Empower patients. Patients need truth and transparency regarding who is treating them and how much they are paying for services. Allow more free market options like direct care so that patients can invest in their own healthcare. Encourage and educate patients to take a more active role in their own healthcare through healthy lifestyle choices.
The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.
In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.
As a part of this series, I had the pleasure to interview Rebekah Bernard, MD and President of Physicians for Patient Protection.
Rebekah Bernard MD is a Family Physician and the co-author of the book Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Health Care” (Universal Publishers 2020). She also serves as the president of Physicians for Patient Protection — a grassroots organization of practicing and retired physicians, residents, medical students, and assistant physicians on a mission to ensure physician-led care for all patients and to advocate for truth and transparency regarding healthcare practitioners. https://www.physiciansforpatientprotection.org
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?
I grew up in a very rural part of south Florida under difficult socioeconomic conditions. My mother developed severe mental illness when I was just twelve, and I watched her struggle to receive quality healthcare in our underserved area. These personal experiences led me to pursue a career as a primary care physician working with populations who struggle to receive medical care.
Can you share the most interesting story that happened to you since you began your career?
My first job at a federally qualified health center in rural Florida was fascinating, because we saw such a wide array of medical conditions. Because many of our patients were migrant workers who lacked access to care, we treated conditions that are relatively rare in the U.S., like malaria, leprosy, and tuberculosis of the bone. We had to be prepared for anything and everything that could walk in the door. We saw patients with serious injuries caused by field work like machete wounds and snake bites. There were only two ambulances to serve the community, and the nearest hospital was 45 minutes away, so sometimes we had to manage emergencies while waiting for an ambulance to make it back to the clinic. I treated a man who had been stung by hundreds of hornets who was having an anaphylactic reaction, a woman giving birth, and a child who fractured his femur after falling off a van he was playing on. Meanwhile, there were always patients who needed care for their routine health conditions like diabetes, hypertension, and mental health issues. Much of our medical care involved trying to determine the least expensive and simplest way to help these patients get the evaluations and treatments they needed. Making a difference in a patient’s life was always incredibly gratifying — especially since our patients were extremely appreciative of any efforts we made to help.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
This is a tough question, because as physicians, it’s hard for us to see humor in our mistakes. In fact, one of the challenges for physicians is that we often expect ourselves to be perfect, and we see anything less than perfection as failure. When I think back to my mistakes in training, I feel more embarrassment and shame that my lack of knowledge could have led to patient harm. This is one of the reasons that physicians are required to practice under supervision during our intern and residency years. We receive constant evaluation and feedback from senior physicians to catch any mistakes that we make before patients are harmed. Of course, we all make mistakes — we are only human. But most doctors beat themselves up about them, which is probably one of the reasons that physicians have a higher suicide rate than the average population.
I’m so sorry to be such a downer! But your readers should know that physicians truly care about doing the best they can for patients. We try our best not to make mistakes, and we do make them, we take them extremely seriously.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“No problem can withstand the assault of sustained thinking.” — Voltaire
I think that one of the biggest dangers in education is teaching students to memorize answers without truly understanding a subject. Students need foundational knowledge, but they also need to know how to apply critical thinking skills to solve problems. In medicine, physicians are trained to formulate a differential diagnosis, which is a list of all the possible medical diagnoses that could be causing a patient’s symptoms. We learn how to sort through all the evidence to come up with the most accurate diagnosis. This is not something that can be learned through shortcuts or following algorithms, but through concentrated, dedicated thinking. I’m always inspired by great thinkers, especially those who innovate new ideas or technologies that solve previously unsolvable problems, and I remind myself of this quote when I feel frustrated or stuck on a problem.
Are you working on any exciting new projects now? How do you think that will help people?
I recently finished my latest book, ‘Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare,’ which aims to show how corporations and government entities are cutting corners when it comes to healthcare. Because there are still so many stories that I am learning about that demonstrate this problem, I created a podcast called ‘Patients at Risk’ to educate the public about the questions they should ask their healthcare provider.
How would you define an “excellent healthcare provider”?
An excellent clinician is someone who has a strong foundational knowledge in their field of medical care, knows how to apply critical thinking to solve problems, communicates well, and shows empathy and compassion to patients. We need both brains and heart in medicine.
Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?
Early in the pandemic we faced severe pressures from a shortage of personal protective equipment, and some healthcare systems responded poorly by punishing or firing clinicians who spoke out about their concerns. To me, this speaks to a larger issue of a disconnect between healthcare administrators / managers and medical staff working in the trenches. Administrators need to show the same compassion to their medical team as they expect to be shown to patients, and that means making healthcare workers’ health and safety a top priority.
Another challenge has been getting PPE, testing equipment, and vaccines into doctors’ offices across the country. Most patients trust their primary care physician, and I think the vaccination rate may have been higher if we had placed more reliance on doctors’ offices rather than chain pharmacies to administer vaccinations.
Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.
I was so impressed with the dedication of frontline workers not only in the health system, but across all industries. It also has been amazing to see what can be accomplished when researchers from across the globe work together to solve a problem — I can only imagine what we could do if we put the same focus and financial resources towards solving other global problems! The pandemic showed the value of local health departments and medical societies who worked together to provide testing and vaccines quickly. I was especially proud of our county medical society which worked to ensure that our physicians had adequate PPE and that healthcare workers were among the first to be vaccinated.
Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- Increase physician residency spots/ training. The U.S. ranks among the lowest of developed nations in number of physicians per capita. Similarly, we have worse health outcomes than these nations. Studies show that having the same doctor over time improves mortality, and yet little is being done to increase the number of practicing physicians. Instead, health policy has focused on training additional team members to take on physician responsibilities, like nurse practitioners and physician assistants. This stopgap is insufficient for providing the comprehensive care that Americans need to improve their health. While efforts have been made to increase medical schools, there are not enough residency training slots, which is the required 3+ years that physicians must train to be licensed to practice independently. Last year, over 2,000 U.S. trained medical school graduates were unable to find a slot and therefore cannot complete their training.
- Value primary care. Studies show that having the same primary care physician over time decreases morbidity by lowering deaths from heart disease and cancer. Despite this important role, primary care physicians are the lowest paid physicians and face the highest amount of paperwork and administrative responsibilities. Medical school graduates with hundreds of thousands of dollars in debt are unlikely to take on this role, as they can more quickly pay student loans through work in a higher-earning specialty field. Primary care is the backbone of our healthcare system and should be prioritized as such.
- End the corporate practice of medicine and put physicians back in charge of healthcare. The biggest danger to the healthcare system is the takeover by private equity. Healthcare is now a commodity to be bought and sold by investors rather than a vocation and calling practiced by dedicated clinicians. This dangerous trend has increased clinician burnout and had a negative impact on patient care and must be stopped. Physicians should be allowed to own hospitals again, and administration must have adequate physician representation.
- Improve clinical communication. Despite the promise of electronic health records, it is more difficult than ever for clinicians to communicate with each other. We need a simplified way to discuss patient care with each other and ensure that proper follow-up occurs. Ideally, physicians need to be able to talk directly to each other when co-managing patients — this saves the system time and money with unnecessary office visits. We also need to eliminate burdensome documentation requirements that make physicians waste time sifting through pages of meaningless details to find out relevant clinical information.
- Empower patients. Patients need truth and transparency regarding who is treating them and how much they are paying for services. Allow more free market options like direct care so that patients can invest in their own healthcare. Encourage and educate patients to take a more active role in their own healthcare through healthy lifestyle choices.
Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?
The U.S. ranks 24th of 28 similar nations for number of physicians per capita. The bottleneck is federal funding for residency training, the required 3+ years that physicians must practice with supervision before they are licensed to practice independently. The government must prioritize physician education and not replace physicians with lesser trained practitioners as a stopgap. Measures can be taken to offer loan repayment or other incentives to encourage physicians to work in underserved areas. This worked for me — I worked for six years in a federally qualified health center in exchange for loan repayment.
How do you think we can address the issue of physician diversity?
When I was in high school, I was selected to participate in an Area Health Education Council (AHEC) Health Career Camp. This government program sent underprivileged high school students to a week-long camp to learn about health careers, and many of my fellow campers were women, minorities, and rural / inner-city residents with decreased socioeconomic status. This camp introduced me to medical students and physicians and propelled me towards medicine. I’d love to see more programs like this targeting, inspiring, and providing tools to young people to lead them towards medicine. We also need to support women physicians who are balancing work with family life, allowing more job flexibility and support.
How do you think we can address the issue of physician burnout?
Physicians need to regain autonomy and control. My advice is to return to self-ownership. For the first time in history, more physicians are owned by a corporation than own themselves. In many cases, these are private equity companies that see physicians and patients as a source of financial profit. This conflicts with core physician values of putting patients’ needs first and leads to burnout. I would love to see more physicians convert to a direct care model, working directly with patients and eliminating third party payers. This puts control back in the hands of patients and physicians, rather than insurers or investors.
What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
The first thing that physicians need to do is to recognize our own value and refuse to participate in schemes intended to increase corporate profits rather than care for patients. We must put aside our differences and work together to demand patient-centered change. Patients must demand change, including truth and transparency from healthcare systems. We must also insist that our legislators institute policies to increase patient access to high quality medical care, including increasing physician training spots.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
I would like to see a return to old time medicine, where physicians can prioritize patient care and patients have quality time with their own doctor. It’s disheartening to see that many patients have lost faith that their doctor cares about them, because we DO care. However, it has become so hard to show it because doctors are so busy typing into computers that we are not able to show the empathy that our patients need. We are so stressed with non-patient care responsibilities that have been added to our plate that we don’t have the time that we need with patients. In this system, neither patients nor physicians benefit.
I think that direct primary care is the best solution to achieve this, and although this movement is already in progress, I hope to inspire other physicians to enter this type of practice. This model empowers physicians and provides the care that patients really need — a true relationship with their own doctor, which has been shown to decrease mortality. I also hope that we see more specialists, surgical centers, and hospitals offering a direct care model that provides affordable quality care to patients without obligation to for-profit health systems or investors.
How can our readers further follow your work online?
More information also available at my website rebekahbernard.com and physiciansforpatientprotection.org.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.