Readers regularly give updates on the crapification of medicine, mainly from the patient but sometimes the provider side. A big driver is insurance: obstacles like pre-approvals or other gatekeeping delaying or perversely restricting care, or narrow networks excluding certain specialists. But the other is corporatization of medicine, which we’ve been writing about for a decade. That means not just a fixation on cost reduction but also standardization, which proponents insist, without or contrary to evidence, improves care.
The result of all of this, not mentioned often enough, is moral injury. Articles about doctors retiring early may deign to mention burnout, caused by fighting with insurers and particularly post-Covid, thin staffing. But they don’t include often enough moral injury, of feeling they are to violating their ethics by being forced to practice in a substandard or even risky manner.
See Casey Means MD below-a doctor that is disgusted with how medicine is focused on revenue generation rather than health care for the patient.
The basic science curriculum at the medical school has been shortened to make way for more clinical rotations. Meanwhile, for the graduates, the career prospects are evolving. Nurse practitioners and physician assistants are taking over the duties formerly performed by MDs and DOs. AI is more accurate than human radiologists in diagnostic imaging. Private equity is taking over practices and community hospitals and draining resources. Here’s an ophthalmologist in Kansas City:
“Medicine is going to hell. I have been asked to write several editorials but it would be so depressing I would feel bad. My own group, owned by 6 physicians, sold out 2 years ago to private equity (PE). Since then, 5 of us have left. You know the drill: fire local management, install bean counter as head person, golden rule now “MORE REVENUE SO WE CAN SELL OUT AT A PROFIT” down-staffed, told shorter patient contacts/more patients per day, more surgery, more revenue generating tests.
Yes medicine is/was always a business. But it has evolved into maximizing revenue generation to the detriment to patient and those that provide the health care.
What a tragic waste of a physician-scientist.
I guess the medical profession is no longer quite the meal ticket it once was. The only constant in the world is change, and the economics of medicine is driving change in medical practice
I am a medical doctor, writer, tech entrepreneur, and aspiring regenerative gardener who lives in a state of awe for the miracle of existence and consciousness. During my training as a surgeon, I saw how broken and exploitative the healthcare system is and left surgery to focus on how to keep people out of the operating room.
She became disillusioned with medicine’s failure to adequately address the most pressing and pervasive causes of disease in our country. Ultimately she left surgery to practice functional medicine and eventually founded, Levels, which uses continuous glucose monitors to help people track their metabolic health.
We often hear about obesity being a public health crisis in America. You frame it slightly differently, saying that most of us have some form of “metabolic dysfunction.” What do you mean by that?
We’re actually referencing a paper that came out of the Journal of the American College of Cardiology in 2022 that showed, based on assessment of the lab results of 55,000 Americans, only 6.8% were metabolically healthy – 93.2% had at least one biomarker indicating metabolic dysfunction.
My mission is to steer more healthcare dollars to incentivize metabolic habits at the root of disease (healthy food, exercise, sleep, stress management). This is where the rubber hits the road to change our current trajectory.
Right now, we have a sick-care system where 95% of healthcare dollars are spent to manage disease after people get sick. It is a big problem when the largest (and fastest growing) industry in the country is incentivized for us to be sick.
I am working to advance this mission in three inter-connected ways:
- Truemed, a company I started that enables tax-free HSA/FSA spending on supplements, exercise, and healthy food.
- Good Energy, a book I co-wrote with my sister Dr. Casey Means that is coming out May 2024.
- Media and advocacy about the broken incentives of the healthcare system, informed by my early career as a consultant for the pharmaceutical and food industries
Yeah Yeah the cynic in me sez brother and sister have just started a business that attacks medicine, food corporations and pharmaceutical corporations. But they are correct in that the US medical system is broken and food corporations make profit by selling consumer garbage classified as food. And the pharmaceutical corporation mission to get everyone on prescription drugs eternally generating revenue.
If you have 2 and 1/2 hours to kill; you might want to check bro & sis on Joe Rogan.
