What is your reaction to the new AMA president describing health care as being in crisis?

Ronald P. Kaufman Jr, MD

Health care is in crisis for several reasons. The day-to-day burden of work continues to increase. There are more patients because people are living longer, and urology tends to be a specialty for which a lot of care involves older patients [who] tend to have other complex medical problems that impact the management of their urologic problems.

The amount of help in the office, the operating room, and the hospital decreased during the pandemic and hasn’t recovered.

Hospitals remain in a financial crisis for many reasons. One issue that jumps out is the nursing shortage and the need to utilize traveling nurses, which [is] very expensive and can be demoralizing to the full-time nurses already working in the hospital.

The burden of preauthorization, reimbursements not keeping up with inflation, and consequently, your abilities to staff and maintain our offices and pay our employees at appropriate levels are also affecting our ability to care for patients.

Hospital compensation and insurance compensation have gone up; physician compensation has been flat for too long, which is demoralizing to most physicians.

Yet, urology is still rewarding. You make a difference, despite the obstacles.

I’ve been an academician my entire career. Applications to medical schools are up, students and residents are brighter and smarter, so the future of urology appears to be very positive. The numbers in urology residencies have increased (not tremendously), but we’re training more urologists now. If medicine didn’t seem to be a rewarding career, students would not be going into health care in the numbers they are.”

Ronald P. Kaufman Jr, MD
Albany, New York

Felipe Rosso, MD

“I consider myself an optimist, and my initial gut feeling was, ‘Well, when are we not in crisis?’ I don’t know [whether] we’re in a worse crisis, but I wouldn’t say we’re spiraling.

It’s a long-standing situation that feels like each year, sometimes each month...new challenges for the medical community [are introduced], but I wouldn’t say it’s a whole lot worse than it’s been. Basically, it’s always a different shade of gray.

I practice in Kansas, in a relatively rural setting, and access to health care is becoming more of an issue. There are financial hardships and other factors. Fifty percent of rural hospitals in Kansas are at risk of closing in the next few years. It’s difficult to recruit physicians and other providers to rural America, and the cost of practicing keeps going up while reimbursements continue declining, making it harder for smaller practices to keep afloat.

Our hospital system is doing OK, but as smaller places struggle, our volume continues to increase, creating new issues, delaying care, and needing more providers here. It’s a cycle. There may be some relief with a Medicaid expansion, but I’m pessimistic about keeping small practices afloat in rural America. If things don’t change, the trend we’ve been seeing nationally of declining private practice is, unfortunately, going to continue.”

Felipe Rosso, MD
Manhattan, Kansas

“I don’t know that it’s anything new. I’ve been practicing 18 years and talking to other physicians. The consensus is that medicine, in general, is the only industry where the longer you work, the more years you put into it, the better you get at your job, the less mistakes you make, the more proficient you become, the less money you will make. You don’t get pay raises; you get pay cuts. Yet allxmy employees are going to expect pay raises, and they deserve them. I will make less the longer I practice.

I don’t know the definition of ‘crisis,’ but I don’t think the quality of health care is nearly as good as it was 13 years ago.

There’s far greater focus on things like [electronic health records], data entry, and other administrative things than on patient care. I understand the importance [of] documentation, but it’s swung too far in the other direction. If we could focus more on interviewing patients, physical exams, and thinking through diagnoses rather than data entry, that would make a huge difference.

When a person comes to the hospital today, the diagnosis is made by the triage nurse and phlebotomist. Once they’re in an exam room, the algorithm is already started and all we’re doing is following an automated algorithm.

Medicine’s going to be technician driven. Physicians doing surgery or procedures will be the last survivors, but docs who don’t do procedures will be weeded out. [Physician assistants] and nurse practitioners are even going to get weeded out by artificial intelligence—not even real artificial intelligence, just algorithms.”

Russell Doubrava, DO
Decatur, Texas