National Doctors Day is today, and is a day to recognize and thank physicians for all that they are and all that they do to care for our loved ones. For me, Doctors Day brings two physicians vividly to mind as I reflect on my own career practicing medicine.
My father was a physician, and the driving reason why I became a doctor. Dad showed me that the physician-patient relationship was the unrivaled center of gravity in healthcare. Put another way, he taught me by his example that doctors hold our patients’ hands and guide them through their journey, and care was the watchword.
I’ve seen many changes throughout my career —some good, some bad and some ugly. The greatest “good” has to be the amazing advancements in technology, equipment, surgical procedures, health screenings and prescription medication that have enhanced the care that we can provide our patients by leaps and bounds.
If I must point to the “bad,” it has to be the ways that the health insurance industry has found a way to warp that once-unrivaled relationship between a physician and a patient. I will never forget the astonishment I felt when testifying at the State Capitol in my days as president of the Connecticut State Medical Society. I was told by a legislator to “get over” the fact that the doctor-patient relationship was “no longer the driving force in delivering healthcare.”
Bit by bit, the insurance carriers have been able to manipulate the state of play so that cash has replaced care, and “it saves money,” has become the criteria for how they believe medicine should be practiced in Connecticut.
Too many patients are now seeing the back of their doctor’s head as we enter data into our computers rather than feeling the touch of our hands. From their ever-narrowing networks to high-deductible health plans and endless paperwork, insurance companies have not only wedged themselves between patients and their doctors, they have physicians playing the role of clerk, money collector and deliverer of bad news when the insurers deny and delay coverage for medical care—to say nothing about the second-guessing the insurance paper-pushers have invented, known as “prior authorization.”
Prior authorization was once a useful tool to screen major medical procedures. Now it is used to delay and deny procedures as routine as colonoscopies, forcing colleagues of mine to tell patients who are prepped and ready for their colonoscopies to get dressed and come back another day. And if the recent investigation by ProPublica is to be believed, medical directors —physicians employed to review insurance claims at one of the country’s largest insurance companies —denied 300,000 procedures in a two-month span last year using the insurer’s automated review system, spending less than two seconds on each case. There’s no other way I can describe that than “ugly.”
The second physician on my mind on Doctors Day is my son. He—and the possibilities that face the future of his career— have me returning to the “good.” This is because despite the “bads” and the “uglies,” physicians are healers —sharing the legacy of our predecessors embodied in the 2000-year-old Hippocratic Oath.
My son and today’s young medical students, interns, residents and fellows are the future of medicine in Connecticut—and they need help because while they put their patients’ care first, they are facing hard decisions to stay here or leave—due to their own finances.
Connecticut ranks as 47th among the 50 states in retaining the physicians we train. Connecticut has three of the finest medical schools in the country, yet according to the Association of American Medical Colleges, more than half of the graduating medical students leave Connecticut to pursue their careers elsewhere.
This is not good for our state’s public health. Thankfully, last year the legislature allocated $1.6 million of the funds appropriated for state loan repayment to be used for repayment of physician loans and formed a working group to explore methods to enhance physician recruitment. This was a good start, but it needs to continue and legislators should also take up the recommendations of the medical liability reform working group.
In another encouraging sign, the legislature’s Human Services Committee just passed a bill to update Connecticut’s Medicaid rates for physician reimbursements and help ensure that Connecticut’s Medicaid beneficiaries have access to the healthcare services they need when they need it. Bravo!
In a state where physicians cannot survive on a Medicaid practice alone, updating Medicaid reimbursement rates will bolster Connecticut’s physician network serving the neediest—our Medicaid population.
I love practicing medicine and being sandwiched as the middle of the three generations of Russo physicians. Connecticut’s physicians have a legacy to keep, and I will mark Doctors Day 2023 with hope —and them— in mind.
Robert D. Russo, MD, is Chief Medical Officer of the Connecticut State Medical Society.