So grateful for beautiful baby girl Ellie, who at five days old, entered my life last Fall as a new patient.
In the midst of a chaotic day, she invited me to step into the moment. To take a deep breath and feel both wonder and awe at the mystery and miracle that is life and provide a reminder about what truly matters.
She was the gift I didn’t know I needed.
Last year, the pace at my small private practice was unbelievably busy! So many sick children with RSV, Covid-19, and Flu A! Barely time to catch my breath, much less eat, stay hydrated, or even use the bathroom!
I joined that practice because it offered more personalized care for patients with longer appointment times: 30-45 minutes on average, a rarity in primary care practices these days. Those of you who know my passion for preventative care, mental health, and children with complex medical needs know that I am inspired and rewarded by getting to the root cause of a patient’s symptoms, where true healing begins. This takes time.
I advocate for families navigating the multidisciplinary care their children require when they are on the spectrum, struggle with ADHD symptoms, behavioral issues, anxiety, depression, and other psychiatric concerns. I am also passionate about newborn care and supporting babies and parents through those early weeks when they need help with breastfeeding and close monitoring for overwhelm and postpartum depressive symptoms.
Last Fall, 15-minute appointments instituted by my practice made it impossible to provide the type of care that sustains me: there was barely time to get a detailed history and perform an exam, much less to educate or reassure exhausted parents. Ten minutes into my visit, a knock on the door: “Dr. Kabir, you have five minutes left.” It was absolutely nuts!
This is not a sustainable model. Though the pandemic has shone a light on some of these issues, little has changed. Our healthcare system is long overdue for a reckoning.
The current insurance-based system reimburses 45% of billed charges on average. What other business model would accept this rate of payment for their services rendered? The current insurance compensation model has forced primary care practices to focus on the volume of patient care visits for revenue generation. And shorter visits can impact the quality of care and patient satisfaction, which are often time dependent.
Further, our healthcare system is a costly one because it incentivizes procedures over prevention. Despite similar years of training, specialists who perform procedures for diagnosis and treatment are more highly compensated by insurance companies than primary care providers on the front lines who spend more time educating patients then performing procedures.
Yet, the best cure for disease is the prevention of disease.
There needs to be a shift from volume based care to outcomes based care. Practices should be rewarded for measurable reductions in disease burden and improved health outcomes for patients, reducing the overall cost of healthcare spending in our country, not for the number of costly procedures they perform.
Further, the recent trend in private equity firms buying out private practices and emergency rooms means that there is increasing pressure on physicians from their new corporate employers to generate profits for stockholders. This is an incredible conflict of interest and burdens physician employees (who are no longer owners) to see more patients more quickly, feel pressured to perform procedures, often unnecessary, or be replaced.
Medicine is a calling for many of us. Providing service and improving the health care of our patients, making a difference in their lives, these things matter. They not only reward us, they sustain us.
These rewards help to offset salaries that are much lower than you’d expect for our years of training which in my case included four years of medical school, five years of residency training (2 in Ob-Gyn and 3 in Pediatrics) and four years of subspecialty fellowship training in Adolescent Medicine.
Think about what the hourly rate would be if I were similarly trained as an attorney, where 13 years of additional training and expertise beyond college would likely be valued in terms of compensation. In the legal system, expertise & years of experience matter.
Something needs to change. Cracks are forming in the halls of medicine; physicians are burning out and leaving in droves, and the suicide rate for physicians? The highest it’s ever been.
That morning, last Fall, in the few precious moments I had to hold baby girl Ellie, who had been crying moments earlier during my exam, I felt so much love for her.
And I felt so much love from her.
Through her peaceful energy, her wise soul spoke to me. Five days ago, she was in her mother’s womb. And before that….?
The mystery of it all is both beautiful and humbling.
Today, snuggled up in my arms, I thought I was comforting her. But instead, she was comforting me.
Have courage and be brave, I felt her say.
The cave you fear to enter, holds the treasure that you seek.
More to come…