“Wherever the art of medicine is loved, there is also a love of humanity.”

–Hippocrates

Forty-seven years ago, I was accepted into medical school. I’m living proof miracles occur! My career was extremely rewarding and I never regretted the decision to practice medicine. But, to borrow from a well-known phrase, today’s ambulance is not your “father’s Buick.”

I would humbly submit that physicians are much like ministers in that they’re involved in the most intimate details of people’s lives, they keep private issues confidential (always!), and they’re often present when a life ends. There’s an implicit sacred trust.

I fear, however, the medical profession is now like the legal and political professions: Folks love their doctor, lawyer, or Congressional representative, but they aren’t particularly fond of how the respective groups operate.

One big problem: corporate medicine. Many decisions today are made at the administrative level and not by the physicians who know how to run a practice. I saw this coming years after I joined what was then termed a “physician hospital organization.” I loved that organization and they treated my partners and me well, but things slowly changed as years went by.

While they mean no harm, non-physicians are making decisions based on economies of scale, reimbursement maximization, price negotiations with insurance companies, the bottom line, and the strategic placement of physicians, irrespective of the location’s proximity to his or her patient population.

From my first office location where I practiced solo–now practically an anachronism–to the final location, all five offices were geographically clustered within a two to three mile radius. Today, physicians are sometimes moved from one practice to another to start a satellite or shore up an office that’s not doing well, with no consideration as to how that inconveniences their patients and disrupts continuity of care–a time-honored feature of primary care.

A close friend and medical colleague of mine bristles at the term “provider.” As he opines, “I knew we were in trouble when we were no longer ‘doctors.'” He then adds, “I didn’t go to provider school; I went to medical school.” Providers can mean physicians or osteopaths, physician assistants, and nurse practitioners. All have their place and most perform their roles admirably … but sometimes don’t you just want to see your doctor, for Pete’s sake?

Much like the frog who didn’t jump from the pot of boiling water because the temperature was increased gradually, the day-to-day practice of primary care slowly but tremendously changed. First, there was the concept of hospitalists. These are docs who manage the care of hospital in-patients. The idea was sold on the basis of immediacy of care on a twenty-four hour basis. But their shifts change and it’s a guessing game as to who will walk in next to make rounds.

Second, most office-based primary care doctors no longer make hospital rounds. That gives them more time at the office, expands their schedules, increases their number of “encounters” (previously called patient visits), and helps the bottom line. The only way they know what transpired during your hospitalization is by reading the hospital discharge summary–because they had no involvement with your care during your hospital stay.

Furthermore, when do you most want to see your actual doctor? When you are the sickest, of course! He or she knows your history, knows you, and often knows your family members. This is especially true in pediatrics and family medicine.

This is not an indictment of physicians, but rather a commentary on today’s healthcare system. Medicine is still an honorable profession and most physicians work so hard that they’re subject to stress and burnout–again, resembling ministers in that regard. I am grateful for the care I receive from each and every one of mine. But that personal touch in our “provider” interactions is lacking.

To be fair, doctors are burdened by rules, regulations, and boxes to be checked in the electronic record, and sometimes that darn computer gets a lot more eye contact and attention from the doctor than the patient does!

This begs the question, “So, why did I and so many of my colleagues join a corporate system?” Simply because it was obvious it would become more and more difficult for an independent physician, practicing solo or in a small group, to survive.

I don’t see us ever going back to the way medicine was once practiced. We’ve strayed too far from that model to imagine it could change. It’s now big business. Maybe I’m wrong and the pendulum will swing back to more and more independent physician practices. I hope so.

But here’s what each of us can do: talk to and ask questions of our doctors, expect and demand accountability from them, and advocate for our own health. Doctors can only do so much. The simple advice of good nutrition, regular exercise, and adequate sleep still holds true as the best medicine, and each of us remains in control of those practices!