Published on December 18, 2016
Reprinted with permission of author, Howard Green, MD
This article was published a while ago. It is seeing a second life on many of the blog sites. While many of the premises in the article are well-known to our colleagues, seeing it all in one place is a wake-up call.
I’m a Harvard Trained physician who grew up in Queens. I spent my formative years in and around the schoolyards of PS 193, JHS 194 and Bayside High. I was not alone. I grew up alongside people who have become Commissioners of Major League Sports, Hedge Fund Magnates, Founders of Small and Large Businesses, Nobel Laureate Candidates, Government Workers, Health or Educational or Fiscal and Legal professionals, Butchers, Bakers, Artists, Athletes, Soldiers and Candlestick Makers. Growing up, we all interacted with scores of people and we quickly learned how to identify a putz. A putz is someone who engages in inconsequential, unproductive or a stupid activity. Yes, some people grow up to be putzes.
By all measures, American Physicians are Putzes. There’s no doubt that becoming a physician entrusted with the lives and well-being of patients and their families is one of life’s greatest joys. The new systems-based medical school curriculum is producing Medical Doctors who are the most skilled and empathetic clinicians in history. However, practicing medicine in today’s healthcare environment is one of life’s greatest disappointments.
America is the only developed nation in the world with a diminishing value of healthcare associated with worsening clinical outcomes, morbidity and mortality and increasing costs. American physicians have no one to blame but themselves for enabling a healthcare system to run amuck with increasing costs and diminishing outcomes. American Physicians are putzes. We’ve wittingly and unwittingly formed the vanguard of the largest shift in healthcare resources in the history of our nation away from patients and their doctors into the ancillary healthcare industries resulting in this diminished healthcare value (outcomes/costs). Putz physicians have enabled this consequential resource shift to the Insurance, Pharma, Med Mal, Publishing, Hospital, Organized Medicine, Medical Certification, Electronic Medical Records and Elected Representative Industries. These industries would not have realized record profits nor would the patients have record costs and physicians record diminishing reimbursements without the aiding and abetting of putz physicians. We physicians are therefore putzes because while patient costs have increased and physician wages decreased, we’ve enabled the increasing clinically-valueless irrational earnings of these 9 major ancillary healthcare industries. We American-physician putzes have therefore facilitated the manufacture and production of the most rationed, inaccessible and expensive healthcare in the developed world.
Wittingly and unwittingly, the American Physician Putz has enabled the ascendancy of the following industries at the expense of their patients and themselves:
1) Health Insurance Industry:
Putz Physicians have remained silent while health insurance companies have formed natural monopolies in most major markets. Monopolistic market collusion has increased patient premiums, co-payments, deductibles and out of pocket expenses. America is the only developed nation in the world where health insurance is considered a luxury and not a utility. All health insurance companies have diminished patient access to contracted doctors and medications and also have decreased reimbursements for physicians’ care. Insurance companies have blanketed physicians with the scourge of prior authorization rationing for preventive, medical, surgical and palliative care. This year, the government via MACRA laws forced physicians to join slow motion HMO’s known as Accountability Care Organizations or ACO’s. ACO’s force physicians to assume the risk for the profitability of the ACO’s shareholders and then return only a small portion of the increased profits to the practicing physicians. ACO’s will never reveal what percent of their profits they will return to physicians for assuming risk. All this avarice of the health insurance industry prevents physician putzes from optimizing preventive, medical, surgical or palliative outcomes with their patients, therefore, diminishing the value (outcomes/costs) of healthcare.
A Nationwide Union of Practicing Physicians would gather and publish online for its members and their patients the insurance company premiums, co-payments, deductibles, out of pocket expenses, physician panels, ACO profits, medication formularies, government subsidies, prior authorization burdens and fee-for-service physician reimbursement rates. Publishing this data would shed some sunlight on the life threatening actuarial collusion against patients and their putz physicians by the health insurance industry which is enabled legally by the McCarron Ferguson Act and several other Federal Legislation’s (see #9 Industry Below).
2) Pharmaceutical Industry:
In return for 100’s of millions of dollars in direct and indirect cash contributions to Professional Medical Societies, Medical Academies, Medical Specialty Associations, Medical Colleges and Universities and individual physicians from the Pharmaceutical and Devices Industry, Physician putzes have remained silent (impotent) and look the other way as the price of all generic and name brand drugs have increased several hundred percent during the last few years. Americans pay the highest prices for medications in the world. In addition, physicians remain silent as 40% of pharmaceutical revenues are redirected to ‘direct to consumer marketing’ telling patients ‘not to trust their putz physician’s history & physical examination and discussion’, but instead; “ask your putz physician if our drug is right for you'”. Direct to Consumer advertising leads to a 15% increase in name brand drug prescriptions written by putz doctors without evidence of improved outcomes/costs. These same pharma companies spend only about 12% of their revenue on R&D. 3rd party Pharmaceutical Benefit Managers (PBM’s) ensure their own wealth by keeping drug prices high serving as middle men between manufacturers, insurance companies and unfortunate patients.
A Nationwide Union of Practicing Physicians could publish all drug prices with or without insurance online including co-payments for its members and their patients and shed some light on a dangerous commercial business plan thereby creating a capitalistic competitive market for drugs and medications based on quality and cost.
3) Medical Malpractice Industry
American Physician putzes are the only professionals in the world prevented from policing themselves and performing quality control (QC). Instead of prospectively identifying under-performing putz Doctors and correcting them, we in America simply retrospectively sue their putzey scrubs off creating a never ending cycle of errors and defensive medicine. In order to improve under-performing physicians and institutions, medical malpractice lawyers will need to be curbed. The medical malpractice trial and insurance industry is huge and neither will want to be neutered in any way just to improve health care in America.
A Union of Practicing Physicians could require that members pledge to cease testifying against other physicians in Medical Malpractice Cases. In addition, a Union of Practicing Physicians could anonymously share error data submitted by nationwide members revealing physician and hospital mistakes via the Internet of Things thereby enabling physicians to correct and improve the practice and the value of healthcare through professional quality control.
4) Publishing Industry
This 2 century old health care peer reviewed time-delayed publication process has served both the publishing industry and putz physician well. Publishing gets free medical content from putz physicians supporting a multi-billion dollar advertising fueled publishing industry, and medical academe get papers published, with much delay, with which to support Academe’s centuries old hierarchical structure. The delayed nature of traditional publishing hurts both physicians and their patients. In addition, the inability to publish negative data due to industry and institution blocking hurts both patients and other putz physicians.
The Union of Practicing Physicians members could pledge to publish their reproduced clinical data online without delay via a number of existing internet medical publishing portals as per Federal Law, or via the Unions own Publishing internet portal in order to accelerate the advancement of science and the value of healthcare.
5) Hospital Industry
Physician putzes remain silent while hospital and medical centers charge exorbitant fees for the care of their patients thereby diminishing the ability of the putz physician to optimize the value (outcomes/costs) of producing their patients’ palliative, medical, surgical and palliative outcomes. Hospitals never reveal the quality or costs of their preventive, medical, surgical or palliative outcomes blocking the ability to create a capitalistic marketplace based on value (outcomes/costs).
A Union of Practicing physicians would gather data from members and their patients regarding hospital charges and reimbursement from patients, insurance companies and the government. Revelation of this hospital revenue data would shed some light on hospital billing, collecting and outcomes and would enable both patients and their physicians to choose the hospital of greatest value (outcomes/costs) for the patients in a qualitative capitalistic market manner.
6) Electronic Health Records (EHR) Industry
Congress and the Administration recently created Federal laws called ‘Meaningful Use and MACRA’ forcing physicians to purchase expensive non-standardized and non-interoperable Electronic Medical Records (EMR’s). This government mandated technology is the only IT used by any industry in America which doesn’t improve the cost or quality of the products produced by that industry (clinical outcomes). In addition, it’s the first new technology or device in the history of modern medicine used by putz physicians with patients with zero or negative improved clinical value for physicians and their patients concerning preventive, medical, surgical or palliative outcomes. Recent studies have confirmed that EHR’s have transformed clinicians in to data processors requiring 2 hours of data input for every hour your physician spends with patients. My paper chart never tried to extract income from me. The proprietary non-standardized and non-interoperable software of every EHR company allows the EHR company to ‘own’ the Putz Physician charts. A single EHR company can charge or blackmail revenue for every work-motion the putz physician performs on that EHR such as communicating with other physicians or patients or MIPS submissions. By charging doctors for MACRA-MIPS data submission to the government EHR companies simply redistribute ‘value’ rewards meant for doctors back to the EHR companies. To add insult to injury, your EHR company sells doctors patients PHI (private health information) and patients aggregated personal health chart data for profits, while never revealing this chart information to patients or their doctors to improve value (outcomes/costs).
A Union of Practicing Physicians would collectively force the EHR industry to standardize software, interoperate EHR’s and improve UX by emulating the “Blue-Flu” of the NYC Policemen. Simply having physicians proof-read every EHR note during office hours would create a massive virtual physician shortage thereby forcing the government and industry to enable better UX, lower EHR costs and institute the interoperability of EHR’s and the associated aggregation and revelation of charted data physicians and patients for healthcare not profit in order to speed the improvement of the value (outcomes/costs) of healthcare. An organized effort by physicians would also stop the practice of the EHR industry’s MACRA fueled extortion of doctors by charging for every work and motion associated with charting, MIPS, communications and sale of the patients’ data that patients provide and Doctors pay to input.
7) Organized Medicine Industry
Organizations such as the American Medical Association (AMA) and Specialty Organizations such as my own American Academy of Dermatology (AAD) began decades ago as strong solo advocates of putz physicians and their patients. Organized Medicine has devolved into a behemoth insurance, pharmaceutical and publishing fueled bureaucracy which has failed to protect putz physician members and their patients from the dismal current state of healthcare in America today. These professional medical organizations in their own interest have looked the other way as the ancillary healthcare industries on this list have devastated the practices of putz physicians and made it almost impossible for most Americans to have access to quality affordable healthcare. Organized medicine has colluded with the ancillary industries by accepting cash gifts in order to maintain their fiscal bureaucratic administrative structure ignoring or demonstrating impotence regarding the needs of putz physicians and their patients.
A Union of Practicing Physicians would not take direct or indirect cash contributions from pharmaceutical, insurance, publishing, med mal or EMR industries quid pro quo and therefore enable the Union of Practicing Physicians to advocate for the well-being of patients and their physicians using the collective means of their members and their patients.
8) Board Certification Industry
During the last two decades, a new industry shifting healthcare resources from putz physicians has evolved. The Specialty Board Re-certification Industry now limits the specialty certification of putz physicians to 10 years for no legitimate reason. Physician putzes are required by these re-certifying boards to pay large fees and perform arbitrary, clinically valueless tasks which are age discriminatory, redundant with CME’s or State licensure and financially damaging in order to remain ‘board certified’. The only documented benefit of The Specialty Board Re-certification or Maintenance of Certification (MOC) process has been to increase the portfolio value of the retirement investment plans of the Administrators and Bureaucrats Serving the Board Certification Industry.
An organized collective and legal effort by a Union of Practicing Physicians would defeat the clinically arbitrary and valueless burden of recertification forced on most younger practicing physicians.
9) Elected Representative
Your elected officials are responsible for the current dismal state of healthcare in America today. There are 10 Federal laws which ensure that American Putz physicians and their patients will practice and receive the most expensive rationed inaccessible healthcare of any developed nation in the world. In exchange for cash gifts and indirect favors from the insurance, pharmaceutical, medical malpractice, publishing, hospital and EHR industries your elected official has legislated the following laws which guarantee subsidizes to these industries, grant immunity to these industries from death and dying related to for-profit rationing of access, diagnostics and treatments. These healthcare laws also ensure that most Americans remain one illness from personal bankruptcy include: Part D Medicare, Medicare Advantage Health Insurance, Employer Based Health Insurance, Direct Pharmaceutical Advertising, Unrestricted Medical Malpractice Attorney’s, HIPPA ACT, McCarron Ferguson Act, ERISA Act (Employee Retirement Income Security Act), ACA (Affordable Care Act), American Recovery and Reinvestment Act (ARRA) Meaningful Use, 1973 HMO Act.
A Union of Practicing Physicians could use the collective power of its members and patients to overcome the interests of the industry corrupted elected officials, drain the swamp and swing the healthcare pendulum back to patients and their physicians to ensure quality and affordable healthcare for all Americans.
None of the above 9 government subsidized ancillary healthcare industries are willing to give up a penny of earnings before interest, tax, depreciation and amortization (EBITDA). Their profits have been garnered solely from redistributing a decreasing pool of patient and physician resources and government subsidies while rationing care to patients via their putz physicians. We need a Union of Practicing Physicians to return healthcare resources sensibly to patients and their physicians in order to optimize the value=outcomes/costs of healthcare provided by physicians in this nation.