Physician Advocacy: The Time is Now

Healthcare is an industry that touches everyone. While only some of us work in healthcare, eventually everyone is a patient. Even prior to the novel coronavirus pandemic, the U.S. had more than its fair share of healthcare problems. Despite some of the highest healthcare prices in the world, we do not have quality scores commensurate with these increased expenditures. No matter who you ask, everyone has an opinion on how to solve those problems. Despite physicians’ expertise in medicine, our voices seem increasingly lost as we struggle to find solutions. If we want to improve healthcare in our state and our country, we’re going to have to get involved.

While I have long since lost the attribution, one of my favorite quotes is: “Every physician has two jobs. One is the practice of medicine. The second job is to improve job one.” Job one has been pretty stressful lately. Physician burnout rates in the mid-40 percent range, and the highest suicide rate of any profession, are symptoms of the increasing stress being placed on our profession.^1,2 Increasing administrative and electronic medical record (EMR) burdens have led us to step away from medical associations and advocacy. As we’ve made changes to try to “survive” the current healthcare landscape, we’ve let go of job two.

I know what it feels like to be overwhelmed. Several years ago I felt like I only had enough time and energy to take care of my patients and my family. I was doing my job, and that was enough, right? Two years ago, the data that indicated that physician suicide was the highest rate of any profession was published. I remember reading the press release for the study and then turning back to continue charting at work and then stopping because I was horrified. I had read something that should have been shocking, but I wasn’t surprised. Around that same time, I had to renew my medical license. I thought about my patients who were also physicians and how reporting was a barrier for mental health treatment. I realized that my anecdotes were consistent with the research and that we needed to change the disclosures to be less invasive. Every physician I talked to agreed.

At first I felt alone standing up and saying we needed to change the rules. But the physicians who needed this rule change the most were unable to speak up. After a lot of work, eventually we had a coalition that included the South Dakota State Medical Association, Avera, and Sanford. As a result of that work, as of May 5, there will be no more questions about mental health history. Instead, the disclosures will only ask about current impairment for any cause. The decision about seeking treatment for your anxiety disorder will no longer have to take into consideration concerns about how reporting will impact your ability to practice. You will no longer have to get a letter from your own physician certifying you’re safe to practice even though you have major depression. This change wouldn’t have been possible without physician advocacy. But my voice alone wasn’t enough—this change wouldn’t have been possible without the combined support that comes from organizing.

Physician advocacy will be increasingly essential in the coming days. The stress we’re all experiencing related to the COVID-19 pandemic is taxing an already taxed system. Changes will need to be made. In order to make sure we make the right changes, we will need to stand up for our patients, the healthcare industry, and our profession as physicians.

Given the current economic climate, more than ever patients will need us on their side to make sure their care is affordable. Our patients need us to advocate for innovative approaches to social determinants of health and healthcare disparities. The most vulnerable people among us come see us for their care, and we are uniquely positioned to stand up for them. They will continue to need our voices to be heard in ongoing issues with mental health and suicide, chronic-disease management, and opioid abuse.

The current pandemic has cast new light on multiple issues in healthcare that need our attention. For example, in 2019 we saw more rural hospitals close in a year than we’ve seen in over a decade.³ COVID-19 has changed the way we do business and exacerbated concerns about the financial solvency of providing healthcare. Many of these issues are bigger than the solo practice, physician-owned group, or healthcare system you practice in. Some of you may be wondering, why do I need to contribute my voice? I would ask you in return, who knows how to do your job better than you do? I think all of us know what it’s like to be handed a new rule or government regulation that wasn’t going to accomplish what it was intended to. Don’t cede all input to people who have never taken care of patients. No one understands the frontlines of healthcare better than those who work in it.

Your colleagues need your advocacy too. While we have a pretty good track record for standing up for patients and their care and safety, we haven’t been as consistent about taking care of each other. The coming days are going to be stressful for all of us. It isn’t enough anymore to just be heard when issues directly impact your own practice. As we’ve seen before, sometimes the people who need help the most aren’t able to speak up.

Standing up for each other also means standing with each other. And that level of coordination requires structure and organization. Please consider supporting your local, state, and national physician organizations. If you agree with their positions, your voice makes those positions stronger. If you don’t agree, then your voice is needed to help make changes to better represent physicians. Complaining to each other in shared offices or in hidden social media groups won’t actually fix any of our problems. Physician advocacy matters more than ever. Please add your voice. If not now, then when?

Dr. Barnes has been a member of the SDSMA since 2011.

References

1. Kane L. Medscape national physician burnout and suicide report 2020: The generational divide. Jan 15, 2020. Retrieved from www.medscape.com/slideshow/2020-lifestyle-burnout-6012460#1.

2. American Psychiatric Association. 2018. Abstract 1-227, presented May 5, 2018.

3. Chartis Center for Rural Health. The rural health safety net under pressure: rural hospital vulnerability. Feb 2020. Retrieved from www.ivantageindex.com/wp-content/uploads/2020/02/CCRH_Vulnerability-Research_FiNAL-02.14.20.pdf.