I want to inspire my children to become doctors, just like my father did when I was a child. He helped us see the nobility of medicine and it was the highest honor to be able to wear a white coat. In India, the competition for medicine was fierce. The cut off percentage was always in the high 90’s. Students went into depression and even killed themselves when they did not make it to the white coat glory, writes Dr. Firdos Sheikh.

My own sister scored a 94.8 and could not get in and later didn’t stop until she became Doctor of Optometry. That explains deep scars and perseverance to hold the “Doctor” title.

I was struck with typhoid just before my pre-university exams and took the longer, tougher road to medicine by completing Bachelors’ degree (BSc). There were only two merit seats per medical school for applicants after a bachelor’s degree. I was thrilled to get 1 of the 2 merit seats in the prestigious Kasturba Medical College in Mangalore, Karnataka.

My Dad being a surgeon, and super brilliant in his craft, felt medicine was the highest and most sophisticated of sciences, and the driving force in helping us take on the medical profession with the deepest sense of commitment.

That was then.

An inspiration that has since helped over 25 of us in the family to become doctors. Including my brother who went to Yale, Mayo and is also a recipient of “The Young Investigators” award, an honor that recognized the top two promising doctors in the whole world.

What about now? Where is the nobility of this great profession?

Let me start by saying, I have an undying passion for my role as a Neurologist. I am loved and respected by my patients which is why I strive to work for them. I decided to write about this journey simply because it simply has to be written.

I go through each day in my clinic with a “second me” battling all these questions and feeling pent up frustrations that I feel I have never taken time to pen. Why you may ask.

The most important reason being – Who would I be saying this to? There is no support system or grievance counter or a venting venue or healing center for doctors.

We are overloaded and targeted by so many industries that the doctors’ fraternity simply do not have time to complain. Which is why some simply hang themselves!

I take responsibility upon myself because I cannot stand the pressure anymore.

I am told I am a strong super woman. Yes, I am. But I am also very sensitive and yet tenacious. I am also a doer, I feel, I owe it to my medical fraternity.

Can I just be a doctor? I love my profession.

Love taking care of my patients and absolutely love interacting and healing, I have walked the extra mile to help my patients get the best treatment possible so that they can go through life as best as they can, under the circumstances.

I was taught by my dad that you look at the patient and listen to their ailments. Never at their insurance or their clothes, if they were dressed well. I have imbibed that lesson, perhaps a little too much. Not too many can fathom the challenges and struggles of a doctor.

In Clinical Practice

I have always been concerned about the burden on the shoulders of a doctor. Making sure your patients are safe in an otherwise unsafe world is already a huge responsibility. But piling up more and more is blatant abuse.

The Insurance Maze

The insurances and their idiosyncrasies are an understated abuse. Each group is agenda-based, to save money and give themselves bonuses at the expense of patients and doctors who have to suffer. There are many facets to how the insurance companies impact our ability to function as doctors. Here’s an example of how inefficient our broken insurance system works:

Let’s start with medications.

The “allowed formulary” medications are not selection based on efficacy, but the cost.

Doctors gain ground and make progress on a particular medication, things start settling for the patient, and all of a sudden, it gets pulled or replaced by another medication for reasons neither the patient nor the doctors can control.

Patients don’t respond to these, now covered formulary medications, and doctors start getting blamed. Frustration begins. We start getting calls. They want to get back on their old medication, so the doctor reverts to the successful treatment protocol and prescribes it. We get told that it is not covered and that we need to get prior authorization. Somehow it becomes my job to win back the same medication that was previously covered and explain myself or convince the insurance company to allow for a drug that I believe would work better.

Meanwhile we face the angry patients and have to start working at filing paper work to obtain that prior authorization. On whose time and expense? – The doctor’s.

Why? So that insurance can save money.

This formulary however keeps changing for the “allowed medications” mind you, based on the deals they get with drug companies.

After we submit a request, it’s not always over. We could get another rejection: “The information provided did not align with the ‘language’ and justifications,” they have in their ‘boxed’ agenda. So, the puppets at the other end reject.

They send another ‘boxed’ message – “there is no medical justification for requesting this medication.”

Says who, I wonder! Does not matter. At the end of every agenda hangs the Doctor.

“Please re-submit if you do not agree,” ‘they’ say.

Meanwhile patient calls 10 times and has filed a grievance with the insurance company.

So, this one visit that is “covered” is now turned into spokes of a wheel with a maze of formulary/non-formulary/denial/calls/faxes to pharmacy/submit-resubmit/re-explain/Using pre-programmed language criteria that the robotic service can “match” before dispensing, and so on.

After all this, it is natural for the staff, the patient and the doctor to be stretched.

And the mossy wheel grinds again. The doctor is now made to bounce like a yoyo at their own cost to appease this hidden hand that deals the dice.

Insurance calls start adding to the spokes by asking doctors to respond to this grievance by their insured. Not the pharmacy, nor the insurance, but the doctor has to find time to describe what transpired from the start of that forsaken pharmacy call, the prior authorization saga/the submit – resubmit ordeal, and even talking to some mysterious voice that call themselves “Peer to Peer Review,” to finally submit a response to the grievance filed against the doctor with a looming deadline. Can you imagine if this is the amount of work on one patient? Each trying to keep their end straight, so they meet compliance, but at the doctor’s time and expense?

Ever wondered, Why?

There is a myth that doctors make a lot of money, which needs to be corrected.

Oh boy! If we only start charging for all these hidden ancillary services and slavery, and unaccounted, uncompensated time, that we spend to help Insurances save money for their bonuses, and pen down explanations to appease Insurances so that their clients are kept happy … but why? Can’t I just be a doctor?

Conveniently put, this is not «work,» and there are no codes assigned to bill for our time. So, a mysterious hand is dragging and stretching them. Doctors are burning out.

Still wondering why doctors are so stretched?

There is more to come in the next issue.