Health Care Should Be More Than Bitter Pills

By SAM URETSKY

...The doctor’s talk was of coughs and chills
And the doctor’s satchel bulged with pills.
The doctor said unto Isabel,
Swallow this, it will make you well.
Isabel, Isabel, didn’t worry,
Isabel didn’t scream or scurry.
She took those pills from the pill concocter,
And Isabel calmly cured the doctor.
-- Ogden Nash (The Adventures of Isabel)

Nobody seems to be happy with the state of healthcare in the United States. The professionals, the patients, and the politicians. Maybe the executives of the health insurers like the system, but that supposes that they understand it, which is giving them a lot of credit that they only questionably deserve.

Alan Reisinger, M.D., Associate Medical Director of MDVIP, an organization that offers one of the alternatives to conventional medical practice, reported on the benefits of organizations like his own. The patient pays a fee, perhaps as much as $2,000 a year, but gets priority service from their primary care physician – an appointment within 48 hours, and the MD’s cell phone number. While many primary care physicians report having a practice of 2,500 to 3,000 patients, the physicians who are affiliated with MDvip or its competitors — SignatureMD, Privia Health and others — can reduce their patient load to 600 while providing more personal care and maintaining their standard of living. That leaves 2,000 wannabe patients who have to have to go find a primary care physician, but whose place on the waiting line has been preempted by the 5-600 people who had $2,000 extra. What’s wrong with this picture?

Dr. Reisinger cited an IPSOS survey of patients reported patient dissatisfaction with getting primary care:

• 61% of consumers say healthcare system is a hassle
• 63% say navigating the system is stressful
• 53% say the healthcare system treats patients more like a number than a person
• 40% of adults have spent much more time in the waiting room than with the physician.

At the same time, MDs are complaining of burnout. Burnout is defined as “a state of mental, physical, and emotional exhaustion that can be caused by chronic stress in the workplace.” Medscape’s 2024 “Physician Burnout and Depression Report,” published Jan. 24, reported that emergency medicine physicians are the most burnt-out medical specialists for the second year in a row, with 63% experiencing burnout. A few of the specialties that are reporting high levels of burnout are:

• Emergency medicine: 63%
• OB-GYN: 53%
• Oncology: 53%
• Pediatrics: 51%
• Family medicine: 51%
• Radiology: 51%

The best areas of medical practice are:

• Pathology: 41%
• Psychiatry: 39%
• Ophthalmology: 39%
• Plastic surgery: 37%

The numbers are significantly higher for female MDs than for males, 63% for women, compared to 46% for men. Other healthcare occupations scored around the same burnout rates. Results from a 2020 survey indicate that almost two-thirds of nurses (62%) experience burnout. It’s especially common among younger nurses, with 69% of nurses under 25 reporting burnout.

Among hospital pharmacists, the burnout rate has been reported at 53.2%, potentially a serious problem in an occupation with a steady decline in college applications and a Bureau of Labor Statistics anticipated annual growth in openings of 3%.

Also. In 2023, a record number healthcare workers, nurses, nursing assistants, technicians, pharmacists, and other specialties went on strike. The strikers were aware of their moral responsibilities and the risks to patients, but felt that working conditions already risked the welfare of their patients.

Here’s a quote from a study published in the International Journal of Research in Public Health “Healthcare workers are particularly susceptible to burnout, especially given the fact that clinical practice is an important burnout trigger due to the ongoing contact with patients and suffering. Burnout among healthcare workers adversely affects not only the department they work in but also their performance and the functioning of the entire healthcare system. It increases the risk of medical errors and adversely affects patients’ safety.”

Of course there’s one group that’s not covered by these statistics – the have nots. The Commonwealth Fund reported “Almost 3.8 Million People Have Lost Their Medicaid Coverage Since the End of the COVID-19 Public Health Emergency.” Medicaid eligibility was frozen for the COVID-19 emergency, but now that the emergency is over, the states are reconsidering eligibility. An estimated 15 million people will lose Medicaid coverage. An educated guess, from a 2022 Census Bureau report claimed 26 million people — or 7.9% of the US population – were uninsured. That was a low number because of the people who were covered by Medicaid but will lose it now the crisis is past. The United States is the only modern nation that doesn’t have universal healthcare. Neither providers or patients are satisfied with the system, but Republicans like their tax breaks for corporation and wealthy people – and that is why the United States spends about 18% of its GDP on healthcare while most modern nations get by on 11%. As it is, the US spends about $1 billion a month on drug advertising alone – not on the drugs themselves, but on TV ads that say “ask your doctor if (Dammitol?) Is right for you.”

It’s worth discussing – soon.

Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sam.uretsky@gmail.com

From The Progressive Populist, May 15, 2024

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