Leaving Medicine Better Than We Found It

Like many of my fellow pediatricians, today I read the three page letter written by American Board of Pediatrics CEO David Nichols.  It was a full day seeing patients and it took me nearly three hours to finish it. The letter was so upsetting I couldn’t handle reading it straight through. I’d start reading and my stomach would turn, I’d start to despair about the future of medicine, and I’d put the letter aside. Thankfully, it was a busy day and I was always rescued from this sadness with a patient. It’s summer, so that means sports physicals.  Today I saw lots of 14 year old girls, the same age as my oldest daughter, and it was fun. But between patients, I’d try to slog through more of the letter and the sadness would return…only to be rescued by a patient.

The emotional swing of my day is just one illustration of the stunning disconnect between the joy we find in being doctors and the soul-crushing work done to us by those in power. After carefully reading the letter, I had planned on writing a witty article making fun of the imaginary bell shaped curve and debunking Nichols’ whole straw man set-up. Now I realize it’s not worth it. Nichols’ letter is just one man’s desperate attempt to justify his million dollar salary. My sadness today was not with Nichols and the ABP, indeed I’m not even board certified through the ABP anymore, so what they say does not really impact me.

The real issue here is leaving medicine better than we found it. I can safely say the generations before me dropped the ball.  I’ve talked to many retired doctors and after chuckling “man I’m glad I got out”, there is a soft sadness and recognition of failure when they see the look on my face at those words.  They failed us.

Those in power now, like Nichols, are continuing to fail us.  At a certain point, even the $1.3 million dollar salary fades away late at night, and Nichols knows he’s made medicine worse for his fellow pediatricians. He’s taken our money, he’s driven good doctors into early retirement, he’s cost us jobs, promotions and pay.  He’s torn nursing physician mothers from their newborn babies, he’s forced physicians from the bedside of their own sick children and parents, he’s made physician cancer victims choose between taking a test to keep their job or taking care of their own health.  This is what the ABP Maintenance of Certification program and never-ending hoops are doing to us.

Nichols and the ABP are the perfect case study in how to ruin medicine and your fellow physicians.  From Nichols’ letter, it’s clear the ABP is not listening. Instead, the letter attempts to divert our attention and divide us.  Those of us who believe MOC is discriminatory, unjust, and an intrusion into the professional joy of the doctor-patient relationship are not just a “faction”, we are the majority.

The beauty of the MOC  fight is that it is also a perfect case study in how to make medicine better.  We are the majority, and we need to act that way.  We need to reject the whole premises and imaginary power of these boards.  We have to stop participating and let the program die away. This new generation of pediatricians graduating should be taking their boards for the first and last time. MOC stops with us.

As it stands, nine out of ten doctors do not recommend medical careers to their children. Those that do, do not recommend primary care.  This is a tragedy.  This world needs good doctors, and who better than the children of healers to carry on this calling?  There are so many things we do for our children to prepare their future, from teaching them to read to saving for college.  We need to take a hard look at the problems in medicine with them in mind. What can we do to make medicine a better career for them, how can we ease their way?

I can think of many toxic aspects of medicine, MOC is just one. I fight it because it’s an easy win. The tough ones on reimbursement and regulation are yet to come, but already we are seeing strong wins for those brave enough to challenge the whole system.  There are some bright spots, some really exciting bright spots in medicine.

Direct primary care, be still my heart!  The disruptors and innovators out there are almost too many to mention, Lee Gross of Epiphany Health, Josh Umbehr of Atlas MD, Ryan Neuhofel of Neucare,  I could go on and on. These docs are doing the impossible: after generations of rapidly deteriorating satisfaction in medicine as a career, they’ve actually created models that are better than the “golden age” of medicine. By meshing old school primary care with technology, they’re providing better quality care, better patient satisfaction, better physician satisfaction and decreased cost. It’s stunning. And it’s happening now.

When I see what these amazing docs are doing, how they are making medicine better for physicians and patients, when I step away and just spend time with my patients, all the babbling by Nichols and the ABP just looks pathetic, archaic, and irrelevant. Tonight, as I was thinking through all these issues and how I can improve my little corner of medicine, Zubin Damania posted this video, and I’m crying. This is exactly what I’m talking about. There is no question. I know where the real revolution in medicine is taking place and where our future lies. Let’s get to work building it.

Photo by Alex E. Proimos