A Doctor’s Declaration of Independence: My Reply

It seems that in the past few weeks, physicians across America have reached the breaking point.

First, internist Daniela Drake wrote in the Daily Beast about how miserable it is to be a physician. She talked about the lack of respect, the lack of time to see patients due to increasing paperwork and the ever-present board certification processes.

This week, orthopedic surgeon Daniel Craviotto Jr. wrote A Doctor’s Declaration of Independence in the Wall Street Journal. In it, Dr. Craviotto states that “In my 23 years as a practicing physician, I’ve learned that the only thing that matters is the doctor-patient relationship.” He goes on to explain that mandates for electronic health records (EHR), the burden of board recertification, and changes in Medicare and Medicaid have added to the burnout facing so many physicians today.

I don’t know about you, but I applaud these doctors for speaking out. What’s even more troubling than the degree of frustration reflected in these articles are the comments left by hundreds of non-physicians. Apparently, many people think that physicians are a wealthy, complaining, and unsympathetic bunch.

How can we respond to this overflow of despair from our fellow doctors and distain from our patient population?

Some facts that you may want to share with your friends, family and patients:

  1. Of the total health care expenditures in the U.S., physician salaries and reimbursements account for 8.6%. This is the second lowest of the Western nations. The lowest is 8.5%.
  2. The average physician salary in the U.S. is $191,500. And the average amount of debt from medical training in the U.S. is over $150,000.
  3. There is a predicted shortage of 90,000 too few physicians by the year 2020 in the U.S.
  4. Nine out of ten physicians state that they would not recommend their profession.
  5. More than 300 doctors commit suicide every year.

There are no easy, simple answers. Connection — to each other, to our support system, and yes, to our patients — is part of the equation. I agree wholeheartedly that feeling connected to a disconnected system is, at the very least, unsettling.

Creative solutions are needed. Such as the one suggested by Art Gardner, an Atlanta patent attorney, currently running for U.S. Senate. He determined that part of the high cost of health care in the U.S. has to do with patented medicine. The price of Crestor, for example can range from $7.50 per pill in the U.S. to $1.78 in Canada. To make a profit, the drug company needs to charge $3 per pill. In America, because of the patent laws, it turns out that Americans are subsidizing artificially low prices throughout the civilized world. It makes sense to help out the impoverished in Africa, but not so much to be subsidizing the Germans, for example.

Thinking outside the box like this can provide answers to reduce medical costs that don’t add to the destruction of the doctor-patient relationship we all cherish.

As I recall, the Declaration of Independence endowed us with Life, Liberty and the pursuit of Happiness.

Perhaps we all need to take a chapter from history and infuse a little modern day George Washington in our world to lead us across the healthcare divide.

CATEGORIES: Blog on May 5, 2014 by Starla Fitch, M.D.

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6 thoughts on “A Doctor’s Declaration of Independence: My Reply

  1. Julieta

    I am speechless Dr. Starla, and happy to know that I’m not alone in the medical world. I have to confess that I don’t recommend any health care career because patients seems to look for a magic cure instead of a path to health.
    On the other side, I have to confess again that I can not live without helping others. I am switching my focus from “doctor” to “coach” maybe to see if I can work with patients who truly want to change their life through food, meditation & will. (+ the right prescription for their case).

    Finally, YES! We all have a recommendation for you & allergies. Have you try Polysaccharides & Polypeptides? They have worked to me and my mother. Here is a link to dr. Howard Peiper Book


    Thank you for every week post,


    1. Starla Fitch, M.D. Post author

      I think the important thing to take in from all this is that you are not alone. Doctors are feeling the pain of our changing medical world. And the patients are feeling it, too. It is so nice when you feel that patients work with you as a team for healing, isn’t it?
      And thank you for the recommendation for my allergies! I will check it out! 🙂
      Many blessings,

  2. Dr. Romie

    Dr. Starla,
    Thank you for your heartfelt response to the firestorm brewing from these two online articles. As a physician that has left traditional medicine to help promote health and wellness, I have realized a few things as well.
    1) I think in the future we need to train physicians early (in medical school and residency) for several different career paths, because practicing physicians cannot do it all.
    2) We see more physicians branch out into promoting health and wellness, technology fields, pharmaceutical industry, etc. We are however not united, but rather divided by the paths we choose. If we can find a way to stay united under a common goal of healing the patient-doctor relationship, we can move mountains.
    3) Physicians have to be ready to take the lead in reforming the multiple broken systems, and I am here to support your mission of bringing physicians together to Love Medicine Again.

    1. Starla Fitch, M.D. Post author

      Dr. Romie,
      You are absolutely right about the need for health care healers who think outside the box. And, the urgency for all of us to work together for the common good of helping patients while keeping ourselves well. The work you are doing, Dr. Romie, on mindfulness and meditation can certainly go a long way to help us all. Let’s take the lead in joining the traditional and the non-traditional healing modalities for the common good. We’re all in this together.
      Thanks again for your support.

  3. Pamela Pappas

    Dr. Starla,
    Thank you for writing this piece. Medicine is very hard these days, and you’re right that there doesn’t seem to be much compassion for physicians as fellow humans. I corresponded with one of your readers on the KevinMD blog (where this article was posted also.) Trying to deal with the misperceptions and overt sarcasm so prevalent there, was painful. Mutual support amongst physicians helps.

    1. Starla Fitch, M.D. Post author

      Dr. Pam,
      Thank you for your supporting words. It is hard to ignore the “slings and arrows” from those who are not in the trenches with us. I feel that lack of compassion is from lack of connection and understanding. The doctor-patient relationship is not the enemy. Open and honest communication between doctors and patients can only help heal us all. Thanks for all the work you do, Dr. Pam, in serving others.


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