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The Physician Balancing Act


My office is understaffed, overworked, and I'm drowning in paperwork. I do not have time for vomiting.

The balancing act of medicine never gets easier. This week my youngest child threw up lunch at school necessitating an unexpected pick up. I received this call as I sat in my office with a social worker that had come down to my office with concerns for a young set of parents. I provide care for the mother and the couple's one-year-old son. My desk has a stack of paperwork for disability, medical necessity, and insurance prior authorizations on it. The office notes from the morning have yet to be completed. As an employed physician I have less control with how my office runs and it seems we are always running behind. We are short staffed and there's a hiring freeze, leaving limited possibilities for replacing staff. My patients suffer with long hold times on the phone, missed messages, and delays in referrals. My staff feels burnt out and underappreciated. I feel obligated to take on extra work to keep everything running as smoothly as possible. I do not have time for vomiting.

I know many physicians feel this crunch. I have do not have the autonomy that my private practice colleagues seem to have, but I have no experience in the business aspect of medicine that I rely on my employer to take on. All of us are feeling the pressure of every imposing regulation and demand from Medicare, Medicaid, and private insurance companies. Patients demand more drugs, more tests, and more instant cures. Few of my patients seem willing to take responsibility for their part in the determining their health. I am the bad guy because I cannot reverse the damage caused by years of uncontrolled diabetes or provide an instant cure for the obesity that doesn't require diet or exercise. Patients read up on their symptoms and assume that they have every "zebra" in the book. While I appreciate it when they take an interest in their health, I struggle when they cannot accept that not every source on the Internet is reliable. I do not have magic pills that will take away every ailment and a whole body MRI demanded for a head cold is not warranted. The goal of partnering with my patients to improve their care is often frustrated by their inability or unwillingness to make changes, comply with medication regimens, or simply show up for their appointments. But partnerships are still important in all aspects of medicine.

A partnership with my spouse ensures that the children are cared for, even if I cannot leave an afternoon of patients. Partnering with my office secretary eases the burden of obtaining records, making sure follow-up appointments are scheduled, and the seemingly endless mounds of paperwork are faxed appropriately. Working together with my clinical staff helps me identify ways to improve the work flow, and moving patients through efficiently without compromising care.

Yet this is not enough. I find that the partnerships I need most are with other physicians. Even though I work in a group practice, I find more and more that I am isolated in my struggles. There is a stigma in saying this life we live is hard. We are often trapped in the regulations and feel helpless to change them. Physicians are burdened with red tape and need to find ways to cut through it. For some there is benefit in specialty associations or hospital committees, but this does not seem to be enough. How do we find allies in the regulating bodies to help us stop putting roadblocks in the way of patient care? How do we effectively fight back against unwieldy insurance companies and their ever-changing formularies? What are the ways to put physicians back in charge of patient care? Employed physicians seem to have so little say and private-practice physicians seem increasingly isolated. We need to get back to that point when physicians direct medical care, because we were the ones trained and experienced in it. Somehow we need to find a better balance in patient care because, as I see it, physicians are no longer the driving forces. We need to get off the sidelines and take back the care of our patients from hospital committees, insurance companies, and eliminate government regulations that don't make sense to our patients or their health.

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