Opinion

Reader letter: Over a 30-year career, I watched the health care system break

Electronic health records, rules and regulations ruined primary care for me.

Editor’s note: This is a letter to the editor; the views expressed are the author’s own and do not necessarily represent the views of The DO or the AOA.

I find primary care medicine to be a very difficult and unsatisfying place to be these days. After 30-plus years in the field, I have retired.

Taking care of patients has always been more focused on the patient, not the medical records and rules that are being shoved down our throats. Involving patients in their health care and helping them achieve a higher quality of life have been of utmost importance to me. This obviously is no longer what is emphasized in health care today.

Barbara Tilben, DO, MSW

Now and then

When I started as a primary care provider years ago, I delivered my patients’ babies, admitted patients to the hospital and held the hands of my dying patients. I also did a variety of procedures.

At the end of my career, I was forced to see patients every 20 minutes, use a complex medical records system and stay up late at home to complete electronic medical records. I no longer delivered patients, and did minimal medical procedures. I also worked with a midlevel provider who felt she did the same thing as me and was angry she earned less money than me.

In addition, I learned painfully that my male counterparts had the same job as me but earned more money than me! Apparently, this is a problem nationwide.

‘Heartbroken’

I can no longer work in this awful/broken system. I am heartbroken I no longer see patients. I no longer fit in the field of medicine as it exists today. My patients are sad I am no longer in practice and still reach out to me.

I know I am not the only physician out there who feels this way. Society still needs us, but the corporate world doesn’t want providers like me. And it is not cost-effective to own my own practice anymore.

I hope something can be done to make primary care medicine great again. It is probably too late for me.

31 comments

  1. Dr. Tilben was the most compationate, caring and knowledgeable doctor I have EVER had the pleasure of knowing! I was introduced to her over 28 years ago, in Michigan, when I was looking for a doctor for my infant daughter. I can remember when my daughter got really sick while we were out of town,I took her to the local hospital and she was diagnosed with strep throat. To make a long story short… She actually had pylonephritis, which was diagnosed by Dr. Tiben when we returned home. My daughter had an extremely high fever and was lifeless!! If it had not been for such an amazing, caring doctor…such as her…who knows what could have happened to my daughter! The other hospital had taken a urine specimen, but they NEVER ran it for bacteria!! She ended up being hospitalized for a week and recovered completely!

    Since I had bragged so much on how wonderful this doctor was…my mother and father decided to give her a try. My father was diagnosed with large cell carcinoma at the age of 53 and Dr. Tilben was nothing but wonderful! She stood beside us all the way, from date of diagnosis to date of death. She was warm, loving, sincere and treated my father as if he was her own father. She guided through some of the toughest decisions we would ever have to make. She even cried with us and felt our sorrow and pain. She is not just a doctor…she is a friend!

    Owosso, Michigan lost the best Doctor anyone could ever ask for when she and her family moved to Arizona! My family, however, not only lost the best Doctor ever…but we lost an amazing friend who was just like family!

    Dr. Tilben is a “One in a Million Doctor”… and me and my family feel extremely blessed to have had her, as a doctor, in our lives!

  2. I miss Dr Tilben we moved to AZ from Seattle and I was over joyed to find a doctor that had that “old school” kind of way the one who listens to the patient asks questions and answered questions who takes time to get to really know you. I have worked in the medical field since 2001 and worked with some great doctors. Things have changed drastically since then. I saw these doctors over time getting burned out and overwhelmed with the patient load because they had to make the numbers for corporate. I have not found a doctor to replace Dr Tilben and it broke my heart that she retired. Lets face it if you want a great doctor, one who has time for you and actually knows what a face to face with a patient is all about then you will need a time machine to go back in time when the “real” Doctors not a PA, nurse or ma provided your medical needs. When you didn’t feel like a number being pushed threw an assembly line. I miss the good old days of real patient care and I’m fearful for my future and the lack of care yet to come.

  3. I will always consider myself to be a patient of Dr. Tilben. She saved my life in 2015 by asking me to come in for a checkup. I had not seen her in over a year, so I decided to go. The visit was always pleasant and warm. My heart rate that day was 132. She immediately did, and EKG a though she was not a heart doctor, diagnosed my condition as a lack of oxygen to my heart. She immediately calls the best cardiologist in the area, Dr. Elgould. I saw him the next day. He confirmed that I indeed had a blockage in my heart and the procedures begin to convince the insurance company that I needed immediate care. After thirty days of fighting with the authorities we pay insurance cost to, they allowed the cardiologist to do his miracle work. I had three stints put in my heart, two for a 98% blockage on the right side and another for an 85% blockage on the left side. Dr. Tilben worked with me over the limited time of twenty minutes to make sure to consoled me for my fears and grief. She checked on me almost every day before the surgery and after the surgery. Today I am alive because she was the doctor on duty that day and only had my health interest on her mind. I am blessed to be alive today because she was a caring and careful doctor. With the industry as it operates today, many patients are not given the type of care that will save or prolong their life because it does not profit the cooperation’s greed for money. Many patients die every year because they do not have a doctor who takes the time to give the correct diagnosis. I was. I thank Dr. Tilben every day in a pray for her service and commitment to healthcare for the patient.

  4. Hassle factor thrives and drives. I will join you by July. Will leave 150′ home patients to find care. Have reduced a Pulmonary / CC to home visits cannot sustain .

  5. Dr. Barbara Tilben, you are a great doctor and a very caring person. I miss you and your family very much and it is a shame the medical world has lost a physician like youself for circumstances such as these. I thought the world was going forward not backwards. Well, enjoy life, your missed! Thanks for the years of care!!!

  6. You are not alone. I am in the process of giving up what I fought most of my life to achieve. I feel we need to apologize to the students who are just grist for the cooperate mill. I am so sorry ,kids. This is not what I wanted for you.

  7. Switch to an all cash concierge type practice. You ditch the insurance and you can see patients on your own terms. Patients benefit as well by getting extra time and staying with a doctor they trust.

    1. Hmm Kellan, you are precisely what is not needed in primary care. I was part of the team that recruited Dr. Tilben in Michigan. She provided that which “concierge” medicine cannot or will not… competency and compassion. Your patients can “trust” you so long as they can pony up the fee…
      No thanks son… there are others out there in medicine for the right reasons. It’s apparently too late for the seat you occupied in medical school

  8. Totally agree, have been in family practice for 38yrs in Texas. I started doing everything, OB, hospital, tonsillectomies, pediatrics, hospital nursery. Was hospitalist for the rest of community as my colleges quit doing hospital. Was eventually “taken off the schedule” by administration in favor of “hospital controlled” hospitalist group. Have tried EMR and hate it/ Can’t see 30-50 patients per day and do EMR too. Have opted to retire soon instead. My suburban town has only 3 other FPs all new and stymied by EMR to 12-15 pts per day.

  9. I left medicine because medicine left me. I really didn’t see it at first because I had no long term knowledge of how destructive ‘organized health care’ could be. Each year a new change would arise that appears just a normal process in the health care industry as our country grew. Lawyers knew they had the upper hand, Big Pharma became bigger and bigger until, just as many others did, I became a part of their huge sales force, state and federal rules/regulations began to add up, and as a ‘private office practice’ I could no longer keep up with the new paperless digital society that used more paper than I ever thought possible. The ratio of patient contact verses paperwork requirements shifted. Burn out was now an everyday occurrence, I became irritable with patient care because it caused me too much paperwork. My office manager had a nervous breakdown trying to fight off governments, insurance companies, employees loss of satisfaction and then two totally nuisance law suits became the final straw. Today’s health care system is not a health care system, physicians are no longer ‘doctors’, hospitals serve food from fast food industries that serve more saturated fat and cholesterol than any restaurant in town. Yep, I couldn’t take it anymore, I left, and I ain’t ever going back. As we use to say out west when we knew our time was over, Adios, M………..F……

    1. Well said, Dr. Knaus…. my thoughts exactly, when I retired from practice over 2 years ago, after 30 years. My final straw was ICD10, another bitter pill foisted upon us, like EMR, pre-authorization of “everything” we did, etc. At least we experienced the last part of good medicine in our careers. No hope for the future generation of Physicians, that will be selling their souls to Corporate Medicine….

  10. I very much can relate to this. I began my career in 1975 as a GP in suburban Detroit. Initially very rewarding and enjoyable. Did all the old-fashioned stuff from house calls to Obstetrics, to minor surgery. By 1979 it became apparent that a residency was needed. I chose however to switch to Anesthesiology. Over the years I was so happy that I made that choice as MBA’s took over running the show as the docs were to busy. Now when I look at Primary Care and all the “stuff” required from MACRA (yuck!) to all the requirements down to even get drug prescriptions pre-authorized it makes me sad. As an Anesthesiologist we are minimally affected compared to primary care. If we do not take back medicine it will become a profession of NO enjoyment, but being a clock puncher.

  11. I agree that practice has changed. I graduated from CCOM in 1963 and after residence practiced pediatrics for 10 years, left to become a Navy Doctor because I was not being paid enough by insurers and medicaid to continue private pediatric practice. I was able to transition to Allergy Immunology and after 20 years as a Navy doc became a locums allergist, volunteer faculty ember and retired Jan 1st, 53 years after becoming a DO.
    The “business of medicine” with government and insurers dictating how we practice has eroded the patient-physician partnership that provided both patients and physicians the trust and satisfaction that motivated most of us to go into medicine

  12. A sad welcome to toyou from a disheartened member of the club. I started to practice in NJ in September, ’59, the first DO in a suburban town east of Philadelphia. I casted simple fractures, delivered babies, made house calls, and cared for hospitalized patients. I became a member of many families after caring for up to four generations in forty years. A year or two after selling my practice, the young doctor who was then my employer, informed me that because I saw only 3-4 patients per hour I wasn’t “earning my Keep”. He was joining a large managed care group and I would have to learn how to increase my production. I have painfully left the practice and the relationships that I so valued. I get phone calls from former friends to see how I am,and if I’m enjoying retirement. They take pride in that I became a voluntary faculty member in the local Osteopathic school. I regret that most of the new generation will miss the warm, caring relationships that Many of us developed by listening carefully, examining ,and diagnosing without multitudes of tests. I doubt that we will ever return to those intimate relationships.

  13. I certainly feel for you and your frustration, but the problem with articles like this is they do not offer solutions. Concierge medicine is a fine option for some physicians, but to many that word has all of he negative connotations of a closed off health system that ignores those in real need. Similarly, returning to the practices of the past is what got us into this mess in the first place. Your midlevel practitioners are unfortunately the system’s low cost solution. Their complaints are the reason for their existence. Is the problem with emr vendor lock in or lack of standardisation or lack of customization? Specific problems should allow for specific solutions.

  14. I too just retired after more than three decades of primary care. I feel your pain. The vocation we joined is now a profession, with far less expectations of both parties. I loved paper records. I loved charity care and RX samples.
    Our generation has been replaced by computer savvy clock watchers. Enjoy your well earned retirement. Hope you have a hobby or outlet for your creativity. The AOA we joined no longer exists, nor does its academic platform. Regards.

  15. What a shame. I have been in solo practice in a small town near Scranton, Pa. for 25 years. I have watched corporate medicine absorb most of my colleagues into the EMR driven morass. Once just like you were, I am now office based but remain EMRless. I’m opting out of MACRA, taking the hit, and planning to keep on keeping on for as long as I’m allowed. As long as I can bill fee for service, I’ll keep my office open, and my 5 employees working. My wife runs the office, and I have several thousand, mostly satisfied patients. My PA still honors the time tested relationship, and it all still works…barely. I have sacrificed much in terms of the material, all measured in the cost of maintaining my independence, conscience and oath. Our health care system is evolving into a mid level driven compromise, which will progressively drive physicians out of primary care, countering the clear need for just the opposite, as our aging population increases exponentially. Organized medicine has been weak and ineffective in its attempts to reverse the trend. The best of the best of us are too busy making our living to effectively spearhead a movement to stop the madness. With such daunting odds, med schools should be at the forefront of initiating the changes necessary to make the system work in a more efficient and meaningful manner. Otherwise, physicians will continue to be reduced to glorified data information generators and information technology slaves, all at the cost of patient care.

  16. I agree with your comments and feelings. I am a solo family physician of 32 years and still practicing, but I knew that EMRs were a waste of time and do not improve the quality of medical care, and have not chosen that option. Yes, I make 3% less on every medicare patient this year, and by 2022, it will become a 9% penalty, so I have chosen to retire before that time. I hope the hospital systems will still by buying practices, but if not, so be it. I love practicing real medicine and treating and helping patients, but the landscape has changed so much and the additional burden of prior authorizations for generic medications, pre-certifications for procedures, HMO referrals, PQRI and other government mandates, has sucked the joy out of primary care. There are only five independent family physicians left in our area north of Philadelphia, and we are all going the way of the dinosaurs. I think of retirement daily and hope I can stave off burnout for the next few years. I only wonder what kind of medical care I will receive as I grow older.

  17. Such a shame to read how healthcare has changed. And yet, people still favor government run healthcare. Primary care has become clicking boxes and maintaining quota, then finishing notes after putting your kids in bed as I have heard from my preceptors.

  18. All these comments I share after 35 years in Family Practice! I was up at 5:00 AM and traveled to the friendly D.O. Hospital every morning. Made rounds on my patients and knew every patient and their family. They received great care from every D.O. Specialist and everyone was happy. Then “World Class Care ” took over and now no one is happy and it’s all about the “Money “. How sad. Then we ask why there is so much crime & corruption in the United States. No one cares about people or family like we were taught in Medical School! Very Very Sad. That’s why I’m retiring. Can’t fight ” World Class Care ” !!!!!!

  19. Agree 100%. I have had the exact same experience. As a rural mich,female D.O. I was forced to leave private practice by corp. Health care. I will retire soon , but hope to find a way to practice the original primary care I loved 30 yrs ago while “refired”

    Anonymous michigan D.O.

  20. This is truly a sad commentary not only on the state of primary care medicine but also on the state of osteopathic medicine.
    I too left the world of private practice because it was no longer sustainable in a practice style that was “real medicine”. Not the electronic 9-5 see 40 patients world expected by many of our new graduates but the one described so aptly by Dr. Tilben. Many of our students will never realize the indescribable satisfaction of total care for their patients.
    I was given the opportunity to teach in one of the newer COMs three years ago only to find it not really controlled by the osteopathic profession but rather by biomedical scientists and our allopathic colleagues. I looked around in amazement to find that there had been a steady stream of revolving door D.O. clinicians at this new institution. The curriculum is driven by everyone but D.O.s The response of the current dean has been only that “the D.O.s let it happen”.
    It is pathetic that there needs to be an optional course titled “Meaningful Medicine”. When I quired about this stating I thought all of osteopathic medical education should be “meaningful medicine”, the answer given was that there are outside funds for the course. By “meaningful medicine”, the course is described as “humanistic medicine”…. concern for the whole patient……body, mind, and spirit. To every D.O. reading this, that should be a very familiar concept. How has what is inherent in our profession now become some optional course in our student’s’ education? In a sense, our Dean is correct. The D.O.s let it happen. As many of us feared, our profession is slowly being eaten up and will soon lose its unique identity.

  21. I took a deep breath while reading the comments from the physicians above. It was a breath of sadness, but also a breath of appreciation knowing that I am not alone. Sadly, I have only been a pediatrician for 12 years and I am getting fed up with the system. I absolutely love seeing patients. I am not stupid and I can figure out EHR, but because I am not stupid, I am also not sold on the idea. I frequently write about the depressing loss of so many in our profession because of all the reasons stated above. Too many people who don’t see patients anymore are “drinking the Kool-aid” of government and managed care ideas of healthcare. They are driving these changes. Additionally, the non-physicians are bullying the doctors. We need to stand up for ourselves. Advocating for physicians is not for the weak! I have lost some friends and some colleagues and some support of family by advocating for physician rights. We need to do it anyway. More people agree with us than disagree. You will find support if you speak out. There is so much fear that we are alone but we aren’t. I can’t retire before I pay off my loans. I don’t want to stop seeing patients and lose the ability to help others. We are drowning and asking for a life preserver. I wish the AOA and state associations would actually listen and help in the way we want and need, not in the way they think they should.

  22. Last year, after practicing for 33 years, I left patient care to go to a state government administrative position. I enjoyed caring for 99% of my patients, meeting and understanding where they were emotionally, physically and spiritually if they asked. But the EMR and more and more Federal Government regulations created the opposite, often unable to barely look at the patient because I was stuck behind a computer and only had 10 – 20 minutes at the most to go on to the next patient since I no longer had any control over my schedule. I could go on but I am singing to the choir.
    My Dad, rural family practice, said when asked why his enthusiasm and joy for medicine had seemed to have diminished so much over the years. His reply “The day government stepped in to medicine was the downfall of medicine.” That was in 1976. Government is the base of all of this disaster. They are the ones that required the EMR, originally “so all patients would have seamless patient care”. Not only do our records not transfer anywhere that doesn’t have our software but then there’s the problem of hacking, “HIPAA?” They were the idiots that made it illegal for a drug rep even to give out pen and note pads because that could influence our choice of medication! What about all the perks of gifts, travel etc. they get? Blatant double standard!! Utter grief is one of the feelings I have for the loss of the relationship we had with our patients. The majority of patients are unhappy and dissatisfied also but they don’t understand why. This is the first time I have expressed my feelings in writing. Please forgive the length.

  23. Your story is my story. After almost 30 years in rural family practice I decided to retire July 2016. “Meaningless Abuse” (my nickname for Meaningful Use) and the other time-consuming EMR regulations created by those who don’t practice medicine made me hate my work. Now I work part-time as a locums hospitalist in a rural community. I still have to deal with the computer, but it is more of a useful tool rather than a worthless burden. I am enjoying medicine again.

  24. After all this time, I just saw this blog, and I agree. Dr. Tilben is/was the ONLY doctor I found after moving to Arizona that acted like a “real” doctor and reminded me of my lifetime doctor (20 yrs old until he retired in 70’s) Henry Randall, M.D., Marietta, GA. I was elated, and then angry at Dignity. I still am. Corporations run the medical profession. They treat doctors like staff. And, I mean no disrespect to nurses, front office, PAs, etc., BUT, a DOCTOR should be the one directing his/her office, and the ONE making my medical decisions. When I’m sick, I can’t wait 3 MONTHS to see a doctor????

    I miss you Dr. Tilben. I am still looking for a great Primary Care, a doctor like you that actually thinks, listens, knows your patients, is patient and strives to get to the root cause of a problem.

    I saw your name, and I got so excited that you had actually opened your own practice.

    Sasa Bond-Williams

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