AAOS Now

Published 8/1/2009
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Stuart J. Fischer, MD

Who can find a happy physician?

Around the world, physicians are under attack

Have modern health care changes affected the doctor-patient relationship in your practice? A new book by a private research group may give you something to think about.

Physician Disempowerment: A Transatlantic Malaise is based on a symposium put together by a nonprofit think tank, The Center for Medicine in the Public Interest. It brings together experts from both sides of the Atlantic who offer their opinions on why physicians are unhappy and how it that impacts the delivery of health care in their respective countries.

The experts are from Great Britain, Canada, Sweden, France, Switzerland, and the United States. Most notable is Francois Sarkozy, a pediatrician, consultant, and brother of the President of France. Each of the speakers discusses the healthcare system in his country. The general consensus is that public systems place multiple constraints on physician practice and thus cause physician disempowerment.

The editor, former USA Today editorial writer Mark Crane, notes that even though other systems are held up as models for reform, “Americans actually know very little about health care systems in Canada and Europe.”

Among the interesting facts that come to light in this book are the following:

  • Private medicine is starting to take hold in Sweden, a largely socialized country.
  • In Canada, 5 million people do not have a family doctor, and physicians are so overworked that they are using lotteries to trim their practices.
  • Swiss doctors have gone on “pencil strikes” where they treat patients but refuse to do paperwork.
  • Switzerland has a ban on new private practices until the year 2010.
  • The use of off-label oncology drugs is becoming more common in the United States.
  • In Great Britain, where government agencies determine cost-effectiveness of treatment, 24 million people in one year paid privately for some part of their medical care.

Physicians are unhappy because they are disempowered. They have lost their independence and are besieged by practice guidelines, drug formularies, profit-driven insurance companies, government interference, and endless paperwork.

In Great Britain, the National Institute for Health and Clinical Excellence determines what drugs and treatments will be provided by the National Health Service. Even if a drug prolongs life for years, it may not be available because it is not cost-effective. In the United States, insurance carriers and government agencies may reward a physician for ordering fewer tests and doing fewer procedures. As Michael A. Weber, MD, who chairs The Center for Medicine in the Public Interest, observes, “There are cases where what’s good for the doctor is bad for the patient.”

As a result, the doctor-patient relationship has changed and the practice of medicine is no longer as satisfying as it used to be.

Eight of the book’s 11 authors are physicians and one, Adolph Crespo, MD, is a Swiss orthopaedic surgeon. All are think-tank members or public health consultants. As such, they are good at listing the root causes of physician dissatisfaction.

Physician Disempowerment focuses on how physicians are affected by health care models in their countries. It says less about how individual physicians can adapt to the changing realities of modern practice. The authors ask many questions, but have few answers for a doctor trapped by the system.

Unfortunately, solutions do not come easily. In broad strokes, the authors suggest that giving physicians greater autonomy would improve the quality of health care, but they offer few specifics as to how to accomplish this.

Can greater physician empowerment bring about a better healthcare system? Can it lead to smarter choices and better use of our limited resources?

Perhaps the real answer is that change will come when both physicians and patients are more empowered to make their own healthcare decisions.

Physician Disempowerment is a quick read. You can finish it on a medium-length airline flight. The questions it asks, however, will be with you for your entire trip.

View a downloadable electronic copy of Physician Disempowerment: A Transatlantic Malaise.

Stuart J. Fischer, MD, is a member of the AAOS Now editorial board. He can be reached at 3pindoc@attglobal.net