In her April 9 column, Dr. Deborah Patten painted a disturbing picture of doctors suffering from burnout and “moral injury” – tension between business and professional responsibilities (“Maine Voices: Emphasis on revenue sabotages medical practices and hospitals”). This matters because our health depends on those doctors.

Implementation of a publicly funded health care system covering everyone (such as described in the Medicare for All Act of 2021, quoted below) would help address five of the problems she mentioned:

• Increasing need for administrative staff. Consolidation of all payers into one public payer would reduce the expense of medical billing departments (“a uniform national system for electronic billing for purposes of making payments”).
• Lower reimbursement for primary care. Reimbursement of these providers would likely be increased to “promote policies that expand the number of primary health care practitioners.” “[R]eview board … assure … fair reimbursements for physician-delivered … services.”
• Time-consuming pre-authorizations. “Benefits provided … without any need for any prior authorization determination.”
• Distraction of the electronic medical record. Coding would be simplified through a “national fee schedule” and documentation could be minimized (“documentation as may be reasonably required”).
• Productivity demands. Self-imposed productivity goals would continue for independent physicians, but negotiated institutional global budgets would limit productivity demands on employed physicians (who “may elect to be paid through such institutional provider’s global budget”).

There are, no doubt, other solutions for burnout and moral injury. The public needs to hear what other physicians have to say on the subject and then advocate for the best solutions – before it’s too late.

Daniel Bryant
Cape Elizabeth