* Article published in Physician Outlook Magazine on 12/27/2020: https://www.physicianoutlook.com/articles/roadmap-independence
Over the past 25 years I’ve witnessed the birth of “Healthcare”.
When younger, I was often asked, “Do you want to be a doctor when you grow up”?
I’d answer, “No, I don’t want to take care of sick people for the rest of my life!”.
But I loved science, math, puzzles, people, learning, anatomy, figuring out how things worked, a challenge, and I matriculated into medical school in 1992.
It was a time of collaborative engagement, new friendships, discovery. We challenged each other to do better, be better, and the whole class supported each other. Our goals were all the same: learn as much as possible in order to care for patients to the best of our abilities. We were challenged and expected to help each other, study together, quiz each other, & work together. We had all worked incredibly hard to be accepted into medical school & now was the time for each of us to learn to excel, depend upon, & work together. A medical hierarchy exists, and mastery is expected, and required, prior to being advanced to the next level, because patient lives are at stake. We had already proven ourselves as capable leaders, and now was the time for us to be molded and taught both the art and science of medicine.
In addition to science, we learned principles of medical ethics: respect for autonomy, beneficence, nonmaleficence, and justice, and the importance of heeding these guiding principles as we entered into the practice of our age old learned profession. For at its core, medicine is the practice of honoring the Hippocratic oath: to first do no harm, and to help & to heal our patients to the best of our abilities, bounded by the code of medical ethics and humanity.
It is this time honored tradition of medicine that creates physicians: caring, capable, driven, resilient human beings that strive, self sacrifice, and give their heart & minds to what drives them most: their patients.
I’m reminded of a saying, “physicians are not made, they are chosen.” In concert with this saying, I‘d theorize the majority of physicians, and the driving force behind all that we do, is the relationship we form with our patients. For the physician-patient relationship is sacred, cultivated over time, and cherished by both parties. Our patients are not numbers, units or items on an assembly line. Our patients are mothers, fathers, husbands, wives, sons, daughters, sisters, brothers, friends, colleagues. Our patients are family. To me, Medicine = Physician + Patient, and I practice as I was trained: honoring my oath to do no harm, and taking the time necessary to appropriately care for, and put my patients first, always.
Enter Healthcare.
Over the past 25+ years, non-physician middlemen have inserted themselves into, between, and in every crevice of our sacred bonded relationships. Patients have become commodities, & physicians have become replaceable pawns in an ever growing corrupt game of increasing prices: the for-profit business called Healthcare.
Physicians, nurses, and patients are no longer in control of medical care & patients often no longer have a choice in who they see when they seek medical care. Hospitals, insurance companies, PBMs, & GPOs have all colluded together, creating monopolized, incentivized networks. These corporate entities OWN healthcare and restrict patient choice re: physicians, hospitals, prescription medications – be in network or else. Script not on our formulary – too bad! Primary physician, Consultant, ER, or hospital out of network – sorry we won’t cover that bill! Insurance reviewer feels the test/procedure ordered by your doctor isn’t indicated – we won’t approve/pay for it! These corporate giants lobby and control the legislators. This corporatization of healthcare has led to the rise of mid-level “providers.” Healthcare is a business whose only concern is money & making more money. Corporate control is why physicians are being fired & replaced by mid-levels.
Moreover the Medical Industrial Complex has created additional obstacles & for profit entities that further impede access to physician-led medical care, including but not limited to:
- Malpractice
- Scope of practice
- Insurance scandals
- Sham peer review
- EHR/surveillance capitalism on the pain and suffering of our patients
- PBM/GPO issue – 1987 Safe Harbor law causing ever increasing drug prices/shortages
- 1997 freeze on SGR – and its effect on GME & lack of residency spots for those graduating medical school
- Tort reform
- PHP programs – speak your mind/contradict the “norm”/ be labeled as disruptive – and be forced into “treatment” or lose your license
- MOC – extorting physicians to pay for their product or lose hospital privileges & insurance reimbursement
Until we – the physician community – acknowledge that all of these issues have a symbiotic parasitic relationship with each other, and that these issues must be recognized and addressed, corporate healthcare will continue to engulf, consume, and disempower the physician community.
Luckily, we physicians have identified and realized the root cause of our problems, and we’ve had enough!
In Dr. Hyder’s first two installments of How to “Flip the Script,” the parasitic infection of middlemen intrusion into medicine is well delineated and described. Additionally, an article I wrote last fall, To extinguish burnout, bring back physician autonomy, further outlines how third party middlemen have created systemic changes that have led to diminished physician control and the creation of for-profit healthcare.
The rise of easily accessible social media platforms have allowed physicians to reconnect with each other, eliminating the silos erected by corporate healthcare giants. Our connections are key to creating change. For we alone, as physicians, hold the power, the knowledge, and thus, the control over our house of medicine & our future.
Physician value and power comes from our identities and the very data we create during each and every patient encounter. As physicians, only we are licensed, trained, and credentialed to practice the science and art of medicine. Without us, our knowledge, our skills, our expertise, our training, OUR DATA, there is no medicine, & without medicine, healthcare will collapse.
Grassroots physician organizations have formed and grown over the past several years. We physicians are leaders, innovators, & resilient, driven individuals. We fix, help, & heal, and we’ve used our collective strengths to develop new ways of connecting with our patients in order to regain our autonomy and practice medicine as we were trained. As physicians, we have the innovative capabilities, the knowledge, training, and drive to collectively create our very own roadmap to independence, free of middleman intrusion and roadblocks.
Direct Primary Care (DPC)
Physicians are breaking up with the corporate healthcare monopolies and starting their own private, self-owned and run practices again. Direct Primary Care (DPC) is a reimagined type of private practice, with an affordable monthly subscription fee, that gives patients access to their doctors and puts physicians back in control. DPC physicians are free of corporate oversight, rules, regulations, government mandates, MOC, insurance regulations, EHR mandates, and reporting measures that do nothing to enhance the patient’s care and only profit the middlemen. DPC is physician autonomy reestablished.
HPEC (Humanitarian Physicians Empowerment Community)
As physicians our credentials are our identity. Our diplomas, our medical licenses, our board certifications verify our education, training, experience, and our credentials are what allows us to practice medicine and be reimbursed for our services. Healthcare middlemen have been using OUR credentials in their for-profit game.
Currently, the healthcare players require physicians to pay them to verify OUR credentials through a process that, on average, takes 4-6 months to complete, and costs over $5 Billion per year. Physicians lose up to $150,000 in revenue for each credentialing event, and it costs healthcare systems over $1Million per physician, per credentialing event.
Using blockchain technology, HPEC is creating a censorship free collaborative network of physicians, wherein each physician has their own secure digital self sovereign identity (SSI) with verifiable credentials. Once your SSI is verified, you alone own and control your digital identity, allowing for direct secure communication without middlemen interference. By leveraging this new technology, physicians will once again own and control their identities and any and all generated data: patient notes/charts, referrals, prescribing patterns, tendencies to order certain tests, insurance trends, billing/coding, your patient’s private medical records. Currently, we have been unknowingly participating and giving up our patients private health information, and corporate healthcare middlemen have taken advantage of this easily accessible generated data, and exploited and used our data to increase their profits, to the detriment of both patients and physicians.
With HPEC, we will own our data, and own our right to work. The digital documentation and sharing of our patient’s information with third parties will no longer be necessary. HPEC allows for secure direct confidential communications between both physicians and their patients, free from third party oversight or influence. Additionally, by digitally owning our credentials, our SSI gives us power, as we are the only source of truth regarding the validity of our credentials, granting us portability and leverage when negotiating contracts, and empowering us to choose with whom we work, and share our knowledge, experience, abilities and professional connections. SSI will also allow for peer to peer collaboration and communication around shared interests and common goals. Physicians will be able to collaborate with their colleagues and vote on issues that concern them in a truly democratic way. Once every physician has their own self sovereign digital identity, they will also be able communicate with their patients in a direct private manner. Because HPEC is decentralized, it eliminates the risk of privacy infringing surveillance models or distant and bloated bureaucracies influencing the practice of medicine.
Built by physicians for physicians, HPEC is a secure, trusted, censorship resistant physician only network which will preserve the sanctity, privacy, and trust of the physician patient relationship, and empower us to regain control over our learned profession, and, once again, own our house of medicine.
myDoqter
With the rise of social media online interactions and searches are now the go to for finding and discovering information. The younger generation has likely never heard of the yellow pages. Word of mouth recommendations still happen, but most occur virtually via social media connections and online reviews. And anyone can post anything on the internet. Online reviews have increased exponentially. Websites pop up claiming “doctor”, “board certified”, “specialist in”, and the public is none the wiser. Even professional sites – once physician only – are now intermingled with non-physician providers, many of which claim to be doctors or are listed as having attended medical school! Transparency in training and actual credentials are often difficult for us to determine, yet alone the public. This is why myDoqter was created.
By physicians, for physicians, myDoqter has created a physician only network. Physicians on the site must be licensed, and their credentials verified (which will become instantaneous once SSI’s by HPEC are utilized!). Physicians then attest their colleagues capabilities and specialty through peer review. Think of it as an online physician referral network. The physicians you’d refer your patients to are now in one place: myDoqter. The best part? The public – as patients – uses the site to find qualified physicians with verifiable transparent credentials approved by their own private physician.
MyDoqter is on its way to becoming the referral network for BOTH physicians and patients. Reconnecting patients with trusted physicians and reestablishing the private physician:patient relationship. Transparency in training, verified by practicing physician peers, available to the public, reconnecting patients with physicians: myDoqter.
DPC, HPEC, and myDoqter all embrace the same underlying principle, that which I believe both physicians and patients alike currently seek: the reconnection and reestablishment of the direct physician:patient relationship, free of third party middlemen interference. Medicine is both a science and an art, and physicians make up its heart and soul. For it’s the time we spend with our patients, the relationships we form, and our connections to each other, that fill our sacred house, and put the human back into medicine.
Now is the time for physicians to realize our significance and value, to overcome the perception of compliance and learned helplessness, and to activate, align and use our innate resilience to take back our house. By leveraging our credentials, training, education, and our connections, we are in the driver’s seat, and in control of our future. For without us, there is no medicine, and without medicine the entire for-profit healthcare conglomerate no longer exists.
Together we are powerful, and if enough of us believe we can change the current system, we will. Dr. Sam Shem recently said, “Power arises in a good connection and a good connection is good medicine.” Let’s reconnect together, harness our potential, unite in our power, reestablish physician autonomy, and follow this roadmap back to the ethical practice of medicine, putting our patients first, above profits, as we were trained.
~ Christina Dewey, MD, FAAP
References/websites:
https://www.physicianoutlook.com/articles/doctors-its-time-to-flip-the-script
https://www.kevinmd.com/blog/2019/09/to-extinguish-burnout-bring-back-physician-autonomy.html
https://doctorsonsocialmedia.com/conversations-with-shem-episode-three/
