Dear Dr. Price,
Congratulations on your upcoming appointment as the new Health and Human Services Secretary under President Trump. As a physician myself, it's great to know that a fellow physician will head up the agency. I'm sure you understand too, having been a practicing orthopedic surgeon, how disheartening and frustrating it is to have non-clinical “experts” making key decisions about health care.
I'm sure you've also seen the news about how your nomination has divided the physician community. Nevertheless, you do have the full support of many of our nation's top physician organizations, including the American Medical Association.
I am all for physicians taking leadership positions in health care, industry, and yes, politics. Your resume is hugely impressive. I'm aware of many of your viewpoints, and in the interests of being completely honest, am not in agreement with all of them—as I'm sure is the case for a large percentage of the over 800,000 physicians in the United States, particularly if you ever propose changes that risk any of our long suffering patients losing access or having the end result of making health care more unaffordable for them. Having said that, I am glad with your consistent wish to put the “doctor-patient relationship” first. Nobody needs to tell you what has gone on over the last decade and how the practice of medicine has changed for the worse. We need to consider the following 5 points to make American Health Care Great Again:
1. The cost of our health care system is simply unsustainable, as we've known for a very long time. Both total cost as a share of GDP and individual cost to the patient. Everything we do has to keep this in mind. Patients can't keep seeing their expenses rise and access limited. That applies to all our citizens.
2. The frontline of medicine has been decimated by excessively onerous regulations. While we certainly need to maintain high standards and raise quality, there are better ways to do it than lumber our physicians (and nurses) with ever more “tick boxes” and layers of expensive administration. Ask some of your physician colleagues, Dr. Price, how much time they are now spending staring at a screen instead of being with their patients? Meaningful Use, whatever its intentions, has caused something of a catastrophe because of suboptimal IT systems that we are now forced to use and spend the majority of our day navigating.
3. Let's keep our independent physicians. The last decade, due to central policy, has heavily favored large health care corporations over independent physicians. These fine doctors, who have traditionally been the backbone of our health care system (such as the good old-school country doctors) now find it impossible to practice independently. Did we need to alienate them so much?
4. Let's foster a health care system that favors doctors (or nurses, or indeed any other health care professionals) in positions of leadership. The move towards corporate medicine and consolidation, has done quite the opposite. The number of non-clinical administrators is exploding, while the number of practicing physicians appears to be drastically shrinking! At the same time as encouraging those physicians who want to lead (such as yourself), let us also address issues that will help put more doctors on the frontline, including practice environment and spiraling medical student debt.
5. As you've already said time and again, we must always remember that it's all about the patient and their doctor. This paradigm is central to all health care systems. True patient-centered care. When we promote a system that understands this, we will be able do many more things—including strengthening our primary care sector and focusing on prevention rather than cure—all while offering patients the freedom and choice that they need with the fewest barriers between them and their doctor.
As much as we need to improve, let's also not forget all of the great things about American health care. We have the most amazing doctors and nurses, and lead the world in innovation and research. We can maintain our high standards, while still giving our patients the best possible deal at much lower costs. We can also make our system a great one to work in for our hard-working doctors. This health care ship can still be reversed—especially by the collective efforts of those physicians who all started off with the same call to service and altruistic intentions that you probably did too.
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.