Richard E. Waltman, MD

	The progressive marginalization of physicians can no longer be denied. We’ve come a long way from the time-in my professional lifetime-when physicians were always voted the “most respected profession” and saying you were a doctor got you a good table at any restaurant without a reservation.

	But over the years I have watched as our profession has been increasingly pushed to the sidelines by other players in the healthcare game. When did it really hit home for me? Perhaps that day a few years ago when my company began to speak of us as “providers,” not physicians, and we accepted the designation with only the quietest of protests.

	Recently my wife went for an ear, nose and throat (ENT) procedure. The title on the door was “Mountain ENT Clinic” and the names of the two physicians who worked there were not displayed. Nor were they on the office business cards. On the way to that office we walked by the Primary Care Clinic and the Gastroenterology Clinic, and in neither location was there any signage indicating the physicians who worked there.

	 I must admit I was initially a bit embarrassed by the near-reverent way I was treated as a new physician. I recall thinking it a bit much, but over the years I confess I learned to like it. That is over. Now I’m just one of many who work for a large healthcare system. We are no longer the stars of the show, no longer even featured performers, just part of the team.

	It’s no longer, “we’ve got the best urologist,” but “we’ve got the best surgical robotics.” And I’m OK with all of this. I still enjoy my work, and I am appreciated and cherished by many of my patients. I just feel obliged to reflect on this major change that is occurring in the way doctors are viewed and treated.

	So to my younger colleagues, I repeat: You are being marginalized. Don’t like it? Step up and reestablish your prominence, and your importance in healthcare. Do a great job, and then don’t be shy about talking about it. Make yourself important by the work you do-and let people know.

	You don’t mind being marginalized? You like just doing your job and going home, with fewer hours, fewer committees, reduced input, but more free time and less worry? So be it. I respect your choice and wish you much success in this new structure. Things change, after all. Perhaps having a reduced role will work for you.

	But whatever happens, take good care of yourselves, take good care of your families, take good care of your coworkers, and most of all, take good care of your patients. 

Do you think medicine is still a respected profession, or are doctors being marginalized? Write to us at 

Articles

A reader argues that physicians have been increasingly pushed to the sidelines by other players in the healthcare game.

Physicians are no longer the stars of healthcare

Editor's Note: We asked our editorial board members to share their opinions of the Supreme Court ruling on the Affordable Care Act. Here's what Richard E. Waltman, MD, said.

Since my specialty is geriatrics, my practice has been greater than 75% Medicare for a long time. Although I share the usual concerns about reimbursement, I must say that Medicare works well for most of my patients. I am able to provide them the care that they need and am usually able to make timely referrals.

I struggle more now with my patients who have private insurance, in terms of getting approval for testing I know they need and finding "preferred"  specialists and surgeons.

Based on my experience, I am a "Medicare-for-all”  advocate. We have a system that is already working well, and I see no need to create anything else. Let's offer Medicare to everyone. Those who want "better care" (concierge medicine) can pay additionally for it.

I do believe as well that a strong primary care focus to our health care system is vital. A large portion of my patients see only me, with occasional visits to the dermatologist or to the ophthalmologist. I send them to specialists when they have an acute problem when I need help (usually tests) or for a complicated decompensation of a known problem. I truly believe I can take care of their chronic problems better than can my specialty colleagues. I see no benefit in a yearly visit to the cardiologist, to the pulmonologist, to the endocrinologist, or to the rheumatologist for a patient who[se condition] is stable and doing well under my care.

Let's encourage medical students to enter primary care, let's train them well, and then let's provide them fair reimbursement. The wide discrepancy in compensation for physicians must stop. Some of should be been getting paid more, and, sorry to say it, guys, but some of should be getting paid less.

Primary care physicians should be rewarded not only for the work that they do but also for the cost savings they bring to the system.

Pearson: Healthcare reform is the right thing to do

Wax: Decision is dark chapter in American history

Medical Economics editorial board member Richard W. Waltman, MD, shares his opinion about the Supreme Court Affordable Care Act ruling.

Waltman: I am a 'Medicare for all' advocate

I received some supportive email responses, but many people were not happy and stated firmly that I and other doctors have no right telling people how to live. 

One respondent said, "If you nag me about smoking, I'll punch you in the face."			

A third reader objected "to the unwelcome and unwarranted intrusion on privacy."			

"BO" said that the writer (me) "had no obligation to invade my personal space, intrude on my life, and insert himself into issues that are none of his concern."			

"Lorenzo" simply told me: "Shut up, Doc." 

I do not agree. I believe it is my obligation to my patients and to all members of society to use the knowledge and experience I have to give people the opportunity to live more healthful and safer lives. 

I know more about the overwhelmingly proven dangers and complications of smoking than the man at the airport does, and I believe he might be more willing to consider cessation if he knew what I know. I chose to remind him of the risk he was taking by smoking and make him aware of the opportunities we have now to help him become tobacco-free. 

When I did my medical training, I was in a university-affiliated hospital, and we waited there until people came in with what was usually illness in an advanced stage. As did my colleagues, I trained in a world where understanding pathology-what was wrong-was stressed, not etiology-what had caused it. The focus was on aggressive intervention, necessary because everyone was so ill. Some people did get better, many did not, but the message we received was that such serious illness could not often be cured. 

We learned to accept blindness and extremity amputation as normal results of diabetes, strokes and heart attacks as the anticipated result of hypertension, and cirrhosis and severe gastrointestinal bleeding the frequent complication of extensive alcohol use. People had workplace accidents, people got mugged, women were abused. People with arthritis stopped walking, people with osteoporosis broke bones, and people with glaucoma lost their vision. 

It was a reactive approach to medicine: wait until something bad happens, and then respond. And that is the way that medicine had always been. Reactive. It never felt right to me. 

Although epidemiologic work, such as the famous Framingham Heart Study, had been completed previously, it was only in the mid-1980s that a new approach developed: Let's look at the causes of illness and determine whether we can prevent or modify those causes-and do so 

I'm not certain when I first heard about that proactive approach, but I was immediately more comfortable with it. And so, it seemed, was everyone else. 

No longer do we wait for patients to show up with life-threatening illness. We want to prevent them from becoming ill or help reduce the disabilities associated with their current illness. That is a huge change-and a very good one, in my opinion. 

Over the past 30 years, we have reduced the complications of metabolic and vascular disease, and we have made great progress in identifying illness at early and treatable phases. Cancer no longer is a death sentence, and patients with diabetes no longer must anticipate amputation, blindness, and dialysis. People are living longer and better, and physicians deserve some of the credit. 

That approach may not sound very revolutionary to a 30-year-old physician, but it is a concept a 60-year-old doctor has had to learn in practice, and it is something a retired 80-year-old colleague never will fully understand. 

Your care of a patient isn't limited to what happens within the four walls of your practice, a Medical Economics board member discovers.

Caring for patients doesn't end in the office

My wife, Ruth, and I are frequent visitors to Yellowstone National Park, and we are respectful of its power and majesty. Sitting on the porch of the Mammoth Hot Springs Hotel 5 years ago, we saw people of many nationalities go by but noticed a definite absence of young American children, particularly those of color. 

We spoke with Jeff Brown of the Yellowstone Association (YA) to see what we could do to have our local kids participate in what the park was doing for underprivileged children, only to learn that no formal program existed. 

Jeff and his associates came up with a wonderful 5-day program, and they were very eager to share their instructors. The program included visits to the Lamar Valley, Old Faithful, the Grand Prismatic Spring, and the Grand Canyon of the Yellowstone, as well as a Junior Ranger training program. The kids would write journals, take photographs, and paint pictures. 

Meanwhile, we were back in Tacoma, Washington, trying to find the kids. Churches? Schools? Repeatedly, the Boys & Girls Clubs of America (BGCA) was suggested, and that`s the organization we contacted, fortunately. Officials there also were eager to participate and said they would choose and train the children. 

A member of the Medical Economics Editorial Advisory Board details how his love of nature and his desire to give back opened the eyes of underprivileged children to the wonders of the National Parks--and opened his eyes to the joys of volunteering.

Author | Richard E. Waltman, MD

Articles

Physicians are no longer the stars of healthcare

Waltman: I am a 'Medicare for all' advocate

Caring for patients doesn't end in the office

Our Yellowstone adventure