Four viewpoints show doctor morale not much better than patient’s

8:19 am by | 9 Comments

Let’s start with a disclaimer:

I am not complaining; I’m just stating the facts.

Honest fact: The morale of doctors in the real world is low–and sinking lower.

I know what you are thinking. “Come on Mandrola, you are nuts if you expect us to feel sympathy for doctors–of all professions.”

Well…you can think that if you wish, but I’m calling it as I see them. And here is why it matters:

Because when you are sick, an available, rested, un-rushed and talented doctor is really important.


You know this: quality health care–real quality, not spreadsheet or Internet quality–stems from basic human-to-human interaction, between patient and doctor. Healthcare reform, with its emphasis on metrics, prevention of fraud and cost-cutting measures has forgotten the basics. Namely, that humans, who have dedicated their life and committed their self-esteem, practice medicine. To take care of people well, doctors need things:

  • We need face time with the patient–not with a computer screen.
  • We need time to listen, to examine and to treat.
  • We need to feel trusted.
  • We need our self-esteem.
  • We need leeway to be human.
  • And of course, we need to be paid a fair wage for the years of training that it took to acquire these skills.

In support of this view, I’ll call your attention to four posts from real doctors:

–My colleague Doctor Wes Fisher talks of the growing culture of hostile dependency towards caregivers. Wes is rightly disturbed by a sensational and one-sided book review (WSJ) of surgeon-author Dr Mark Makary’s Unaccountable. Agree or not with Wes, his words come from the heart of a man who hangs a lot of his self-esteem on the doctoring peg. Wes is a guy I would want to have as a doctor. If healthcare reform keeps going in this direction, patients will have fewer Wes Fisher’s around to pull them out of fires.

–Here’s a quote (via email) from an esteemed colleague–another guy you would want as your doctor.

We doctors are absolutely being demonized. Every day something new is written pinning our healthcare crisis squarely on our shoulders. It’s really affecting me emotionally. I’ve actually started to think it might be a good idea to take a media holiday for a while. I appreciate that you still have the energy to fight. I’m getting pretty tired.

–One of the most obvious unintended consequences of cutting healthcare costs on the backs of doctors providers is the flight of good primary care doctors to concierge medicine. One of the best posts I have read on the topic of Dropping Out comes from Dr Rob Lamberts. Dr Rob is a beautiful writer and another passionate practitioner of Medicine. I’ve been reading his stuff for years, and it is clear that Dr Rob has unequivocally mastered the obvious.

–Finally, there’s me. I wrote an In the Prime post today about the two sides of the canvas of healthcare reform. It was in response to a nicely written opinion piece in the Courier-Journal. A local doctor pointed out that we must not settle for anything less than universal insurance coverage. He’s right; but there is also the important question: What good is universal coverage if there are not enough caregivers?

Doctors don’t expect sympathy. That’s not what we want. We want the people–our patients–to know the consequences of hostility towards caregivers–be it in mistrust, hyper-regulation or lower pay.

We welcome reform, but we can’t sit still and watch it destroy the practice of Medicine.

Copyright 2015 MedCity News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

John Mandrola, MD

By John Mandrola, MD

Dr. Mandrola's post originally appeared on his website. Dr. Mandrola is a cardiologist who specializes in heart rhythm disorders. He writes about doctoring and cycling at and is a regular columnist at
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@vmcombs Just about every provider I've been to over past year grumbles about #EMRs, #Tech & data entry!


There are TONS of docs - they're just not in primary/preventative care - because that's not what our system rewards. The "average" annual salary (according to Medscape's 2011 Physician Salary Survey) for primary care is about $170k/yr. The "average" for a radiologist? Over $300k. On what planet does it make sense for a Radiologist to make 2X what a primary doc makes? It's the same planet where there are more MRI machines in Pittsburgh than Canada. 


We're paying for healthcare by the "piece" - in a fee-for-service model that rewards high-cost specialty care (for those with insurance) at the expense of low-cost primary care. The system is performing well - for it's intended purpose - but it's not a healthcare system - it's a for-profit sick-care system.


I understand how frustrating this is for docs - but what about those of us as patients who are funneled into tests, procedures and high-cost care that is often unnecessary - and often more damaging than if we were left alone?The "system" we have is chugging along at $3 trillion per year - 18% of our GDP - and rising at a rate of about 5% per year. It's a global embarrassment - and national emergency.


That is incredibly low for an interventional cardiologist...


 @danmunro "18% of our GDP - and rising at a rate of about 5% per year. It's a global embarrassment - and national emergency." -- I agree. The cost of health care puts the U.S. at a significant competitive disadvantage. But what's the best way to fix it?


Income is only one part of the equation, and the notion that higher salary can make up for all the other problems only goes so far.  Many of the other issues, if addressed effectively, would increase quality of care, reduce misdiagnoses and unnecessary tests/medications/procedures, and thus likely lower overall costs.  The US is in a shockingly under-reported provider-shortage crisis that will only become more clear with the addition of 30 million new forcibly insured patients.



 If we want to control healthcare costs, the first place we should start is with pharma.  These companies have created a majority of products which are not designed to cure anything, but are meant to keep people taking them for the rest of their lives.  They are not in the business of curing, only securing their revenue stream. 


 @WillPeavy The options are narrowing. The healthcare industrial complex can't solve it - politicians can't solve it - so we're left with the last group with scale and power - non-healthcare businesses. It's not quite a revolution yet - but they have the means and the motive to engage a new weapon against high-cost specialty care - low-cost primary and preventative care.


 @CarrieMillermanElsass I'm all for reducing health care costs. What do you think would be the best way to get big pharma to be more efficient (and by efficient, I mean lower costs and better patient outcomes)?