Doctors Not Students

Hey there. If you made your way here, you’re already aware that we have a doctor shortage in the US artificially created by the Flexner report funded by Rockefeller in the 1920s, establishing roadblocks that have nothing to do with patient care outcomes and everything to do with raising healthcare costs (less doctors=higher demand=more money).

Here’s what we need to demand to stop the doctor shortage (along with who you need to contact, below):

Changes at the medical school level: MAKE DOCTORS NOT STUDENTS

Demand removal of tests whose scores do not correlate to improved patient outcomes, like the MCAT. Would you test a mechanic on things that don’t make your car work better? Tests for future doctors should correlate with improved patient outcomes! (Controlling for specialty, obviously) In fact,

Demand removal of all artificial prerequisites which keep students out of medicine based on anything that doesn’t correlate to patient outcomes. If physics doesn’t measurably correlate with patient outcomes, get rid of that requirement. If orgo chem doesn’t correlate to patient outcomes, get rid of that requirement. We don’t have enough doctors. It’s an emergency. Why are we adding blocks to creating new doctors?

-Additionally, given that…

  • The medical school selection process is broken. It’s easy for medical schools to pick the best students and then claim success. But the best students would have been successful regardless of the medical school. That’s no reason for the school to get paid millions or take credit. Instead, medical schools should focus on CREATING the best DOCTORS from the people they get, not just picking the people who would probably succeeded anyway without the school.
  • The medical school training process is broken. Top performers in medical school have not necessarily been shown to correlate to being the kindest doctors (and in fact often top performers in medical school have communication issues that lead to more malpractice suits). The competitive system encourages cheating and backstabbing instead of cooperation to reach our dreams.
  • The medical school system continues to be ridiculously expensive, keeping underprivileged voices OUT.

…It stands to reason that a paid apprenticeship system is far more appropriate for a hands-on trade like medicine. In an apprenticeship system,

  • Young hybrid college+medical students would earn advancing skills and certifications first in training as a medical assistant, then physician’s assistant, and finally physician, so that if at any point they decide to leave the journey, they still leave with skills and certifications the healthcare system can actually use
  • Apprentices would spend half the week in clinic and the rest of the week studying basic foundational academic sciences actually proven necessary for work as a physician
  • Apprentices would start by assisting hospitals with useful work, cleaning bedpans and filing paperwork under nurses and physician’s assistants, instilling in them systems knowledge, humility, and respect for allied health professionals as they advance
  • Such an extended program over six or more years would allow a normal work-life balance, decreasing physician suicide and leaving graduates with less debt (currently the average medical student accrues over $500k in loans!)
  • An ideal apprenticeship would include in its later years a biochemical or clinical research project on either an “alternative” or “orphan” medical treatment that would otherwise go unstudied, so we a) critically evaluate and prove/disprove all perspectives instead of allowing medical thought to stagnate in uniform ideology and b) stop only researching “rich people” diseases
  • Once apprentices have gained the skills necessary for general practice, states can begin licensure based on ten confidential patient recommendations, ten patient case submissions, and a signed skill log–a much more realistic metric of physician ability than random tests and elitist physician recs
  • This system naturally allows replacement of the current residency system (which eliminates even more prospective doctors!): young, new physicians could continue to work under their original physician/hospital as they gain the skills needed for a particular specialty, or transfer to a different one, but none would be left without employment (ultimately increasing the number of doctors for patients!)

Such an apprenticeship progression from medical assistant to physician assistant to physician would allow students to continue to earn during training while increasing quality of education, which would bring more voices from disadvantaged backgrounds who can’t handle exorbitant medical school prices. Patients deserve doctors fresh from an extended and productive learning period instead of the crammed psychological hellscape created by the arbitrary four year completion requirement for MD. A physician who is treated like a human will treat others more like humans, and possessing the humility to clean a bedpan is just as important as the intelligence to study biochemistry.

Please copy and paste the above, add your own thoughts and experiences, and send it to the following:

The LCME (which accredits medical schools) here.

Association of American Medical Colleges
655 K Street NW, Suite 100
Washington, DC, 20001-2399
202-828-0400

You can also at them on social media with this page.

CHANGES AT THE STATE MEDICAL BOARD LEVEL: COOPERATION NOT MONOPOLY

-Demand they increase the number of physicians practicing in your state by automatically accrediting anyone with a license in another state, without any further fees, especially for telehealth.

Demand your state push a new Interstate Medical Licensing Compact that includes generalist physicians without specialty board certifications; currently, some states will accredit physicians from other states if they have board certifications, but no controlled research study has shown board certifications lead to an improvement in patient care, and most states are currently licensing PAs and NPs with less qualifications than unboarded generalist physicians! This double-standard licensing PAs but not generalist physicians gives us less qualified primary care, not more!

Ask your state to accept competing standards of accreditation to break the monopolies. This means they should accept any diploma or board certification that they’ve independently investigated and found to support quality patient care, not just those certifications from programs accredited by the ACGME, LCME, and ABMS.

Support tort reform that caps how much a physician can be sued. While this may seem counterintuitive, when physicians are paying $4k monthly minimum for malpractice insurance to protect themselves from lawsuits, they’re not seeing underprivileged patients. They can’t afford to!

To contact your state medical board, simply find your state here.

CHANGES AT THE RESIDENCY LEVEL: HUMAN RIGHTS FOR RESIDENTS

Encourage longer, more relaxed residencies that operate like actual jobs and not like worker-abuse torture chambers–let residencies cater to people with disabilities instead of discriminating against them. A study in JAMA argued that decreasing residency hours from 120+ to 80 didn’t demonstrate changes in patient outcomes, but that was largely because they’re still not decreased to an actual human level that medically optimizes brain function. We would never recommend our patients to do precise and dangerous operations without sleep, but we do them ourselves, despite the fact that we know lack of sleep literally equates to elevated blood alcohol levels. Hand-offs need to be improved, as they are the main reason that decreasing hours did not improve patient safety–but hand-offs can also be longer and more precise if there are more physicians working less hours. You have the right to refuse to be attended by anyone who has been on shift longer than sixteen hours.

Remove tests like the USMLE that do not correlate with patient outcomes and replace them with standards that do.

-Instead of making patient care ONE out of the FIVE areas in which the ACGME rates a resident, make patient care 100% of how a physician is rated, and incorporate patient feedback into evaluations. We have all seen physicians who had excellent patient care be punished because they didn’t make a supervisor happy socially, and that’s supported by current ACGME standards. That needs to change.

Demand competing board standards, not just boards accepted by the ABMS–more options always = better (and cheaper because of competition!)

To contact the ACGME, go here.

CHANGES AT THE FEDERAL LEVEL: INSURANCE COMPANIES AREN’T DOCTORS

-Demand your lawmakers end the monopolization of healthcare: currently, hospitals are eating up small practices because with all of the insurance billing red tape, it’s almost impossible for a private physician in a solo practice to afford to pay the legal and administrative experts needed to navigate the system. Less physician practices=hospitals alone in regions where they’re free to jack up prices as they see fit! Demand simplified insurance regulation so a person no longer needs a separate degree to understand it (yes, there are entire college degrees in medical billing!), so small practices can compete.

Perform aggressive tax cuts on all physician practices, with a greater tax cut on practices with less than five physicians, but at the same time–

If the CEO of a hospital makes six figures, take away that hospital’s charity status. Currently, many hospitals that claim to be “charities” and live tax-free actually charge the majority of their patients or only see free patients in a limited capacity. Meanwhile small practices can’t afford to see patients at reduced cost because they’re still paying taxes while competing with these tax-free giants. Require giant hospitals to pay their fair share.

As a step to simplified billing so small practices can compete, require insurance companies to make appeals processes easy and automatic by creating portals on their websites. They can afford automatic evaluation systems, they can afford to let physicians and patients appeal those automatic decisions without having to mail and fax a million different pieces of paper.  (Aetna’s automatic system actually came under investigation for auto-rejecting several million claims in seconds without evaluating them!)

Demand that Medicare lift its cumbersome documentation requirements and reimburse based on recorded patient care, not the patient note. Originally, a physician note was for communication between physicians and to help a physician track and improve a patient’s care, but currently physicians are paid based on frivolous details required in that note (which is why your doctor pays more attention to their computer than to you). To avoid fraud, have patient visits recorded on audio for Medicare to audit once a quarter if they’re suspicious; otherwise, let physicians just send an itemized bill, no questions asked! Currently, Medicare and other insurance programs pretend to decide whether the physician should or should not administer certain treatments, and then they pay. But the physician and the patient should decide what treatment the patient needs, not Medicare. To avoid overwhelming the system with expensive requests, Medicare can provide a list of treatments they simply will not cover without study citations in a special report (a blacklist instead of a whitelist)–but it’s not their job to evaluate the patient and decide what treatment that person doesn’t need! That’s a licensed physician’s job! Tell Congress to stop allowing insurance companies to act as physicians.

Bottom line, “healthcare administration” should not be a multi-million-dollar industry; medical providers and patients should make the decisions! Contact your representative here.

SOMETHING ELSE YOU CAN DO?

Support DPC (direct primary care) practices and medical sharing instead of insurance companies when you can.

Share this page with your friends and family (and if you can come up with a way to automate it so we contact every single member of Congress, plus every decision-maker in these big orgs, let me know at jen (at) byjenfinelli.com!)