Research Paper

Shahadat Rahman

English 21003

28 November, 2017

Research Paper

                                            Abstract

This paper will provide an understanding of the current crisis regarding American healthcare and how it affects patients, slowly transitioning into how these problems can be remedied to help doctors. Every year a multitude students apply to medical schools, yet physicians have the lowest job satisfaction rate in America. Why would healthcare practitioners, after receiving nearly 13 years of education and training, realize the plights of the medical field when they have reached the point of no return? This is primarily due to the fact that doctors face mountains of problems, ranging from paperwork to patient interactions. Yet even though these problems are abundant— from doctors and residents being overworked doing unnecessary paperwork and working extensive hours to a lack of a patient’s understanding when choosing an insurance plan— it was found that a number of them can easily be rectified.

Key Words: Insurance

Affordable Care Act

Pre-existing Conditions Clause

Health Savings Account Premiums

Medicine: The Greatest Money Scheme

When most medical students are asked why they chose to pursue medicine, most of them would give the same response: they want to save lives. Why else would one dedicate nearly 13 years of their life to higher education? Yet the American healthcare system poses a host of problems for physicians when treating patients. The idyllic perception posed by the idea of helping others is shattered when doctors face the bureaucracy established by hospital administrations and insurance companies: patients no longer receive the care they deserve, instead transforming a selfless profession into a game of money; doctors are unable to fulfill the Hippocratic oath that defines them, as they are restricted to treating patients based on insurance policies that are heavily dependent on one’s wealth. It is crucial for those considering a career in medicine to realize the problems doctors face with the American healthcare system, as well as the responsibility of the American people to offer a solution to the disorganized structure. The plight doctors face when treating patients —especially regarding insurance— accumulates into a burden that systematically diminishes patient care; in order to aid physicians in treating patients, these challenges must be rectified.

Insurance Is Not a Problem For Only Patients, It Damages Doctors As Well

Every year, nearly 20,000 students are accepted into a medical school; yet when they become doctors, studies state that approximately 63% of physicians are unhappy with the medical field (Adams 1). In fact, healthcare practitioners have the lowest job satisfaction rate in America and only 54% of practitioners would choose medicine again as a career (Adams 3). After committing nearly 13 years to higher education, why is it doctors do not realize their dissatisfaction with medicine sooner? The answer lies not within medicine itself, but in the way medicine is distributed. Physicians possess little control over how they can treat patients, with insurance companies playing the biggest role in dictating treatment plans. Given recent potential legislation regarding American healthcare, the way doctors help patients could deteriorate rapidly.

Insurance has even begun to dictate how doctors treat patients, controlling the amount of time physicians can interact with patients and subsequently diminishing the quality of care. The average amount of time a doctor spends with a patient is approximately 15 minutes— the same amount of time spent on a toilet each day (Dugdale 1). The reason for this is simple: insurance reimbursements. These reimbursements pay hospitals, clinics and doctors enough for only 15 minute interactions with patients. This decision stemmed from Medicare in 1992, when the program began to use a formula to reduce variability in physician fees; the 15-minute time restriction became a byproduct of these calculations. As a result, patient care is made less personal when given a time limit. “Patient history—like if a patient has been feeling depressed and has started drinking a lot lately, or if they have recently taken up smoking—can really affect our diagnosis and how the patient is treated. We cannot talk about these in such a short amount of time” according to Dr. Lucy Chang (Chang 1). Indeed, the solution is not always as simple as asking what is wrong, doing a check-up, and prescribing some pills. As a result of this lack of attention, misdiagnosis has increased leading to inappropriate prescription: this has exacerbated the problem by forcing patients to return to the hospital when their prescribed treatment plan is ineffective, costing insurance companies more money. This has also impacted patient satisfaction, which has been proven to influence patient outcome. In fact, it was found that peptic ulcer disease patients who were satisfied with their care had improved functional status than patients who were not satisfied with their care (Solomon 24).  By merely providing more time, better care can be given to patients, saving insurance companies money in the long-run and allowing them to give more money to doctors to spend more time with patients.

The inability to help patients is also aggravated by the path physicians take to become healthcare professionals. Most physicians spend between 11 to 13 years receiving education— including residency— with the average cost of medical school being around $250,000 for 4 years. Although residents are paid during their 5 years of working, the average pay of a resident is only a mere $50,000 in a large metropolitan area such as New York; this includes working 12 hour shifts and nearly 80 hours every week (AAMC 2). When factoring in the cost of living, it becomes apparent why medical practitioners have the lowest job satisfaction rate in America.The time and energy consumed represents a dimension of health care that goes beyond technical competence: insurers do not acknowledge the value of the services physicians provide and rarely compensate primary care doctors for them. As a result, many healthcare practitioners cannot afford to take time off to rejuvenate their spirits. Others have suffered physical and psychological and marital problems trying to deal with the stresses and dissatisfaction of a career in primary care. In fact, A Harvard Medical School Study which analyzed the divorce rate among approximately 250,000 physicians found that physicians had a 31% likelihood of divorce; female doctors are 1.5 times more likely to experience divorce as well (McGreevy 3). The personal plights of doctors often diffuses into their professional lives, and why would it not? Working 80 hours a week for meager pay while simultaneously drowning in debt from medical school hardly calls for a friendly demeanor in the workplace, especially with patients; this perpetuates the stereotype that medical practitioners are cold-hearted. But, it is known that demeanor and patient satisfaction can have dramatic impacts on a patient’s health and recovery. Therefore, the personal and professional plights physicians face must be rectified so they do not begin to affect the care patients receive.

            Furthermore, physician’s jobs are impeded by the mountains of paperwork they must complete every day, subsequently interfering with their ability to treat patients. As mentioned earlier, there was a 3 hour wait time to see a doctor— and that was in the emergency room, the most vital part of a hospital. This trend is common in other departments as well. “Every day I spend between 3 to 4 hours on paperwork” states Dr. Lucy Chang, a pediatrician at Bellevue Hospital, “my day is split between medicine and clerical work to the point where sometimes I feel like an accountant rather than a doctor. But it needs to be filled out every day to keep medical records as accurate as possible” (Chang 2). This causes healthcare practitioners unnecessary stress and as a result impacts patient care. As it stands physicians don’t have time for their families or leisure. If a physician works 12 hours a day and spends another 3 hours on paperwork, there isn’t even enough time for a full night’s sleep. Doctors waste time on paperwork rather than treating patients, leading to long wait times, inefficient care, and nominal life outside of work; this affects their mood and how they act around patients. Even something so simple as a doctor’s mood can have lasting effects on how patients heal. Coupled with the limited amount of time doctors are allowed to spend with patients, there is a perfect storm of inadequate care.

The Healthcare System Has Started to Fight Patients Instead of Treat Them

            The healthcare system has reached a point where insurance determines patient care. Doctors are no longer able to treat patients the way they want or the way they were taught; instead treatment plans are dictated by insurance companies, and I have a personal story which exemplifies this. In August of 2017, I remember coming home one night and my mother noticing a huge bump on my face— I had not seen it. Being facetious I ignored it until the next morning, when it had continued to swell until it covered my right eye. When I rushed to the emergency room I was stuck waiting for three hours in a hallway, as all the rooms were full. After the wait in the disease-ridden hallway, a doctor finally arrived to say I had something called cellulitis— a serious bacterial infection of the skin and tissues beneath it. He said that if I had waited even a few hours longer, I could have lost my eye. After giving me a dose, the doctors proceeded to prescribe me doxocycline hyclate, an antibiotic common in treating cellulitis as well as other bacterial infections; little did I know this would be a futile effort. When I had gone to the pharmacy I was told that this common medication was not covered by my insurance, a feat that had confused the pharmacist as well as all the doctors I proceeded to speak with. Dr. Chang even claimed, “it’s stupid that they the insurance companies would keep such a crucial medicine from you, it’s so common” (Chang 1).  After hours of struggling I was finally given an answer by my insurance company, I was allowed to have a slightly modified version of the antibiotic called doxocyline mono. I then travelled back to the hospital to retrieve my new prescription, but had to wait until the next morning to get it fulfilled. If I had not received the initial dose of the antibiotic at the hospital, I would have lost my eye. What if there was someone with a more serious illness having this issue? The disconnect between hospitals and insurance companies has become so severe that this miscommunication wastes hours and lives.  If the patient were wealthier and had a more accommodating insurance plan, this problem would not exist. But somehow, this problem plagues those who need the insurance the most: the poor. Thus, medicine has shifted from being a noble profession that serves everyone to a selective idea that only works for the wealthy.

            There are several other instances that involve patients with chronic conditions whose lives revolve around their insurance. Often patients with arising, permanent conditions such as HIV (human immunodeficiency virus) restrict their careers, fearing that they will lose their insurance benefits and will have to face HIV without medical coverage. A known practice in insurance companies is to include a pre-existing condition clause in their plans: these plans state that conditions existing before the insurance plan was purchased are not covered (Shelby 105). “I feel trapped,” claims Dennis Blake, an HIV patient who relies on his employer’s insurance, “I really would like to get another job, but then I would lose my benefits. Then I would really be in trouble. Not only would my salary be cut in half, but I would lose my benefits” (Shelby 107). Even those who decide to take the risk and pay for insurance on their own are hindered by the pesky clause; the pre-existing time period becomes an important marker where people pay for an insurance plan for years before they can make use of it. Insurance companies have created a paradoxical effect where their policies have fostered a sense of uncertainty in their protection, rather than a feeling of security. This uncertainty can invade even the most well-made plans, transforming a lifetime of preparing how to spend their retirement into preparing for how one will die.

A major contributor to these issues is the lack of a consumer’s understanding as to how insurance plans function. This is becoming increasingly important as employers are shifting from providing their employees with insurance to giving workers a set amount of money to buy their own coverage. The deception in insurance plans       lies in the marketing. Companies often create enticing deals involving cheap premiums — the cost that must be paid each month — without informing people how much they need to pay when they receive care. Federal health law requires that health plans provide a standardized description of the benefits, allowing them to be easily compared [Figure 1]. Yet these summaries are often too complicated to understand, failing to provide definitions of crucial terms such as copayment, coinsurance, deductibles, and out-of-pocket costs; immigrants and those who have a poor command of the English language are predisposed to fall victim to poor insurance plans. The deceptive insurance marketing creates a perpetual cycle in which patients have poor insurance, inhibiting doctors from treating them properly, costing insurance companies even more money, prompting them to create more expensive plans.

Alternative Views on Healthcare: Two Sides of a Dull Coin

Despite the problems with modern American insurance, there are those who claim that policies such as the Affordable Care Act (ACA) has saved the American populace from being uninsured. About 20% of American adults were uninsured before the Affordable Care Act was enacted in 2010. After the ACA was legislated this number steadily dropped to about 17.3% in 2015— meaning millions of Americans gained insurance as soon as the ACA was created [Figure 2]. Indeed, the goal of this new law was simple: provide the right of affordable and accessible healthcare to the American people. But its simplicity may be the problem. Premiums have risen, meaning the uninsured people who likely cannot afford insurance anyway are paying higher prices every year (Amadeo 1). The very people the ACA is meant to help puts them in an even more stressful situation. Furthermore, the ACA cannot be properly enforced in businesses: between 3 million and 5 million people lost their company health insurance due to the fact that businesses found it was more cost-effective to pay the penalty rather than provide their workers with health insurance (Amadeo 2). If businesses can get away with not providing their employees with health insurance and face nominal repercussions, then a large portion of an employee’s paycheck will go to health insurance, especially considering the rising cost of premiums. The ACA is nice in theory but it has not been properly executed.

            On the other hand, some people oppose the Affordable Care Act in favor of the new GOP health care bill—  another flawed plan. The new Republican health care bill aims to give states more flexibility to pursue premium costs and cease Medicare expansion, simultaneously repealing and replacing the ACA. The Republican Party claims that the plan would also include refundable tax credits for those who do not receive insurance from their employers and expand their Health Savings Accounts (HSA), allowing people to have more options when choosing a healthcare plan. The bill also states that it would provide $8 billion for those with pre-existing conditions [Video 1]. But the plan still contains its own flaws. While the Senate health care plan might push premiums down for some citizens, the costs would shift elsewhere, increasing deductibles; therefore, for those at the bottom of the income bracket, there would be higher out-of-pocket costs. This was done intentionally, as Paul Ryan — Speaker of the House — believes that providing less coverage for younger and healthier people will motivate them to work harder, subsequently pulling premiums down and lowering health spending (Kurtzlben 1). On the other hand, this provides a notion that college students are already of the working class, when a number of them are still paying off college debt. Allowing them to remain on their parents’ health insurance plan would provide some relief. Furthermore, even if premiums become more affordable, if deductibles are nearly $6000 then people at the lower end of the income spectrum will not be in a position to use their insurance, rendering the plan useless. Although the Affordable Care Act is certainly flawed the new healthcare plan proposed by the senate is merely a façade, gutting people of their insurance coverage for the sake of saving money for the wealthy.

We Know The Problems, What Are The Solutions?

Although there is a plethora of problems doctors face every day, many of them can easily be rectified— namely, paperwork. One of the greatest causes of stress is the amount of paper work doctors must fill out every day. If a doctor works a 12 hour shift, it is implausible for them to spend another 3-4 hours doing uncompensated paper work as well as spending time with family and sleeping. Hospitals can outsource this work to people who are specialized to complete these clerical tasks. Furthermore, these tasks can be electronically submitted rather than handwriting them. This improves efficiency not only because it is more convenient and faster, but also because it simultaneously solves the problem of physician’s handwriting. One of the leading non-medical causes of death is actually the poor handwriting of doctors (Solomon 4). This shift would not only bring relief to doctors, but also save lives. Furthermore, by electronically updating and storing patient’s medical histories, doctors can spend more time with their patients.

            In addition, a number of problems that both doctors and patients face stems from the middleman: insurance; eliminating it would create more options for doctors to treat patients and provide more direct care. In today’s political climate it is nearly impossible to create a basic health insurance policy that everyone can agree on; so rather than try and rectify health insurance, medical practitioners should bypass it altogether. Ever since major health insurance companies have begun to sign checks for even minor health care expenses, it has had a destructive impact on the doctor-patient relationship. This approach of bypassing the middleman attempts to reverse this damage. By being paid directly, physicians can reduce the cost of care due to the lack of coding and billing, meaning there is no need to hire staff to take care of these problems. This also allows care to become more personal, where not every emergency has to be screened by insurance before treatment and patients only pay for the what they need; doctors can spend the time they need with patients to learn the full history and develop a better relationship. Furthermore, some practitioners who refuse to accept insurance charge low subscription fees of nearly $130 for a family of four and charge $25 to $40 for an x-ray; in comparison, patients with insurance pay — on average — $350 (Dugdale 4). Although this tactic seems ideal, it is still difficult to employ. The government can help this method be more widely integrated by allowing patients to use their tax-deductible Health Savings Accounts (HSA) to pay direct primary care doctors. By doing so, it brings relief to patients by reducing out-of-pocket expenses and aids doctors by allowing them to focus on helping the patient rather than on their payment.

Conclusion

            The idea that medicine is about treating patients is merely a façade: insurance dictates how doctors treat patients, while doctors work 80 hours a week and fill out paperwork rather than practice medicine. Insurance companies focus on money rather than treating patients, treating medicine as a business rather that a humanitarian profession. This transforms the roles of doctors, who swore to abide by the Hippocratic oath and give everyone treatment, into salesman rather than healthcare professionals. The inadequacies in both insurance and the chances doctors are given to treat patients contribute to the failing American healthcare landscape. It is even more unfortunate that several of these problems are easily fixed. The excess paperwork doctors must fill out can be outsourced so doctors can focus on treating patients, while insurance can be bypassed to provide more personal and efficient care. While these problems will take time to mend, it is imperative for medical students to realize these problems before they enter the medical field, lest they too will contribute to the high job dissatisfaction among physicians.

Works Cited

Adams, Susan. “Why Do So Many Doctors Regret Their Job Choice?” Forbes, Forbes Magazine, 30 Apr. 2012, www.forbes.com/sites/susanadams/2012/04/27/why do-so many-doctors-regret-their-job-choice/#2f1c07ce37fa.

Amadeo, Kimberly. “Challenges Presented by Obamacare.” The Balance,          www.thebalance.com/what-is-wrong-with-obamacare-3306076.

Becker, Arielle Levin. “Obamacare got them insurance, but patients still face barriers  to care.” The CT Mirror, 15 May 2014, ctmirror.org/2014/05/15/Obamacare        got-them insurance-but-patients-still-face-barriers-to-care/.

Chang, Lucy Personal Interview, in discussion with the author, 5 November 2017

Dugdale, David C, et al. “Time and the Patient–Physician Relationship.” Journal of    General Internal Medicine, Blackwell Science Inc, Jan. 2012

Glied, Sherry, and Adlan Jackson. "The Future of the Affordable Care Act and  Insurance Coverage." The Future of the Affordable Care Act and Insurance  Coverage | AJPH | Vol. 107 Issue 4. American Journal of Public Health, 08         Mar. 2017. Web.

McGreevy, Sue. “HMS.” Doctors and Divorce, 29 Sept. 2015,      hms.harvard.edu/news/doctors and-divorce. Kurtzleben, Danielle. “Obamacare       Has Problems. The Senate Health Care Bill Doesn't Solve Them, Experts Say.”

NPR, NPR, 30 June 2017, www.npr.org/2017/06/30/534756511/senate-bill-leaves      key-problems-with-health-care system-unresolved. Shelby, R. Dennis. People         with HIV and those who help them: challenges, integration, intervention. Haworth Press, 2013.

Solomon, Micah. “Finding the Heart of [Hospital]Ity: Patient Satisfaction and the       Healthcare Experience.” Journal of Patient Experience, vol. 1, no. 1, 2014, pp.         23–25.

“Tuition and Student Fees - Data and Analysis - AAMC.” Association    of American Medical Colleges, www.aamc.org/data/tuitionandstudentfees/.        

“What is in the Republican Healthcare Bill,” Fox News, 4 May 2017,