Dr. Sandeep Jauhar is mad as hell.
American health care is in upheaval. On one side, overhead and malpractice insurance costs keep increasing, while salaries stagnate. On the other, patients believe that expensive drugs are better, more people are on government-run insurance that pays less, while private insurance fights every claim.
Now doctors spend most of their time trying to game the system, requiring endless paperwork, protracted bureaucratic battles and “treadmill medicine,” seeing as many patients as possible in as little time. This problem will only intensify as millions join the ranks of the insured under the Affordable Care Act.
In this self-perpetuating cycle, doctors spend most of their time as businessmen — and care suffers.
It’s no wonder then that doctors no longer enjoy their jobs, explains Jauhar, director of the Heart Failure Program at Long Island Jewish Medical Center and author of “Doctored: The Disillusionment of an American Physician” (Farrar, Straus and Giroux), out now.
“This book is meant to be like the scene in ‘Network’ when [Howard Beale] opens the window and yells, ‘We’re not going to take it anymore,’ ” Jauhar says in an interview with The Post.
“I see an emotional emptiness created by the relentless consideration of money. Most of us went into medicine for intellectual stimulation or the desire to develop relationships with patients, not to maximize income,” he writes.
In a 2008 study of 12,000 physicians, only 6% described their morale as positive. Even insurance claim clerks polled in a different study were happier.
As managed care has grown (by the 2000s, 95% of insured workers were in some kind of managed care plans), so has physicians’ discontent. In 1973, fewer than 15% of physicians reported any doubts about career choices. Today nearly 40% say that they would not choose to enter the medical profession if given the opportunity to do it all over.
If things continue as they are, the US can expect a shortage of 150,000 doctors by 2025, according to the American Medical College. Jauhar says that doctors on the online community SERMO are threatening to leave the country or scrap their private practices.
The serious downside here is obvious: Unhappy doctors make for unhappier patients.
“The physician-patient relationship is the worst it ever was,” he says.
To hammer in this point, Jauhar quotes facts from the Commonwealth Fund: The US ranks 45th in life expectancy (“behind Bosnia and Jordan,” he adds) and compared to other developed countries near last in infant mortality and health-care quality, access and efficiency. We also have fewer physicians and hospital beds than average.
This “mid-life crisis in medicine” is reflected in Jauhar’s own writing.
Readers can follow his skepticism in “Intern,” his first book about his internship year at New York Presybterian, harden into disillusionment in “Doctored,” which chronicles his time at LIJ as he enters his middle age (he’s now 44).
“Doctored” opens with: “When I look at my career in midlife, I realize that in many ways I have become the kind of doctor I never thought I’d be: impatient, occasionally indifferent, at times dismissive or paternalistic.”
This “kind of doctor,” once so idealistic, now takes morally ambiguous speaking gigs with pharmaceutical companies and side-jobs at “sketchy” cardiologist private practices who push for expensive and often unnecessary tests for the reimbursements.
And this is where the book gets really bleak. Doctors — like his own brother, also a cardiologist — refer to patients as “commodities.” One physician at LIJ admitted that “sometimes you have to drag out” a hospital stay for a patient if you want to get paid.
He writes about one of his patients, a 50-something man who complained of shortness of breath. Fourteen doctors, 12 procedures, and hundreds of thousands of dollars later, he was released with minimal improvement.
This is a problem not only of milking income, which of course happens, but because doctors just don’t have the time to do their jobs. Primary care physicians (doctors who Jauhar believes are most unhappy) spend an average of eight to 10 minutes per patient.
It’s a self-fulfilling prophecy. With less time for each patient—studies show (no surprise here) that rushed doctors listen less — relying on expensive tests, which don’t necessarily lead to more accurate diagnoses. Med school advises doctors-in-training that you should be able to diagnose 80% of cases with a health history and an exam alone. No further tests required.
But in this exam on-the-run environment, doctors are more likely to practice “defensive medicine,” or “cover your ass” medicine — costing us about $750 billion a year (of the $3.8 trillion we spend a year) in wasteful procedures that lead nowhere.
“After so many years in medicine, I am convinced of one thing: The vast majority of doctors aren’t bad. It is the system that makes us bad, makes us make mistakes,” he writes. “There is a palpable sense of grieving. The job for many has become just that — a job.”