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Between the Rock and the Hard Place: Defending Work Inside a Broken System

I have debated for a while now on whether to write this post. I don’t want to sound insensitive, or like I am living in denial or as if I am blind to legitimate concerns about the medical system. However, I have recently come face to face with my own set of realities regarding my role in that system, and have found myself feeling a feeling I did not expect: a little pride. And I think that needs a little explanation, not just because it was unexpected, but because I think discussing it with others will help those on the outside of that system looking in (with understandable frustration) understand the choices we inside it have to make every day.

Here are some examples of those choices, in practical terms. They are a list of economic realities we face daily in the American medical system. This is not an exhaustive list, but I have stuck to the ones that carry the most weight around our collective necks.

1. Money is a necessary commodity to keep the literal lights on in an office.

Whether a provider is part of a private practice or a publicly supported entity, money still matters. If an office closes because there is no money to keep the lights on, we help literally no one.

2. Money does not grow on trees.

It has to come from somewhere. In our system it comes from some combination of direct patient payment, insurance companies and taxes. And no matter where it comes from, it is not endless. It is always limited.

3. The more patients a practice sees, the more likely that practice will stay viable.

This is why your visits never feel long enough. They don’t feel long enough to us either.

4. The more money a practice charges, the more likely that practice will stay viable.

Love the concept of your provider only seeing 5 patients a day for two hours at a time? Expect to pay a buttload of cash. #conciergemedicine

5. There are pros and cons to taking insurance.

Its not all bad. It allows providers to see very low income people who otherwise wouldn’t receive care. But it comes with a whole lot of rules and demands.

I’m not particularly fond of the fact that I, as a provider, am part of American capitalism. I’m not particularly fond of American capitalism in general, let alone that so many of the decisions that govern our health as humans are influenced by money. That…shouldn’t be the way it is. And perhaps someday it wont be. Perhaps someday we will exist in a world where none of the things I am going to write about today have to be considerations, and I not only look forward to that day, but will continue to do whatever is in my power to do to make that happen. And maybe someday I will write a post about ways in which we could make that happen, ways I can help, ways you can help, ways our elected officials can help. But today is not that day.

Because those changes won’t happen overnight. They wont happen this year, or next year, or in the next ten years. Fundamental changes to influence of the free market in American health care is a long, long way off, if it ever happens at all. So everything we are discussing today – It. Is. Not. Going. To. Change. Anytime. Soon.

And fighting to change it – that is not a productive part of my everyday existence as a medical provider. It just not. I can spend days whining about the system, learning to work within its rules or I can leave it. Those are my options. Everything else – the fighting against it part – can’t be what I spend all my time focused on. None of my patients would ever get better because I would be too consumed with fighting to have any energy left to properly diagnose people. I am only one person, a mere human, and I have to make choices about where I put my energy each day.

So that’s reality #1 and reality #2. I haven’t even gotten to the part where I discuss the details of those options I mentioned, and those are already tough pills to swallow a lot of the time. Just admitting that the system is going to stay the way it is for a long time and that I can’t do much about it on a daily basis, that took years for me to admit. To say out loud. I am not a person that likes to admit negative realities. But here we are. Welcome to my personal emotional growth lol.

Reality #3 is something that I know, but I didn’t know before. And I think it needs to be said, because I think a lot of you may not know it either. Reality #1 and reality #2, they piss all of us off. Its not just me. I guarantee you, I promise you, that healthcare provider that you are frustrated with because it looks like they don’t care about you, they are frustrated too. With some exceptions of course, no bright-eyed 17 year old decided to go pre-med in college because they want to see 25 patients a day and go home completely exhausted feeling like they helped no one, just so that their practice can make more money. Doctors are not monsters. They are people, just like you and me. They got into this because they want to make a difference. But then, they were whacked across the face with realities #1 and #2. Joy. You need to understand that. Understanding that, understanding us and the challenges we are faced with each day, is part of being on the same team with your healthcare provider. You want that for yourself from us – there is some give and take there. Sorry to whack you across the face also, but there that is.

So we are all faced with choices, and these choices are all trade-offs. There are no perfect answers for patients or providers. I want to give some examples of the way these trade-offs manifest for patients first, and then ill end with my tough choices, and try to give a defense for them.

Here we go.

1. If you want a provider that spends 1-2 hours with you, be prepared to pay for that service out of pocket.

Concierge providers (which include most holistic providers) do not usually take insurance and because they see fewer patients a day, their direct-pay rates are high. They also need to keep their lights on, and you and the other two patients they see that day will be paying that bill.

2. If you want to skirt the national practice guidelines, be prepared to pay for that too.

Want to come off your Lipitor but your cholesterol is still high? In order for us to keep taking your insurance, we actually can’t do that. Youll need to see a provider outside the insurance system. See your local credit union for financing options.

3. If you are expecting immediate call-backs and responses from your provider’s office, you are also expecting that everyone else’s calls be ignored.

The healthcare system is not a perfect system. Not everything happens exactly the way it should in a perfect world. Especially with current staffing situations. Be patient and kind to people, especially nurses. And remember that offices need to stay busy to stay afloat.

At the end of the day, everyone has to remember the country we live in has decided that healthcare must partake in the free market. This may not be a pleasant reality, but it is the reality. And the people trying to take care of you are dealing with that same rock and a hard place that you are find yourself in when you feel frustrated. So lets talk a little more about that.

As I mentioned before, providers really have three options when it comes to our role in the system. Here’s what they are:

1. Leave it.

So many friends and colleagues have made this choice. Finding the mainstream healthcare structure limiting, crushing and generally full of anguish, they have left to pursue careers in concierge, insurance-free medicine.

As I have already said, however, this is a trade-off too. They aren’t able to help as many people, they don’t have access to as many resources and they still have to keep their lights on as well. This usually ends in those costs being passed on directly to the consumer.

2. Complain About It.

I mean, we are somewhat in this category. No one likes the situation we find ourselves in. And I was squarely in this group until recently. I felt like I spent most of my time pushing back against the rules I had to follow, but mostly that just created a lot of stress for me and distraction from patient care. Furthermore, endlessly whining and complaining will eventually get you alienated from your peers and higher ups. And if you want to make positive change in the system, you cant be the person that no one wants to work with.

3. Roll With It.

It took me a long time to get here, but here I am. Its not a popular choice, to be honest. As a holistic provider, my peers who have left the system think I’m settling. I’m sure there are those that would label me a sell-out in some way. Or maybe “not a real herbalist”. Or see my admittedly endless compromising as exhausting (sometimes it is). But here’s the thing: this is the best decision for my career I have ever made.

The Final Chapter: Not Such a Hard Place After All

This post is really a defense of doing good work in a broken system. Not of fixing the system, not of rejecting the system, but of making the best of it. Like I said, that’s not a super popular standpoint, especially in the holistic world. Hence my long rambling justification. And speaking of which, the following are the reasons I have made the choice I have:

1. I want to keep seeing low-income people.

You just cant do that if you don’t take Medicaid. Sorry not sorry. That’s the end of that story.

2. I want to help more than 4-5 people a day.

Do you know how long people have to wait for appointments to see their provider? No. Id rather make more visits happen, not less.

3. My care is more important than whining about the rules.

If I left, what would happen to my patients? Who would take care of them? Someone has to do this work. If everyone leaves the system, there is no one left to take care of people, and no one left to work towards positive change.

Also, and this one is some tough love for holistic providers out there, if all you can do is complain or leave, then you’re probably not doing something right. I know that seeing a patient for a 20 minute follow up is really limiting, but schedule them to come back if you don’t get through everything. I know insurance guidelines for medications are tough, but help your patients use integrative interventions to hit those guidelines and then you can take them off their meds afterwards. I know seeing a ton of patients everyday doesn’t always leave you enough time to think, but learn to manage your time better and rest well knowing you helped so many people in one day.

If you can’t figure out a way to make the realities of our healthcare system work, or if you are too busy butting your head against it all day long, no one wins in the end. No one. There are ways to still be an awesome, holistic provider and not bail on a system that needs more good people, not less. While every provider and every patient has their own choices to make about the realities in front of them, I will never leave the healthcare system. I will always be here, holding my patients’ hands as we maneuver the rock and the hard place together. I will always be here, giving my patients herbal remedies until their insurance says we can come off their high blood pressure medications. I will always be here, fixing my charting templates again, and again, and again, until I can finish each chart in 2 minutes instead of 5 so I can see enough patients in a day and still get home to my family on time.

I will always be here.

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I will be moving to an area south of Syracuse (NY) in February. Your blog is on point of where our heathcare system is failing so many. It is not fair to the patients as well as doctors and nurses. The latter two are overburdened with idiotic time consuming regulations by not allowing doctors to provide the right care to their patients. I will be looking for providers for myself but so far all are “booked”. I am a patient advocate so I will be able to navigate the complexities of various healthcare centers. I am glad many doctors are rebelling and practicing the right medicine.


Laurel R W
Laurel R W
Jul 25, 2023

We're about to relocate just outside of Syracuse and I stumbled across your page today while looking for a local herbiary. This is a thoughtful, rational, and well-written post. A welcome relief and something I needed to hear right now as I'm struggling to establish new Healthcare connections in the are for my family. Offices are are so overwhelmed and short-staffed, most aren't even accepting new patients. Those that are have a backlog of new patients which means we will wait months to get in to see anyone. Not so bad if you're in perfect health, but for those of us with chronic conditions, these waiting times can be awful. It is good to be reminded that none of us…

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