"Thank You" Used to Mean Quality

This is a response I wrote to a Blogger Friend who was lamenting about her mother being ignored out of getting a referral which she needed in a part of the healthcare system out west.

When I read your Mom’s story, I know it’s totally true. And sad. I mourn for my profession which sold out to Wall Street, dressed as harmless hospital administrators and pharmaceutical representatives and faceless insurance companies with phony quality initiatives and empty terms that somehow appealed to good boy and girl scouts like physicians. 

Now, we have “Value” based care and drop down bonus-based EHR’s that prevent us from seeing the patient, who doesn’t get a drop down bonus of their own. The mutant brain of the physician, who amassed impressive SAT and/or ACT scores is dulled by the mechanistic drivel of the pile of prescription rejections at the start of every year and the ensuing Prior Authorization forms to get the patient out of tier 4 and back to tier 2 on their pharmaceutical co-pay. There’s little room in the physician’s brain for the challenge and fun of developing a complex differential diagnosis that get’s your mother aligned with the best opportunity for achieving her remaining dreams. They used to have fun and get great satisfaction our of the patient’s “Thank You, Doctor.” That was the bonus. That assured the quality. That relationship kept the thieves away. I mourn for my profession and the patients it has abandoned.

The NP’s and PA’s are used in places to keep physicians practicing at the “Top of their license”, meaning they don’t get to enjoy and deliver relationship-based care. The PA’s and NP’s have their own limitations in education and sometimes of licensure, depending on state laws, some of which you already mentioned.
(p.s., I don’t use an EHR, but own two. I have fun every day. Patients say “Thank You, Doctor.” I get to discuss personal (even complex nutrigenomic) strategies daily with patients, if indicated, with time to listen to their story- the most important part of the visit- and their values, goals and dreams. I am a fossil. Endangered fossil. I expect to drop all relationships with insurance companies at the end of this year to expand my Direct Family Medicine practice which enables patients to tell their story, unencumbered with the next massive wave of phony quality initiatives which will result in a 6 to 9% penalty ($) for Medicare patients and already is 12% with one commercial carrier.)
Oops, this is long enough to be a blog post- so I’ll post it on my blog, too.
Peace to you and yours.