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What do you call a situation where you're responsible for your patients, yet constantly obstructed from providing the care they need? I call it frustrating, soul-crushing, and infuriating. It’s the daily reality for every physician — and I think one of the main reasons many are leaving medicine altogether.

How did we get here, and what can we do about it?

When I was in medical school two decades ago, Harry Truman's famous phrase "The buck stops here!" echoed through the wards. We were taught that "the doctor is the captain of the ship," instilling in us a sense of ultimate responsibility and accountability for our patients and their outcomes. This ethos of personal ownership has long been a cornerstone of medical practice: You own your patients and their outcomes. If something needs to be done, sometimes you have to do it yourself.

Yet, this ethos feels increasingly out of place in today’s healthcare system.

“The buck stops here” encompasses both the power to act and the responsibility to do so. Today’s doctors, however, find themselves in a troubling paradox. The healthcare system expects us to take full responsibility for every problem but often strips us of the power to act — to solve problems for our patients.

Consider these scenarios we encounter daily:

• We're the ones named personally in malpractice cases when health insurers or hospitals refuse necessary treatments or diagnostic tests for our patients.
• We're expected to manage increasingly complex patients with fewer resources, shorter appointments, and stricter admission criteria.
• We spend countless hours fighting prior authorization rejections for basic, necessary treatments that even a first year medical student could support.

In each of these cases, responsibility stops with us, but power to make decisions has been largely transferred to other entities. We are dealing with only half the buck.

This misalignment of responsibility and authority has far-reaching consequences for us and our patients:

• Patient Perception: Many of our patients still believe that we have ultimate control over their healthcare decisions. What we say goes. That’s not simply not true in American healthcare. Insurers dodge accountability by saying, "Doctors can do whatever they want; we just won't pay for it." This isn’t practicing medicine without a license, they claim; it’s just regulating payment and reimbursement. (This is laughable; they don’t even try to understand the nuances of what our patients are facing.)
• Our Burnout: Our constant struggle against systemic barriers while bearing full responsibility for outcomes contributes significantly to our burnout and job dissatisfaction.
• Quality of Care: When we're constrained by external factors but still held accountable for outcomes, it can lead to defensive medicine practices or hesitancy in taking on complex cases.
• Legal and Professional Risks: We face potential legal and professional consequences for outcomes that may be largely out of our control.

A Call for Our Collective Action

I know that each of us entered this profession with a deep commitment to patient care and a willingness to bear significant responsibility. However, the current healthcare system often leaves us feeling like scapegoats rather than empowered caregivers.

Somehow, physicians have been cast as the villains in this story. It’s time we change that narrative. I’m tired of being seen as the uncaring doctor who won't help his patients or isn't working hard enough. I know you're tired of it, too.

Join the Discussion

Do you feel this too? I’d love to hear and highlight other examples of the modern reality of being a doctor. What are the biggest changes you are feeling from how the ethos we were taught in medical school are divorced from modern reality?