By Leo Lopez, III, MD
During the 2017 Texas legislative session, I spent time at the State Capitol in Austin as a recipient of the TAFP Foundation James C. Martin, MD, Scholarship, appreciating the depth, scope, and importance of physician advocacy. In my time as a medical student and resident, I’ve watched health policy debates evolve. I’ve watched them triumph from inception to implementation. I’ve watched them fall in committee at the behest of a deluge of lobbying efforts and special interests.
As these important issues revolving around clinical practice, graduate medical education, and access to health care are debated, the relative silence of the physician voice is impressive. While many outstanding physician leaders make selfless sacrifices to protect patient and physician interests, the gross physician influence in advocacy and health policy is severely impoverished.
Coupling my time with TAFP and my clinical experience as a resident, it comes with little surprise that physicians suffer burnout at alarming rates, are dissatisfied with administrative burdens, resist mounting regulations, and struggle with insecurity in the ever-evolving zeitgeist of the U.S. health care system. My colleagues and I inherited a culture of medical practice that engenders a defensive approach to clinical medicine, leading to excessive documentation and a “CYA” mindset.
I’ve often felt as though a lawyer or insurance executive or bureaucrat lurks over my shoulder, ensuring I’ve checked the requisite boxes, or have performed the satisfactory physical exam maneuvers. I’ve been conditioned to be chiefly concerned with which insurance my patient has, as this will dictate the medication, health service, or imaging study accessible to them. On several occasions, I’ve spent more time filling prior authorizations and waiting on hold for a peer-to-peer appeal for a medical service than I have at the bedside with my patient.
This culture is in stark contrast with the practice of medicine I envisioned during the infancy of my training. Non-clinician forces utilized public policy to transform medicine, disproportionately, into an administrative career field. If we hope to take back our beloved, ancient discipline, stand for justice for our patients, and create a thriving environment for clinical practice, we must stand in solidarity and become active, relentless advocates on issues of health policy.