It’s a wonder why anyone with the smarts to get admitted to medical school would pursue a career as a physician. Don’t get me wrong: I think being a doctor ranks among the noblest of callings, and you would be hard-pressed to find someone more respectful and admiring of physicians. I insist on calling someone “Dr.” even when I develop a non-medical relationship with a physician and they suggest I use their first name.
It’s my admiration and respect that make me wonder why anyone would pursue a career in medicine—or even stay in the miserable business.
And medicine is indeed a business, an undeniably unhappy one for doctors who care mightily about the quality of care they deliver. The U.S. health care system has undergone rapid consolidation—mergers, acquisitions and private equity takeovers—that have sidelined physicians from spearheading medical care into a subordinate role where their expertise and advanced training are no longer respected.
A study released last October by The Physicians Foundation, a nonprofit focused on improving working conditions for MDs, found that 45% of practicing physicians in America are considering career changes or earlier retirement. One must be a pie-eyed optimist to take on as much as $300,000 in student debt to pursue a career where those already in it say the stress and lack of autonomy just aren’t worth it.
Medical school graduates today have pretty dismal choices: they can work for hospital-controlled physician practices or ones controlled by private equity. In both instances, their employer is more focused on milking insurance companies or Medicare for every last possible dollar. Doctors are regarded as hired help, and how they practice is dictated by empty suits who, unlike many doctors, care more about their bottom lines than patients who flatline.
Adding insult to injury, hospitals and other health care facilities prefer physician assistants and nurse practitioners who have a fraction of the training and clinical skills of medical doctors, yet bill their less qualified services at the same rates as physicians.
Spare me all the questionable studies claiming NPs and PAs deliver the same quality of care as a medical doctor. An MD undergoes as many as 15,000 hours of grueling clinical training, while someone can get licensed as an NP with as little as 1,500 hours of clinical training. Let’s not forget that it’s statistically harder to get into medical school than any other health care profession except veterinary college.
Medical schools have a 43% acceptance rate, while the acceptance rate at veterinary schools is less than 15%. I treat my dog’s vet with as much respect as I do my physicians—possibly more so.
I’ve previously written on this issue and continue to regard NPs and PAs as MD-Lites. I prefer to be treated by physicians who attended U.S. or internationally recognized medical schools and completed their residencies at reputable teaching hospitals.
Increasingly, that’s become a formidable challenge—one likely to worsen.
I was an early embracer of One Medical, a McMedical chain of healthcare practices that was subsequently acquired by Amazon. When I first signed up, the One Medical closest to me was staffed mostly by doctors who studied and trained at schools and hospitals I was familiar with. The care was phenomenal, and I preferred it to relying on a single doctor for my wellness oversight.
But as One Medical grew, the company began replacing—or perhaps could not attract and retain—American-trained physicians. One Medical increasingly relies on NPs and PAs who, in addition to lacking the training of physicians, are incredibly young and haven’t yet garnered much experience.
It takes a doctor at least 10 years to achieve maximum competency; I shudder to think of the competency level of a newly minted NP or PA.
A new potential obstacle has emerged that makes going to medical school even more questionable than most students likely understand.
Do No Harm, a medical advocacy group that has made a name challenging “the disastrous consequences of identity politics” in healthcare, has filed a civil rights complaint alleging that three U.S. hospitals discriminate on the basis of national origin, favoring foreign-trained physicians in their internal medicine residency programs over American-trained doctors.
The three hospitals are Corewell Health’s hospital in Dearborn, Michigan, Texas Tech University Health Sciences Center in Amarillo, and HCA Healthcare’s hospital in Brandon, Florida.
“National origin discrimination is both unlawful and inconsistent with the broader American commitment to equal treatment,” Kurt Miceli, MD, Chief Medical Officer at Do No Harm, said in a news release.
“When residency programs favor foreign-trained physicians over American-trained doctors, they effectively prevent qualified Americans from accessing valuable, competitive, and prestigious learning opportunities. It is deeply concerning that these programs appear to be discriminating against graduates of U.S. medical schools. Medical institutions and their directors should be hiring residents based on their ability to deliver high-quality patient care, not on national origin.”
Do No Harm’s complaint asks the Justice Department to take a closer look. The organization cites numbers that speak for themselves.
Of 33 residents at Corewell Dearborn, only one attended medical school in the United States. The rest trained abroad, largely in a tight cluster of countries.
Nine are from Sudan. Eight from Pakistan. Four from Jordan. Others from Palestine, Bahrain, Iraq, and Saudi Arabia. Do No Harm said Corewell Dearborn’s residency director attended medical school in Lebanon but didn’t identify the person.
You can review the backgrounds of Corewell Dearborn’s residents here.
Of Texas Tech’s current residents, Do No Harm alleges that 95% are from foreign medical schools, including Pakistan, Bangladesh, Egypt, Iraq, the United Arab Emirates, Saudi Arabia, Sudan, and Syria. The program’s directors attended medical school in Iraq, the complaint alleges.
Over 70% of HCA Healthcare’s residents in Brandon were trained abroad, and in the most recent cohort, there are no American-trained residents, according to Do No Harm’s complaint. Residents are from, among other countries, Pakistan, Libya, Iraq, Jordan, Syria, and Turkey. The program’s directors received medical training in Egypt and Pakistan.
Do No Harm was founded in April 2022 by Dr. Stanley Goldfarb, a former Associate Dean of Curriculum at the University of Pennsylvania Perelman School of Medicine. The organization claims to have 50,000 members, including doctors, nurses, and concerned citizens across all 50 states and 14 countries.
Pennsylvania, notably, appears to be a hotbed of conscientious medical objectors—physicians willing to challenge the direction of their profession.
Dr. Marion Mass, an intrepid pediatrician I previously profiled for daring to speak out against the medical establishment, is an urgent care pediatrician at Children’s Hospital of Philadelphia. Dr. Robert McNamara, Chair of Emergency Medicine at the Lewis Katz School of Medicine at Temple University and Chief Medical Officer of Temple Faculty Physicians, has been outspoken about private equity’s disastrous foray into hospital ER staffing.
That Do No Harm has garnered 50,000 members in four years is impressive. While the American Medical Association claims to have some 280,000 members, most of them aren’t dues-paying active physicians.
The AMA’s primary activity is generating and updating CPT codes used to bill for medical procedures and services, an exclusive right it was granted by the federal government in 1983. Bill Cassidy, Chairman of the U.S. Senate Committee on Health, Education, Labor, and Pensions and a licensed physician, last year questioned the AMA’s commitment to improving medical care.
“I am concerned that the status quo focuses on enriching the AMA at the expense of patients, while the organization subsequently uses the revenue to advance a political agenda that is not representative of the majority of the medical community,” Cassidy said in a letter to the AMA’s president last December.
It speaks volumes that Do No Harm, and not the AMA, is concerned about the job prospects of American-trained medical students.
One group is asking whether young physicians have a future. The other seems content to manage the billing codes.