Podcast #20: Fighting for Physicians: Dr. Rishi Patel on Unions, EMRs, and Autonomy
Dr. Rishi Patel, a new Advocacy member, joins the DocNation hosts to discuss the decline of private practice, the burdens of electronic medical records, physician burnout, and the urgent need for physician unity and advocacy.
Podcast Transcript
Justin Nabity
This is the DocNation podcast. We are a movement founded by doctors for doctors dedicated to empowering medical professionals to reclaim control over health care decisions and advocating for their fair share of the industry’s resources. Please note the views expressed are those of DocNation and not necessarily those of our Guest or Reference Health centers.
Reid Lancaster
Let’s let’s start with that. Doctor Patel, what are your thoughts on that? If you don’t mind, I’d like to just start with that question. Why do you…
Justin Nabity
About which part?
Reid Lancaster
What?
Justin Nabity
About which part?
Reid Lancaster
Why do you think the IPA has gone from 300,000 to 150,000? So if there’s a million physicians in the United States.
Dr. Rishi Patel
Yeah.
Reid Lancaster
And, 300,000 were a part of the IPA, and I don’t know what year it went from 300,000 to 150,000 over the last. Go ahead, Justin.
Justin Nabity
Yeah. Ten years is with me.
Reid Lancaster
Over the last ten years, it’s it’s gone down to what? Call it, you know, 15%. Why do you think that is?
Dr. Rishi Patel
Well, the biggest thing has been the Affordable Care Act. And really, you know, my dad was in private practice for a number of years. I used to go with him to buy some of the chemo. My mom did his billing growing up. And really with the Affordable Care Act and the introduction of electronic medical records, it really added so much compliance in a lot of different rules and regulations that made it so difficult for private practice folks to really stay in business.
And then on top of that, with the advent of and I’m not saying that, you know, obviously the Affordable Care Act had good things that came out of it with, you know, requiring insurance and so forth. But you had a lot of different types of insurance plans that came out that really cut reimbursement or really added different stipulations for reimbursement.
And so it became very difficult. And so, I mean, if you look at the practice I’m part of, we have over 20, you know, oncologists and we’re considered a moderately sized private practice. But if you’re a solo practitioner or private practice, those days are unfortunately gone. It’s so difficult to maintain the overhead costs to have an EMR to, you know, keep up with this and that, that most, you know, people have no other option but to be employed.
It’s really sad seeing that.
Reid Lancaster
So you said the ACA and, the invention of the electronic medical records?
Dr. Rishi Patel
Yeah.
Reid Lancaster
Just purely because of cost. The overhead, to be a solo practitioner, it is becoming impossible to be able to keep your doors open.
Justin Nabity
Are you saying that if it was cut in half the cost, that would make a difference or a lot lower? Is it is this just the technology itself is the issue because I think a patient would be like, well, everything’s digital. Why wouldn’t I want to have my doctor in the 21st century doing digital things that are running their business, if they’re not in 21st century doing current tech stuff, and they’re probably not a good doctor because they’re old fashioned, they’re out of touch, stuff like that.
So I would want the EMR to be up to date. So why is this this, this EMR and regulation requirement? Why is that a problem? Why is that not good for our patients in in this regard. Like what’s, what’s the, the the indirect effect of what this is doing for them.
Dr. Rishi Patel
So I would say this electronic medical records are not made for doctors. They’re made for ensuring, for insurance and billing. Really? You know, it was never created with the intention of providing better care. Maybe you could argue epic, right? But, you know, in many ways, epic is completely unaffordable. Most, most people in, you know, small private practices and so forth just use whatever generic, you know, EMR system.
All you’re doing is putting on documents in one single area. But when it comes to actually providing care, I don’t just go based on the EMR, I have a system where I look back at labs and look back at all the documents that I got, and I make a decision.
I think aside from maybe having some radiology on the computer and maybe having some labs on there. I don’t think having, you know, so-and-so like paper on an EMR makes a difference for me. I always go through everything in detail, but the problem is, is, is fatigue, you know? So really, I was talking to my wife about topics I wanted to talk about because this can be so broad.
But, you know, one of the things is an EMR and being forced in a slave on the computer has led to physicians being so unhappy. Because I think of my dad and back in the day when he could see patients and really provide care and not have to worry about that, you know, on a given day, I might I’ll see my patients, I’ll write my notes, I’ll go through 200 labs on a computer screen.
I put in orders on a computer. The thing I hate the most about my day is that I’m forced to spend 80% or 90% of my day in front of a computer with the least amount of physician interaction, and it makes me sad inside, thinking that every time I go see a patient, the first thing I’m thinking is well after on the computer and take care of this.
And then move on. That’s the worst thing.
Reid Lancaster
That’s insane. So you’re saying 80 or 90% of your time as a physician is spent, uploading information for the patients?
Dr. Rishi Patel
Yeah.
Reid Lancaster
What were some of the topics you and your wife were talking about that you were thinking about bringing up? Because I’m most interested in that, actually.
Dr. Rishi Patel
You know, I didn’t I didn’t want to dive too much into the business side of things, but you know, how to keep a clinic afloat and some of the unnecessary business things you have to learn about, you know, thinking about reimbursement, drug reimbursement, services. The other thing we talked about was burnout in general. And then I had it. What else did I have right now?
Justin Nabity
Let’s do this too, though. Reid, I haven’t told you about his background with organizing doctors. He has a prior life experience that got him immersed in the thick of organizing. Tell us, Doctor Patel, what you did and what that was like and what you see as far as being able to organize now, even when you have private practices and you have employed doctors.
Reid Lancaster
So you’re the son of a doctor. You got to watch it growing up. You got to see what it was like. Tell me why you started this. And what is it? Because you’re right, Justin. I don’t know about this yet.
Dr. Rishi Patel
Yeah, yeah, yeah. So, you know, honestly, for me, when I was a resident in Chicago at UIC, I had heard about unions. My dad, when he was a resident in New York City, in Brooklyn, had been part of a resident union. And so they came up to me and brought up the idea of a union.
I realized when I was in Chicago, everyone else had their own union. The nurses had their union, hell, the transporters had their own union. I remember my first weekend on, there was a big strike, and we were having to divert patients over. I remember having to wheel my own patients down, and I started thinking—why is it that in the name of morals and so forth, physicians are asked, “Hey, don’t do this, don’t do that,” but everyone else can? How are they not part of the system as well?
So I started realizing that’s not right. I don’t think people will listen until you have some type of formalized bargaining power. And I think doctors are so disjointed in general. There’s private practice, there’s hospital-based—there’s been no group.
The AMA—I remember hearing your podcast with that gentleman as part of the AMA. I disagree with the AMA because I think for the longest time, they’ve not done a good job of really bringing people together. I remember back in the day during President Obama’s presidency—and I’m not trying to be political—but the president of the AMA and President Obama were grabbing lunch and dinner together, and they were both based out of Chicago.
Dr. Rishi Patel
What type of signal does that send when something like that is being done without actually getting the opinion of physicians on how they feel about certain things?
Justin Nabity
So then what happened? What did you do?
Dr. Rishi Patel
We started the process. We got about 50 or 100 residents at UIC to sign a paper. Then we went to our hospital board and said, “We want to start a union.” They initially tried to find ways to get us not to be interested in it. Ultimately, once I graduated and went to fellowship, I heard that it got passed.
Now their salaries went up a lot, they have more benefits, but more importantly, they have more bargaining power in determining what safe practice of medicine looks like. And I think that’s important.
Reid Lancaster
When you say “we started it,” do you mean you? Or were there a couple of other people?
Dr. Rishi Patel
It was me and like four other people. We all graduated, but we kept the momentum going. Finally, we got enough ballots signed where more residents—greater than 50%—said they wanted a union, and then it got passed.
Reid Lancaster
I ask that question because I want everybody else out there to hear that. I’m not saying it’s easy. I’m not saying you guys had a bunch of time on your hands at that time. But I am saying that it’s doable, and that you actually do have the power.
Justin Nabity
And there are pockets around the country that have these. Why isn’t it that every single location has these as the foundation of what would come after you leave? Why don’t you leave an ecosystem that is becoming more favorable to you, respecting you more, and giving you more say in your decisions?
Why does that not carry forward? Why is it that because you moved on, it doesn’t continue? I know that the way the rules are, you can’t have a union based on your occupation class—it’s employer by employer. It isn’t that way overseas in other places. But why do you think it’s not being carried forward beyond the residency and fellowship stage?
Dr. Rishi Patel
There’s this old-school idea that if you’re a doctor, you do whatever you need to take care of patients. A lot of the older folks would say, “Hey, what do you want a union for? Your goal as a trainee should be to do as much as you can, take in as much as you can to become the best doctor you can be, and then move forward.”
And I think that’s the type of culture that has always been perpetuated. That needs to change.
I was talking to my dad—when he was a trainee, he could go out and provide good care to people without having to deal with putting in an order or dealing with this or that. Now there’s so much fatigue and burnout because of being in front of a computer, electronic medical records, coordinating care, and all these bureaucratic tasks. There’s no way one person can do it all in one day.
Reid Lancaster
Yeah. Your dad’s coming from the heyday of medicine.
Dr. Rishi Patel
I mean, those were the golden years.
Reid Lancaster
When there was autonomy. I mean, that’s really the number one word. People look at this and say, “Oh, this is just a money grab by physicians.” It’s not that. Look at the CMS cuts over the last ten years—it’s ridiculous.
So not only are you getting paid a lot less, but you enjoy your job a lot less. Physician suicide is twice that of non-physicians in the United States population. Why is that?
Justin Nabity
It’s double the average population. Yeah, I just looked it up to double-check the numbers. Well, no, no, no, not that—something related to it. What percentage of medical students would you say, Doctor Patel, do you think are on antidepressants?
Dr. Rishi Patel
Is it 50%? 75, like three-fourths?
Justin Nabity
75.
Dr. Rishi Patel
Holy snap. That’s crazy.
Justin Nabity
So this is where the sausage is getting made. This conversation—this is big time. I want to take this offline with you and look at what you did at UIC.
Dr. Rishi Patel
Yep.
Justin Nabity
And get a process going. Why don’t we have this at every single location? If we had it at every single location, people would start to realize that there is a serious problem. Once you leave, we need to start taking with us some of what we’ve done in the past, which is in those training years—75% of medical students.
That’s a problem.
Dr. Rishi Patel
A huge problem.
Justin Nabity
I mean, I just looked it up right now. That’s how bad it is.
Reid Lancaster
I think what I’m about to say—I think it’s okay for people to hear. But when you have the tip of the spear of Americans, right? It takes a certain level of person to pursue medicine, to become a doctor, okay? It’s not average. It’s not an average thing.
Justin Nabity
They’re giving eight-plus years of their life to take care of people.
Reid Lancaster
It’s not an average thing. Not everybody can do it mentally. Not everybody is even smart enough. That’s just the truth. When you’re a struggling patient and you’re potentially on your deathbed, you want to look up and think, “I hope this guy or this lady is really, really smart and really, really good—maybe beyond what I ever could have achieved—because I’m looking for life-saving results here.”
And when you have those people going through so much that 75% of them need medicine just to be cognitively okay—that’s horrible. That’s disgusting.
And why is that? It’s because you have no autonomy. You do not have the autonomy to practice care the way you want to. You have to become a whole bunch of different things just to be a doctor.
I think the biggest thing for me in this podcast is that you spend 80 to 90% of your time on a computer screen. I don’t want to be your patient. I’m sorry. I don’t want to be your patient.
Justin Nabity
No patient wants to be a patient to anybody. And that’s the way it is inherently across the board.
Dr. Rishi Patel
That’s the worst thing about it. And I think that’s what’s driving depression rates. Right? I think—when I say it this way, it’s not really politically correct—but when you look at how medical school and the training process has changed…
Back in the day, people who went into medicine were people who had some type of connection with society. They liked science, they wanted to provide a greater good. I think medical schools have changed their admissions to selectively choose people who are more research- or statistically-oriented and less service-oriented, despite grades.
And then, on top of that, they add a whole slew of requirements—”Oh, you need to have this research paper, you need to have this done, this done”—and that does not reflect or add inherent value to becoming a better doctor.
In doing so, I think a lot of the folks who are there are just constantly doing this, this, and that, and they’re so disjointed from society. I honestly don’t feel like I found my calling again until I started back in private practice and I felt like I was part of the community.
For me, it brings so much joy. But I feel like if you’re in a large inner city or a hospital-based practice, or you’re constantly moving around, you don’t feel like the people you’re treating are actually benefiting from the care you provide. It doesn’t feel like you’re part of that.
Reid Lancaster
So to go through all of that—eight, ten years of school, or more—to get to a place where you’re like, “Wow, this is not what I thought it was.” And I think most people sit in that. They’re like, “Okay, I just spent a decade of my life doing this.”
Not a lot of people are reaching out to do private practice, so now they’re in a position where they hate their lives. They’re working 70, 80 hours a week. They’re not making the money they thought they were going to make. But what else? What are they going to do? Where are they going to go from being a physician?
I mean, that’s the truth. What is there—another level you can step up to? Like, maybe an astronaut? And I’m not trying to make anybody feel less, but when you become a physician in the United States, that is top-tier.
Where do you go from there? So you’re just going to be miserable for the next 30, 40 years of your life? I truly believe that’s where most physicians are today.
Dr. Rishi Patel
Yeah, I agree 100%. I think where we go from here is we start by creating a unifying process that brings physicians together and gives them a voice. The AMA really needs to be reset. And something like what you guys are talking about—getting a union in its simplest form that brings people together—that’s the next step.
Reid Lancaster
And I also want people to know that there are a lot of things that need to change for healthcare as a whole to change. But if you want to make a change and you want to make it immediately, understand this—our company exists to negotiate contracts so you have a fair chance.
We’ve gone through all the EMR/EHR systems, so we know which one to get you. We know how to handle the business side of things to get you to a place where you can actually provide a living for your family and be an independent physician. We exist to do many things, but that is one thing we exist to do.
Dr. Patel, you’ve been wonderful.
Reid Lancaster
Thank you for your service. And thank you for doing all the things that never made you money—things that were outside of medicine—for the betterment of your colleagues.
We were on a podcast right before this one, and this gentleman—a seasoned physician—said, “We have ten years left. We have ten years left to turn the tide before this becomes purely corporate medicine. And if we don’t do it in ten years, we never will.”
DocNation—we have hope and we’re fighters. But there are roadblocks left and right. And one of the biggest roadblocks is physicians themselves not being willing to speak up.
So, very grateful for you and for your time and for your history.
Justin Nabity
Yeah. Dr. Patel, maybe for your last word, share with DocNation what you would say to them about joining this cause we’re talking about.
Dr. Rishi Patel
Yeah. I mean, I would say about joining this cause—whatever you do, you always have to fight for it, no matter what. Every group—whether it be nurses, pharmacists, lawyers—every group always has to go to the bargaining table. Physicians are no different, unfortunately.
Bargaining does not mean bad care. It does not mean you are not providing the best care. This is about sitting down and finding ways to provide better care while also being able to take care of yourself.
Justin Nabity
Excellent.
Reid Lancaster
Thanks, Dr. Patel.
Dr. Rishi Patel
Thank you, guys.
Reid Lancaster
Have a great day.
Justin Nabity
This has been the DocNation podcast. If you like what you heard, be sure to subscribe, rate, and leave us a review on Apple Podcasts, Spotify, or wherever you’re listening. Thanks for listening.
Register Now!
Don’t miss out on the latest insights and strategies from top medical professionals. Subscribe now to our YouTube channel so you don’t miss an episode!