Original Published on Dr. Robert Pearl’s website
Demoralization syndrome is a disorder frequently connected to terminal illness and it is marked by a sense of hopelessness and lack of purpose. For a long time, doctors have diagnosed many sick patients with this syndrome. Today, more and more American doctors are experiencing a similar condition. However, instead of being demoralized by an illness, doctors are demoralized by the sick care system which they work for. Here are the challenges facing U.S healthcare system today.
Lack of Universal Healthcare Coverage in the U.S and it’s repercussions
Healthcare is so expensive in the united states and because of this, thousands of avoidable deaths occur at least every year. This country is the only large, high-income country that does not offer all of its citizens’ access to universal healthcare and continues to support a for-profit medical system.
The repercussions of this policy have become worse during the Covid-19 pandemic. According to one study, the United States may have avoided at least 338,000 COVID fatalities if there had been universal health care. As a result of this generational calamity, numerous healthcare professionals have been traumatized.
Chronic Physician Shortage
“Doctoring in a broken environment needed me to have a continuous believe that the place would become better as a result of my efforts, but I could no longer hold that belief,” wrote Dr. Rachael Bedard about her decision to leave the Rikers Island prison complex in New York City during the pandemic.
Thousands of doctors in the United States, not just in prisons but also in rich and powerful hospitals, appear to feel the same way. According to one report, approximately 117,000 physicians left the workforce in 2021, while less than 40,000 joined. This has exacerbated a chronic physician shortage, leaving many hospitals and clinics in distress. And things will only get worse. It is reported that One out of five doctors is planning to retire in the next few years.
Physician burnout
Almost two-thirds of physicians say they are experiencing symptoms of burnout. However, the burnout expression overlooks the larger issue in this case: what is burning out healthcare workers is not the strenuous conditions under which they work, but rather their diminishing faith in the systems for which they work. Occupational burnout has been identified as a symptom of a deeper collapse and a gradual demise of American medical ideology is seen.
It’s enlightening to consider the healthcare worker crisis, partially as an ideological crisis. That is, a belief system comprised of interconnected political, moral, and cultural narratives on which we rely to make sense of our social world. Faith in the traditional stories about American medicine that have long sustained what should have been an unsustainable system is now fading.
Health Disparities and Underinvestment of Public Health Systems
During the pandemic, physicians saw our hospitals almost fall apart due to lack of investment in public health systems and uneven distribution of medical infrastructure. Long-ignored disparities in the quality of care available to rich and poor Americans were front-page news as bodies were piled in empty hospital rooms and improvised morgues. Many healthcare workers have been traumatized by the ineffectiveness of their efforts to prevent the recurrent waves of death, with nearly one-fifth of physicians reporting knowing a colleague who had considered, attempted, or died by suicide during the first year of the pandemic alone.
Institutional Structural Immorality
Although COVID-related deaths have decreased, healthcare workers’ disappointment has grown. Recent scandals have revealed even more of our institutions’ structural immorality. According to a New York Times investigation, ostensibly nonprofit charity hospitals have illegally saddled poor patients with debt for receiving care to which they were entitled at no cost and have made large profits by taking advantage of tax breaks intended to promote care for poor communities. While sitting on billions of dollars in cash reserves, hospitals deliberately understaff themselves and undercut patient care. Little of this is novel, but doctors’ sense of our complicity in prioritizing profits over people has become increasingly difficult to ignore.
Resistance to Self-criticism
For so long, resistance to self-criticism has been a hallmark of US medicine and the industry it has shaped. From at least the 1930s to the present day, physicians have made efforts to prevent the specter of socialized medicine. Doctors have repeatedly defended healthcare as an entrepreneurial endeavor against the threat of it becoming a public institution driven by rights rather than revenue.
This is partly related to the fact that doctors were being told that if health care became a public service, they would lose their professional autonomy and earn less money. For a profession that has been struggling for more than a century to achieve a higher status, this deeply resonated.
Therefore doctors have acquired the ability to defend a profoundly unequal healthcare system that places a greater emphasis on an individual’s moral duty for protecting their health than protecting health of the general population. Doctors sit at the bedsides of patients and advise them on how to reduce their risk of obesity, heart disease, and diabetes, for example, while generally disregarding how these diseases are connected to inequities in economic access to healthy food. Or, more lately, counseling patients on how to adjust their personal choices to lower their chance of developing COVID while working in occupations with poor safety procedures and labor protections.
Part of what attracts them to this norm is that doctors learn by doing, that is, through apprenticeship, where they repeat what has been modeled for them. To some extent, this is a required aspect of training in an applied technical field. It is also a fundamentally conservative learning model that teaches doctors to suppress critical thinking and trust the system, even when it provides perverse incentives.
It becomes difficult to identify the origins of much of what they do and whose interests it serves as a result. For example, the American Medical Association invented a billing code system as part of a political strategy to protect its vision of for-profit health care, and it now dictates almost every aspect of medical practice, trying to produce not only endless administrative work but also subtly shaping treatment choices.
Moving Forward
Addressing the healthcare system’s flaws will necessarily require uncomfortable introspection and bold action. Any illusion that medicine and politics are or should be different spheres has been shattered by the death of over 1.1 million Americans from a pandemic that was, in many ways, a preventable disaster. And many physicians are now struggling to dispel the perception that our institutions are primarily a money-making machine.
- Doctors can no longer stand by and watch as these harms occur. They must use their collective power to demand changes such as universal health care and paid sick leave. Investments in community health worker programs and essential housing and social welfare systems need to be made. Neither major political party is currently prioritizing universal health care, but doctors do have significant power to initiate health policy reforms. We can start by following in the footsteps of colleagues at Montefiore Medical Center in the Bronx, who like thousands of other doctors before them, recently took steps to unionize. If we can establish an organizing network through doctors’ unions, proposals to demand universal health care through collective civil disobedience, such as physicians’ control over health care documentation and billing, could progress from visions to genuinely actionable steps.
- To be able to build the systems we require, we must admit that our current healthcare institutions are a part of the problem. Until doctors come together to demand a fundamental reorganization of our medical system, our work will not accomplish what we were promised (Reinhart, E, 2023).
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