Laying Down My Stethoscope

One of the Star Tribune’s leading articles 8/7/16 is “Doctors Battling Crisis of Burnout.”  The article talks about how many health care organizations are recognizing physician stress and burnout as an important issue and taking steps to help providers develop “resilience” in the face of stress.  Such steps include offering an exercise room at work, hosting dinners to discuss stress, and sending cleaners to doctors’ homes when the workload is particularly dense.

Pardon me while I try to prevent my brain from exploding.

People ask me at least weekly if I’m going back to work anytime soon.  After I completed residency, I signed a contract for ¾ time with one of the major healthcare organizations in the Twin Cities.  I had my own dedicated RN – this sounds possessive, but I assure you, I was hers, too.  Full-time status was considered to be 28 face-to-face hours with patients per week.  This doesn’t include the hours spent on phone calls, charting, paperwork, prescription refills, etc.

I worked one week out of every eight in the hospital, loving the interaction with our clinic’s patients and hospital specialists with whom I’d trained.  I took overnight call about three times a month, sometimes more.  Those nights were rough, often with little sleep and hours spent at the hospital.

I dictated my patient visits and handed the tape to our site transcriptionist.  The notes were filed in the chart in reverse chronological order.  The paper-bound story of a patient’s medical life.

When my son was born, we were up to 34 face-to-face hours as the expectation for full-time status.  Not including phone calls, charting, paperwork,, prescription refills, etc.  Benefits were dependent on your FTE (full time equivalent).  I was my own transcriptionist at that point.  We had transitioned, painfully, to an electronic medical record.  Physicians were encouraged to develop “dot phrases,” generic pre-fab chart note chunks, that could be plunked into anyone’s note and tweaked as necessary.  It’s like calling paint-by-number “art.”

We were paid on “production,” how much revenue we generated for the organization.  wRVUs is the technical term – “work Relative Value Units.”

RNs were a hot commodity by that time, sequestered into specialized roles like Coumadin management and phone triage.  Providers (we were mostly physicians with a couple nurse practitioners) worked with medical assistants, some of whom floated to different clinic sites.

So when the Big E was born, Ace and I each had non-coordinated, independent, overnight call schedules.  I asked for some time away from call with a concomitant decrease in pay.  The organization turfed the question back to my colleagues.  They declined.  I can understand it – if I didn’t take call and the organization offered no support, the burden fell upon my partners.

I gave my notice.  But the organization contractually required ninety days.  Eventually, the ninety years/days were up.  I wanted to continue working for the organization in urgent care sporadically but that meant I couldn’t cash in on the physician retention benefit plan.  I worked in urgent care twice and haven’t worked for money since.  We are fortunate.  We can make it on one income.

Last time I checked, “full-time” was considered to be 38 face-to-face hours per week.  That still doesn’t include phone calls, charting, paperwork, prescription refills, etc.  Part-time employment is not allowed unless you were “grandfathered” in.  Patient visits are scheduled at twenty minute intervals.  Yes, you’re expected to do a complete physical exam in twenty minutes on that 64-year-old three-pack-per-day hypertensive, dyslipidemic, diabetic who is transferring care from Florida and arrives with an oxygen tank and a wheelchair.  Providers work with whatever medical assistant is assigned to the patient care team for that day.

“When are you going back to clinic?” you ask.

After the revolution.

Physicians and mid-level providers are the way healthcare organizations make money.  VPs do not generate revenue.  Nurse managers do not generate revenue.  Presidents do not generate revenue.  When organizations find themselves in tough times financially, they whip the doctors. Work more!  See more patients!  Get us more money!

Pay-for-performance is a particularly devious form of torture.  Your pay is docked if your patients’ blood sugar control isn’t perfect or if their blood pressure isn’t within certain parameters.  Physicians are held personally responsible for patient outcomes.  On one level, of course this is appropriate.  Physicians must practice ethical, up-to-date medicine.  On another level, I can’t control whether my patients actually take their medication, follow my exercise advice, or smoke right before their appointment.

What would a revolution look like?

1) Medical scribes for all providers.  Physicians shouldn’t be typing their notes.  This is an unbelievable waste of the specialized knowledge of the sole income generators in a healthcare system.

2) Single-payer, universal healthcare system.  You can’t imagine the convoluted mess of human resources necessary to support our idiotic patchwork-payer system.

3) Allow part-time employment and build in support for life circumstances (illness, leave, surgery, birth, family emergency).

4) Reward thinking specialties (family medicine, internal medicine, pediatrics), not just procedure-driven specialties (gastroenterology, surgery, etc).

5) Make medical school free.  I graduated from med school in 1997 with $60,600 debt.  I paid most of it off during residency.  The average medical student today graduates with $170,000 in debt.  And we wonder why there is a shortage of primary care docs.

6) Study upper-level administrative pay and figure out a rational approach.

(7)As long as we’re having a revolution, let’s make it possible for a family to live on one average  income.)

8) Give some control back to docs.  If I want 45 minutes for a complete physical, let me have it.  I know I won’t be paid as much.  So be it.

9) Pay should depend upon quality and complexity of care as well as production.  But figure out the right ways to measure quality.

10) Off-load providers.  Providers should only be doing provider-level work.  This sounds arrogant to some, I realize.  Gee, the poor doctor didn’t want to room her own patient.  In terms of office efficiency, though, this is the only system that makes sense.  Develop protocols for refills, triage, rooming, updating chart info, etc, AND FOLLOW THEM.  PharmDs can do a lot of medication management for chronic disease.

There’s a lot more to the revolution.  And I have a headache.

In short, it’s great that more attention is being paid to physician burnout and stress.  However, the answers lie not in fixing the physicians, making them more “resilient,” but in fixing the healthcare system that’s burning them out.

PS (8/11/2016): Over 4500 people have read this post since Monday.

1) Thank you for caring about the health of healthcare.

2) I plan to continue with this topic for at least a couple weeks.  I generally post on Mondays.  If you want to stay in the conversation, please consider signing up for my blog (below or up on the right-hand side).  You’ll get a confirming email RIGHT AWAY saying Thanks For Subscribing!  If you don’t see the confirmation, check your spam folder.  Please.  (And here’s the next post.)

Musical Moment


This entry was posted in Blog and tagged , , , . Bookmark the permalink.

68 Responses to Laying Down My Stethoscope

  1. Melissa says:

    Amen sister! Amen…

  2. Linda Madden says:

    Anne – this is so perfect and beautifully written and, most importantly, from a doctor’s perspective. I say to soooo many people that healthcare cannot be a for-profit business, because the bottom line (i.e. shareholders expecting increases in the value of their stock and beyond ridiculous through the roof executive compensation – anyone pay attention to what the CEO of United Healthcare makes a year?) is always going to win over the patient’s/doctor’s etc. etc. best interests. I pretty much abandoned the US healthcare system about 5 years ago, in spite of the face that I have insurance.

  3. Ev says:

    in some ways, I feel you could take out “doctors” and “healthcare” and insert “teachers” and “education,” and have a startlingly similar narrative!
    The picture you paint is the unseen human toll of a broken system- very interesting and engaging read!

    • anne says:

      Yes! The parallels are striking. Penalizing teachers for low test scores. Increasing class size. Eliminating teaching assistants.

  4. Jen McKeand says:

    I love this!!

  5. Alison Warford says:

    Just today I received an email from my employer (a large local health system) requesting input on how to reduce physician burnout and asking for my opinion on physician compensation (I am a primary care physician). Do you mind if I share this?

    • anne says:

      Thanks for taking the time to read. Please share. I’d love to hear more about your work situation and will email you.

  6. Debbie Kenney says:

    If you would have included some thoughts on Big Pharma, I think you have just correctly written the ACA “Obamacare”.

    • anne says:

      Yes, I definitely have thoughts on Big Pharma. The trouble with Obamacare is the continued reliance on private insurance companies – a profit-driven model. Personally, I don’t think a profit-driven model is appropriate for healthcare.

  7. Kathy says:

    Superb! The eloquence at summarizing the horrible labyrinth called healthcare deserves applause! Thank you for taking the time.

  8. Nicole Paul says:

    Anne, I have been out of residency for only 3 years and I’m already ready to quit! Your article is literally what I have been saying for so long now. And the production-based salary is just the worst insult to a doctor…could you imagine a CEO agreeing to a production-based salary? Hell no, but doctors are bullied into doing so. Since when is it okay to treat doctors like this?!? We save/improve lives!! We make critical decisions all day, every day! Clearly that doesn’t count for anything! I wish we could unionize and go on strike like the junior NHS physicians did not that long ago! I wholeheartedly support a revolution, so what’s next? I can’t sit idly by and let medicine continue to be destroyed.

    • anne says:

      “What’s next” is a great question. Most docs are working so hard that they literally don’t have the time/energy to try to effect change. Or they’re afraid to speak up, thinking they’d be axed. One physician organization that I trust is is Physicians for a National Health Program. There are state-based chapters of this organization. Where are you practicing?

  9. celeste pennington says:

    Superb statement, Anne. It was a parallel – gruesome – process that I was experiencing as a mental health provider which helped me decide to exit the field. [the call for Revolution swells!!!] Love and admiration from across the miles.

    • anne says:

      Thanks, Celeste. Oh boy, the mental health situation in the US is dire indeed. Do you have any examples of countries that do it well?

  10. Amy Petersen CNM, WHNP, DNP says:

    Brilliant! Although I am a mid-level much of this still applies. And in some ways it can be worse because at the moment I don’t have an option for RVU but would like to earn more money. I see the same amount (more than some) of patients as MD’s but have little to no potential to earn more through surgery or procedures. So I am left with working lore for less with 90k worth of debt to slowly chip down. I am only in my 3rd year of practice and feeling the burn. I think as providers we are expected to be wonder men and women and feel the pressures of seeing more doing more but we and the patients suffer. I really appreciate your input and say thank you for the beautifully written article!

    • anne says:

      Amy, thanks for reading and for your comments. Absolutely – it applies. So you’re salaried? Interesting if you are – all the NPs were on wRVUs in my former system. Regarding your procedural privileges (just out of my curiosity) – can you perform IUD insertion/removal, vulvar lesion biopsy, implantable birth control, EMBx?

      • Kathryn Newburn says:

        Yes many of our in medical offce/hospital CNM’s do these procedures afture receiving training and or certifications. E.g., 1st & 3rd trimester ultrasounds, Colposcopies with Tissue Bx and Tx’s , are within our scope of practice. As CNM’s we can perform episiotomy, & lac repair.Usually 3rd+ degrees are referred to OB/GYN but some are skilled in this. Kaiser Permenente utilizes CNM’s as first assists at C/S also. The law in California allows RNP/CNM’s special procedure designations also to perform some other interventions as well, but requires more approvals from medical back up providers and hospital committees. We are working at removing the OB ‘supervisor’ language in our B&P code. 46 other states do not require Nurse midwifery to be defined by that requirement. This has not resulted in substandard outcomes either. In fact just the opposite.
        Kathryn Newburn CNM, RNP California.

        • anne says:

          I’m not at all surprised about the outcomes data. Thank you for the wonderful work you do! And thanks for the procedural clarification. Regarding compensation (if you’re comfortable sharing), is your compensation tied to production, or are you on strict salary independent of production?

          • Amy Petersen CNM, WHNP, DNP says:

            Strictly Salart

          • anne says:

            Amy – You might start by asking to see your production numbers – I’m sure they exist, whether or not they are being shared with you. Compare your production to other CNM providers and OB/Gyn providers and see if it might be worth your while to ask for a production model of compensation. Just a thought.

  11. Steven Reiter says:

    Healthcare for profit is illegal in most countries. True affordable healthcare would eliminate the insurance companies. Big Pharmaceuticals sets outrageous pricing only in the USA. It’s illegal in just about every other country in the world. Lobbying in Washington for big pharma and insurance companies should be illegal. We have so called nonprofit hospitals with CEOs taking home millions in salary. The system is corrupt beyond fixing. A revolution will require dismantling corruption from the top down. Starting in Washington. 50 years ago Doctors were in charge. Now the tail is waging the dog. And everyone suffers the consequences. Except for our elected representatives in DC, they have their own private plan.

  12. Therese says:

    I was offered a scribe by my former employer. The catch was I had to pay the scribe myself it was the equivalent of one months worth of pay. Your comments on this our use of administrators is spot on.

  13. Jen says:

    Check out One Medical Group! They’re working on making primary care feasible for providers and a great experience for patients. I love working for them.

  14. CD says:

    Really enjoyed your article. Unfortunately, a lot of the issues you mention also happen here in Canada – where we do have a single-payer healthcare system. GPs and family doctors are getting harder and harder to find, patients are forced to go to walk-in clinics where docs will only address a single issue per visit (as communicated in signs posted everywhere, including the examination room), and the wait times are long and efficiency for patients is lacking. Not sure what the solutions are (am not a doctor) but wanted to bring that to light.

    • anne says:

      Oh No! And here I thought Trudeau’s Nirvana was only seven hours away! (I’m in St Paul, Minnesota). I’m wondering about reimbursement, if the Canadian system is procedure-driven as we are here in the US, and that’s why there’s a shortage of family docs. Clearly I need to do more cross-cultural reading. Interestingly, many of Cuba’s health outcomes are far better than those in the US, including infant and child mortality rates. Must continue to study. Perhaps docs need to form a world-wide union. Might as well dream big…

  15. Sue Haddow says:

    Thank you for articulating this so well. Especially the part about “Pardon me while I try to prevent my brain from exploding.” There was another article a few years ago that noted if a full time primary care doc were to try to accomplish all the things required to do the “quality measures”, etc, for an average patient population of around 1300 (give or take), that is would take 22 hours per day! I truly did laugh out loud. At our organization we have 4 of us doing integrative, holistic and functional medicine primary care and have 30 minutes for all follow ups and 60 minutes for all new patients. (I still get behind with annual physicals, 30 minutes is not enough for that.) We are running resilience courses. We start with saying we are not doing this to try get more work out of every one for less pay, or making you feel better about working in a dysfunctional system. It is for skills for your life – home, work, wherever – and perhaps it will help motivate all of us to make the changes in the system and/or our own lives to be healthy. One thing our system is doing is actually PAYING employees to attend the training, and not expecting it outside of work hours, that is at least something. I worked in New Zealand for 6 months, under a national health plan, and it was just fine. It has its flaws, no doubt, but was very functional and everyone knew that had coverage, would not go broke if they broke their leg and needed surgery. Everyone paid their tax for it. There is no perfect system, to be sure, but there are better ones. Imagine all the overhead from insurance companies going to a National Health Plan and the current insurance companies would down size and be the local administrators of the National Plan. There would still be plenty of jobs, but many fewer of those really high end ones, perhaps. One of our docs has sent your blog to Dr. Linzer, noted in the article you referenced. There was a recent Family Practice Management editorial regarding burnout and getting to the root cause.
    However, if I read those words: “work more efficiently” again in regards to burnout I think I may have to pardon myself while I try to prevent my brain from exploding as well! I also did not go into medicine to have my patients be a problem. Yes we need boundaries, and I find if I do not operate from a place of compassion when people come to me suffering, then I begin to feel and get sick myself. We have built a system where compassion is not part of the equation. Taking care of patients is messy business, no matter what field you are in. No one wants to be treated like a cog in a factory wheel, as I have heard some of my patients refer to a certain GI group in those terms. Who is demanding we see more people faster and why? I think there are studies out there saying around $75,000 per year as income for the most part, alleviates poverty, distress and contributes to emotional well being.
    Thanks again and let’s continue this conversation…

    • anne says:

      Hi Sue! Thanks for taking the time to read and respond. And thanks to your colleague for forwarding my post. I’m delighted to see that HCMC is paying providers to do the resilience training. This is not the case at other large Twin Cities health systems… The bottom line question, I think, is how do we continue the conversation? How do we start the revolution?

  16. Bonnie Manderschied says:

    This article is great. I couldn’t agree more with the things you’ve pointed out. I’ve witnessed, first hand, physicians being expected to do more without the needed support staff. The expectation is to see more and do more regardless of the complexity of the patients you see. I also see a lot of nursing staff that get the workload of completing the necessary work for community measures and such. Who do you think is following up with those patients in 3 and 6 months regarding their previous ACT score or PHQ9 score? I’ll tell you, 9 times out of 10 its the nursing staff. They complete all the leg work with absolutely no incentive for themselves. I hear PCP’s telling their nurses all the time “you gotta help me get my #’s up”. Medicine is no longer about taking care of the patient. Its turned into a cut throat business that only demands more and more. I appreciate you speaking out about this.

    • anne says:

      Thanks for your comments Bonnie. I was reflecting more on this tonight. So many organizations are using “Patient Satisfaction” scores as a means of evaluation providers. I wonder if we could use patient satisfaction to help turn this tide. If patients fully understood what was going on, how the therapeutic relationship between provider and patient is threatened by the for-profit model, perhaps patients would rally around their docs? Perhaps?

  17. Mary says:

    My husband sent me your article, finding many similarities in what I say as an employed physician with what you wrote. I am proud of my cognitive and interpersonal communication skills that I rely upon to be the best physician I can be. What I am actually responsible for within the organization is much less talent and professionalism, much more quantity of measurable outputs. I too would love to see a revolution. Maybe social media can allow us to talk about these difficult topics so we can effect the change needed for us to be able to devote ourselves to caring for our patients.

    • anne says:

      Dr. Mary – thanks for your words. How do we start the revolution?

      • Mary says:

        I think you are correct to start conversations. Most of the conversations I have with physicians outside of our offices will wind up talking about the frustrations of practicing medicine, sometimes with tears and almost always with an escalation of tone from conversation to stress. Thank you for being aware of how sensitive identifying these stories can be for the tellers.

  18. Connie Gratias says:

    So well stated! Thank you!

  19. Arwyn says:

    Thoughtfully written, and I have shared this! To think that physicians aren’t resilient, and that we need additional training for “stress” is asinine considering the rigors of our training. There is another group called Physicians Working Together (PWT) that is attempting to make change and start the revolution. We need to take healthcare back, but we’ve all stood on the sidelines or have just been too busy to pay attention to what has happened to our field. So much more can be said, but we need action! Thank you for initiating conversation. Who knows, this may start the revolution!

    • anne says:

      Thanks for your comments – and for sharing my post. I’m headed over to the Physicians Working Together website NOW!

  20. Michael says:

    Thanks for speaking up Anne

    The revolution starts when we stop complying.

    That means no more preauthorizations. No more redo of meds to deal with shifting formularies . No more signing home health authorization and plans of care, the worlds least useful document anywhere. When he listen to patients and ignore administrators. When a million of us march.

    Nothing changes when one of us acts. Everything changes when 100000 of us do.

    We exist in a medical services market place not a health care system. It changes when we change it and not one second before that.

  21. Lynn says:

    In 1992 I saw at least 30 patients per day, delivered 60-70 patients per year, sewed up every laceration that walked in, casted fractures, held hands of dying patients, did circumcisions, raised two children, ran several committees, taught students, etc. Now, in a large health system, I am .8 FTE, see 52 patients per week, make less money (RVU’s) than my younger partners, have incredibly efficient diagnostic expertise, mentor my coworkers, am in the top 1% of national “Patient Satisfaction”- none of which I get a nickel for (I got a plaque). And my brain is exploding to boot. I’m ok with being a public utility, just let me do it, and pay me for my knowledge and abilities so well honed. If my airconditioning repairman had spent his time staring at his computer and typing while thinking about my appliance, I would have worried he was not focusing and would miss something. Family Medicine is a seriously undervalued profession. Internists get paid more while we now do the same work, and they too are under valued. Any highly paid CEO would be aghast at our current working conditions- the ergonomics (you must have an affliction to get a standing desk), the quick lunch over the keyboard (if you remembered to bring one), all while being slave to an electronic billing machine. And save lives if you can. And be sure your staff doesn’t see you sigh or you will get reported for nastiness because no one has taught them why we’re really there. This is the EMR, this is your (7 years of post graduate education) brain going to waste. Medicine is in trouble, and I fear for my older years, and my children’s.

    • anne says:

      Wow. Thanks for your comments. “If my airconditioning repairman had spent his time staring at his computer and typing while thinking about my appliance, I would have worried he was not focusing and would miss something.” Yes, I used to warn patients that I would be typing and my typing meant that I was listening to them… How do we start the overhaul?

      • Lynn says:

        Patients are the drivers of change as they are the Consumers of a defective product. They know when their provider is stressed and missing things.
        We could make the product more defective by not filled out certain forms, prior authorizations, etc , in a way that does not harm them.
        Social media could help at least bring awareness to the ridiculousness of the end result (in the trenches)of silly metrics like meaningful use and medication reconciliation. It’s a “take away” whether staff or providers do the work. We could just stop doing all that dumb stuff.
        However, The uppity providers will eventually get replaced by complying providers. This is a train already out of the station. If you don’t have a second income to fall back on, you’re in deep and must make the best of it. Or find a new career.
        My favorite new quote “it’s not cynical if it’s right”.

  22. Pingback: Suggestion Saturday: August 13, 2016 | On The Other Hand

    • anne says:

      Lydia – thanks for mentioning my post on your website. I’m looking forward to reading your other suggested pieces, particularly “This is the best way to motivate yourself to exercise.” I need it…

  23. Mia D Sorcinelli Smith says:

    Just back to work after baby #3– add in pumping during lunch and night nursing and I feel the same way. Also our visits are 15 minutes, with 30 for physicals and over 75. I don’t know how much more I can take.

    • anne says:

      Thank you for nursing your baby. Thank you for the hard work you’re doing. If I could send you seven hours of uninterrupted sleep, gift-wrapped, I would. You might even settle for four…

  24. Mary Loken Veiseth says:

    Right on !! We were scheduled with every 10 minute appointments – try a physical in that time. I would use at least 30 minutes for a physical – and that wasn’t enough. However, the other docs didn’t want to change the scheduling – even though not a one of them was ever “on schedule.” Where does the patient come in here? My work day went to almost 12 hours with the advent of the computer; I feel the computer has more to do with burnout than a lot of the other issues.

    • anne says:

      Every ten minutes? It took me five minutes to check in about a patient’s grandchildren, pets, etc! I think you’re exactly right about the computer – a common refrain is that the computers exist for the benefit of coding/reimbursement, not for the benefit of patient care.

  25. Ariel Carls says:

    Yes. Yes. Yes. If you figure out how to make the revolution happen, please let me know. I’ll help. I echo all of your sentiments. Still working as a family medicine doctor in the twin cities, but I am disillusioned on a daily basis by the “system.”

  26. Sarah Snell says:

    there is an additional group “let my doctor practice” that is organizing the plans that you have discussed above.

  27. Dan says:

    I am probably more of a fighter than the next guy, and agree we need to fight to take our profession back, but I think the reality is grim. Right now the health care system itself is on the verge of collapse, and with politicians refusing to recognize reality (can’t admit to the other party that their solutions don’t work) we will be living on this verge for at least another decade while more money is borrowed to pay for the unaffordable health care system that exists now. The hospital systems won’t budge because they will be desperately trying not to go bankrupt. And what’s more, they want MDs to drop out, because they want the future to look like 1 MD supervising a small army of PAs and NPs to save money.

    In sum, the complaints of the doctors right now are like the complaints of the crew members on the titanic complaining they are hungry when the boat is sinking…nobody is going to listen. So I say get out while the getting out is good, and don’t recommend this field to your children unless they want to become plastic surgeons.

  28. Pingback: Lend Me Your Eir - Anne LippinAnne Lippin

  29. Kim Kiser says:

    Hi Anne: I enjoy your writing. I’m one of the editors of Minnesota Medicine magazine. We are focusing our November/December on physician well-being. We would love to reprint your blog post. Please contact me at and we can discuss this further. Thank you for your consideration. Kim

  30. Deborah White says:

    Hi Anne
    I recognized your name from Med. School! I sang in the a Capella group with you. Loved your article. I’m a PCP in Tampa and I need a scribe!

  31. Atticus says:

    As a doctor who is much older than you, I see your employment and subsequent dissatisfaction as a physician as part of the natural evolution healthcare is undergoing. Years before you went to medical school, my generation of physician was selected for our independence. As the selection process has changed over the years, doctors have become more willing to become employees of The System rather than run their own practices and manage their own futures. Part of this evolution has also been brought on by the costs of healthcare, outside pressures from government, and from the litigious nature of our society. Eventually you will get your universal single payer system as this evolution continues, but you will never get your revolution. And you will find that a single payer system will bring with it new problems such as MD shortages, rationing of care, and a host of other issues common to government workers. As a doctor married to a doctor, our advise to our son who is now in a prestigious medical school is to find some area in medicine that excites you and that is far removed from the reaches of government and the coming over-regulation of healthcare, even if the area you choose is a bit removed from medicine. Marcus Welby medicine and personal healthcare is a thing of the past that will never return, but many of us older physicians remember it fondly, along with the joy we were able to bring to our patients because of the decisions we made independently and without the aid of a computer system.

    • anne says:

      Thank you so much for your comments! You bring a wonderful perspective to this discussion. I think the evolution was also forced by the crazy complexities of the US insurance “system.” One would need to pursue a dual MD/MBA to deal with the business ramifications of physician-owned practice. I’d be very interested to know the experience of you and your spouse as you navigated med school, residency, marriage, practice, parenting, etc. If there are health systems in other countries that you admire, please speak up.

      and PS – I still want a Revolution…

Leave a Reply

Your email address will not be published. Required fields are marked *