Ask physicians why they chose to sacrifice many of the best years of their lives to the rigorous and exhausting discipline of a medical education and you will usually get some variation on the same answer.

We wanted to make a difference. We wanted to alleviate suffering and promote health. We wanted to use our training and experience to do what was right for our patients. We wanted to build lasting relationships with the people we served.

Sure, we also wanted to be compensated fairly for our time and expertise. We wanted to have control over our practices and freedom to organize our businesses as we saw fit.

What went wrong? How did the connection with our patients become a casualty? How did we find ourselves on this treadmill? Where did our autonomy go?

I work closely with physicians who are actively seeking to improve their professional and personal lives. They come to me with many different issues and concerns related to the practice of medicine. Dissatisfaction with the current private health insurance environment is one of the more frequently cited areas of concern for frustrated and disillusioned doctors.

Here is some of what they tell me:

  • The current system is destroying the physician/patient relationships that are essential to good medicine. More time and energy are expended in dealing with third party payers than in providing exemplary health care. Paperwork, phone calls and interminable denials drive a wedge between doctor and patient.

  • The doctor no longer gets to decide what is best for his or her patient. Treatment decisions are made based on statistics generated with little or no input from the people who know best, the practicing clinicians.

  • Insurance companies have fostered an environment that removes the incentive to promote good health and keep patients out of the hospital. Doctors are primarily rewarded for efficiency and volume with a huge emphasis on disease management rather than health maintenance.

  • The current system has created a business model based on a billing cycle of up to 120 days (or longer, with denials). What other service industry could survive while waiting four months to get paid?

  • Financial pressures imposed by third party payers often force doctors to rely on a less effective therapy or procedure.

  • The satisfaction of shareholders has taken priority over the health of patients.

  • Private insurance passes on huge costs to the consumer (including administration, marketing, and profits), making it a system that hurts both the physician and his patient.

  • Insurance companies measure the quality of a physician’s care using unclear and suspicious methodologies, often employing tiny sample populations.

  • Our current system has imposed a one-size-fits-all and paint-by-numbers approach to patient management. Far too many patients slip through the cracks. Conveyor belts work well for assembling cars but not for the delivery high-quality health care.

  • Only physicians can develop safe and sustainable efficiencies. Non-physicians (such as insurance company actuaries) simply lack the requisite training, experience, and knowledge to safely balance maximal efficiency with maximal efficacy.

  • Health insurance companies today are basically providing health care financing for the majority of their clients. They are doing so at huge cost to the consumer while assuming very little real risk.

Granted, private health insurance is by no means the only problem in our complex, bloated and top-heavy healthcare system. There are many other factors that contrive to limit access, inflate costs and strangle reimbursement. Our system is deeply flawed and reform is desperately needed but we should not look to private health insurance executives for the answer.

The first steps in reform must include the repair of the doctor/patient relationship, incentives for health maintenance, a return to truly patient-centered care and the empowerment of physicians to safely develop maximal efficiencies within their own practices.