Becker's Hospital Review

24 CMO / CARE DELIVERY Does prestige belong in medicine? By Mackenzie Bean and Erica Carbajal A n air of prestige has accompanied a career in medicine for centuries. Today, those in medicine are still largely respected, but different factors — including the democratization of information, an increasingly polarized society and new care models — are changing the public's view of physicians and the patient- provider relationship. "Historically — for centuries, really — a career in medicine has been one that was meaningful and highly valued by communities," said Gary Kaplan, MD, who has 43 years of healthcare experience and served as CEO of Seattle-based Virginia Mason Franciscan Health from 2000 to 2020. Fast forward to 2022, and research indicates some physicians' own interest in and positive perception of the field may be declining, with some even second-guessing a career in medicine entirely. Only 68 percent of physicians under age 40 said they would choose medicine again if they could redo their careers, down from 76 percent the previous year, a Sept. 23 Medscape report found. To understand how and why the perception of medicine has changed — and what benefits or drawbacks this brings to the profession — Becker's spoke with two physician leaders with a combined 82 years in the industry. An evolving view of medicine and the patient-provider relationship An esteemed view of physicians dates to at least 91 B.C., when a Bithynian physician named Asclepiades established Greek medicine in Rome. "He brought a prestige to Greek medicine" and laid the groundwork for Greece's Methodic school of medicine, which significantly influenced how medicine is practiced today, researchers wrote in a 2017 study published in Medicines. roughout history, different theoretical models of the doctor-patient relationship also existed. From the time of ancient Greek physician Hippocrates through the 1970s, most of these models were highly paternalistic and based on the idea that physicians are the sole experts and decision-makers regarding medical care. A growing recognition for patient autonomy and values began to shi the physician-patient dynamic in the 1970s. "ere was a huge transformation in American medicine — in particular in the 1960s and 1970s — that paralleled what was going on in the country with the civil rights movement, feminist movement, and the antiwar movement and challenging authority," said Joseph Carrese, MD, a bioethicist, physician and professor in the department of medicine at Baltimore-based Johns Hopkins. "We went from a system where doctors … know best — a very paternalistic, hierarchical model — to one where patients took center stage with patient autonomy and self-determination," he said. "e model of the doctor-patient relationship changed to one where now, I think appropriately, [it's] sort of a partnership." Today, shared-decision making dominates the lexicon in healthcare, which the Agency for Healthcare Research and Quality defines as "a model of patient-centered care that enables and encourages people to play a role in the medical decisions that affect their health." Although healthcare now operates on this much more balanced model, several factors stand to threaten the level of trust and respect patients have toward physicians' clinical expertise. e rise of the information age. Patients have a seemingly infinite amount of information at their fingertips, which means physicians are no longer the single voice of reason or expertise. "Sometimes that's challenging to the physician-patient relationship," Dr. Kaplan said. "But I would submit that it's really an opportunity because the more aware, the more dialed in a patient is to their own health and well-being, the better they will be able to embrace healthy behaviors and the advice of their clinicians." Disinformation's prevalence has also grown in recent years, contributing to an increasingly polarized society. As a result, some people are clinging to a "default suspicion of authority," Dr. Kaplan said. He pointed to Anthony Fauci, MD, the nation's top infection control leader and director of the National Institute of Allergy and Infectious Diseases, as a key example. "I know of no greater physician contributor to our profession and to the health of our society than Tony Fauci," he said. "And yet there are many people who don't trust him for all kinds of conspiracy theories and things about him, none of which are true." is skepticism of federal health officials and public health information can oen outweigh patients' trust in their own physicians' medical opinions. Dr. Carrese said he has several longtime patients who refuse to get COVID-19 vaccinations and disregard other medical advice gives them, despite having a strong patient-physician relationship. "I have no ability to make a dent in their views," he said. "At the same time, those people — some who have been seeing me for years — will agree to get other vaccinations or other new meds I'm recommending." Disruptors in healthcare delivery. Speed and accessibility are at the forefront of healthcare's consumerism era, with disruptors such as Amazon and CVS Health set to dig deeper into healthcare delivery. Amazon plans to acquire virtual and in-person primary care company One Medical — a $3.9 billion deal that would give Amazon more than 180 clinics with employed physicians across two dozen U.S. markets. Disruptors in the care delivery space tout their moves as a bridge to better access, improved outcomes and lower costs. But in reality, those pros come with potential cons. As virtual and on-demand healthcare services grow and different companies try to own different segments of the care journey, patients' healthcare could become more segmented. And while there will always be situations where patients must see a provider they have not previously, disruptors' growth in "I don't want want to be regarded with prestige by my patients in the sense that I'm put up on a pedestal … I would like to be highly regarded and trusted and respected because I've earned it." — Joseph Carrese, MD, Johns Hopkins

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