doing nothing is not an option!

Doing nothing and continuing to complain is the definition of insanity.

So, choose your path and get started.

And the sooner you do, the better your life will be!



​Ben Holt, M.D.