#obligatory I am a fat trans person who has faced medical discrimination for both of these things

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I went and found the original post in question, and I read all of the expectedly negative responses, so now I feel compelled to add this. 

I’ve found almost universally that any nonmedical person talking about a failure of our medical system chooses to blame that failure on either the malice or the incompetence of individual doctors.

Earlier today I was on instagram and came across a reel mocking of the idea of hospitals having a physician week the way they have nurses week, and I think I finally realized why this happens.

Historically, physicians have been the owner/employer class. It is ingrained in our cultural consciousness that doctors are in charge. They own practices, they hire (and abuse and exploit and underpay and undervalue, etc etc) nurses, they make their own schedules, they choose whether they are willing to be there for you as a patient. Why would you hold an appreciation week for your CEO?

Except that’s very much not the case anymore. Doctors are employees now. They’re cogs in the machine. They’re told what to do and how to do it and spend mandatory meetings learning how to meet their metrics and get emails every month telling whether if they did it fast enough and cheap enough, from someone who couldn’t tell you the first thing about why. 

As of 2023 a huge percentage of doctors - 77.6% - are employees of hospitals or corporations. I couldn’t find whether this number includes “independent contractors” like ER doctors, who are functionally employees. If it doesn’t, the number is even higher. And, because of how corporate medicine practices, I guarantee you these employee physicians account for an even higher percentage of patient encounters. 

Since we’re almost 6 months into 2024, it has also almost certainly already gone up. This is not a casual shift. It’s an active corporate takeover. In 2018, that percentage was 47.4. Corporations and hospitals bought up 30% of private practice physicians in the past 6 years.

I’ve seen a lot of people mock the idea that working in medicine can be akin to a customer service job. But when such a majority of doctors are employees, it absolutely is. And much like blaming your waitress for being slow when the restaurant is understaffed, these corporations are counting on you blaming the doctor. If they demand your doctor perform an impossible amount of work caring for an impossible number of patients and you walk away thinking “my doctor just sucks” you’ve fallen for their grift. 

I’m not saying this system doesn’t produce bad care, or that you shouldn’t be mad about receiving it. Quite the opposite. It provides horrible care! You should be mad!

But we have to be mad at the system which has deprived you of the quality care that your doctor wanted to give you. We can’t be so mad at the individual doctors. Even the ones who are so burnt out they aren’t trying anymore. Not because they should be allowed to be horrible, but because treating a symptom does not cure the disease.

I don’t know what the solution is here. I look at our healthcare system and I fear for our future. But I do know that blaming the corporations instead of the individuals and supporting doctors the way you would support any other exploited worker is a step in the right direction.

Got reblogged by Seanan McGuire again; can safely assume my notes will be a nightmare of people accusing me of being a lazy, incompetent, distracted, inhumane doctor, assuming they notice I’m a doctor. May take a week off.

People will simultaneously describe all the elements of the current US medical system that lead to burnout in service of making the very few shareholders very rich, and then pretend that doctors aren’t also profoundly negatively affected by it, and then decide the system is also actually our fault.