A Call to Action for Physicians: Become Informed and Empowered and Begin to Heal Thyself

Stephen J. Thomas Stephen J. Thomas, MD, is an infectious diseases physician-scientist who treats adults at SUNY Upstate Medical University in Syracuse, NY. He chairs a basic science department and directs a global health and translational sciences institute. Along with his partners, Dr. Thomas co-founded Phairify.

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This article has been updated to include the following Correction:

The February Kidney News article “A Call to Action for Physicians: Become Informed and Empowered, and Begin to Heal Thyself” includes the statement, “The RUC [American Medical Association (AMA) Relative Value Update Committee] is a group of 32 physicians and other health care professionals who advise CMS [Centers for Medicare & Medicaid Services] on how to value various medical services. The advice of the RUC is nearly always accepted by CMS, yet nephrology is not currently represented on the committee.”

In reality, nephrology has access to the RUC, because the Renal Physicians Association (RPA) is a member of the AMA House of Delegates (1), and Adam J. Weinstein, MD, was elected to one of the two 2-year internal medicine rotating seats of the RUC at its January 12–15, 2022, meeting. Kidney News congratulates Dr. Weinstein, who serves as Chief Medical Information Officer for DaVita, on his recent appointment and apologizes for the oversight.

Additionally, RPA's Health Care Payment Committee maintains a liaison with the AMA Current Procedural Terminology (CPT) advisory panel (2), which is another way the nephrology community can influence the RUC.

Can you recall a more trying time for physicians? Burnout and moral injury among physicians were on the uptick prior to the COVID-19 pandemic. Doctor shortages, the burden of exorbitant student loans, longer work hours, worsening administrative requirements, and dysfunctional and disparate electronic medical records were all taking a professional, and often personal, toll. Now, as we enter the third year of the pandemic, many physicians are thoroughly exhausted and deflated, and they are digging deep to find their resilience.

How did we arrive here? Clearly, the answer is complex and multi-factorial, and not all of the challenges facing physicians were foreseeable or controllable—although many were and remain so. (Perhaps this is why doctors are adding “learned helplessness” to the list of problems afflicting our community.) Thus, instead of asking ourselves “How did we arrive here?” the more important question may be “Why do we stay here?”

The answer begins with the understanding—or lack of understanding—of our individual and collective values. What value does a physician bring to his or her patients, profession, colleagues, and employer? What value does a specialty bring to a health care system and the elusive goal of providing high-quality, affordable, and well-coordinated medical care? Finally, how does physician value translate into worth, as reflected in compensation, workload, call schedule, benefits, and other terms of employment?

Nephrologists care for some of the sickest and most complex patients. They work across multiple specialties to treat underlying medical problems, trying to halt advancing kidney disease. They intensely manage the approximately 780,000 Americans who ultimately develop end stage kidney disease. They direct dialysis units serving over half a million people and manage over a quarter of a million people living with a kidney transplant. They make themselves available day and night, addressing medical emergencies. Many in academia attempt to balance their clinical activities with teaching and research responsibilities. Consequently, who determines what these contributions are worth?

Thereupon enters the resource-based relative value scale (RBRVS): the physician payment system used by the Centers for Medicare & Medicaid Services (CMS) and other payers. The RBRVS system established relative value units (RVUs), which determine physicians’ compensation for their services and the resources required to provide them. The RVS is determined by the RVS Update Committee (RUC). The RUC is a group of 32 physicians and other health care professionals who advise CMS on how to value various medical services. The advice of the RUC is nearly always accepted by CMS, yet nephrology is not currently represented on the committee.

Whether you are an employed nephrologist or in your own private practice, it is unrealistic to think a Current Procedural Terminology (CPT) code, and associated RVU, accurately reflects your value. Even if an RVU was cable of capturing the complexity and effort associated with a single type of patient interaction, it cannot capture the interaction's downstream value. Almost every patient interaction results in blood work, imaging studies, renal biopsies, or interventional radiology or surgical consultations for placement or creation of dialysis catheters, fistulas, or grafts. How is this value captured?

US medicine and the industries that orbit it have a physician valuation problem, and the trickle-down effects are impacting the quality of care we deliver to our patients.

How do we fix it? At Phairify, we believe solving the physician value dilemma will be a long journey, and it is our mission to show you the correct azimuth. First, we engage physicians to help them understand the problem and to appreciate how inaction promulgates it. Second, we are encouraging doctors to come together around a common purpose to create change. Third, we believe physicians can, and should, assert control over generating accurate, timely, and specialty-specific value information. Fourth, we offer a physician-first alternative to the current employer-oriented and directed marketplace.

Phairify has innovated a digital platform designed to inform physicians of their value and empower them to build their best careers. On Phairify's platform, physicians anonymously and collectively share value information. The information is timely, multi-dimensional, and filterable, enabling doctors to understand how their current employment situation compares with peers. Empowered with this information, physicians then use the platform to anonymously explore the job marketplace and direct a fair balance between their value and worth.

It is time for physicians to decide if they will follow Albert Einstein's famous witticism, which suggests that by changing nothing, we can still hope for a different outcome. Or will we accept a call to action, define our own value, and begin to level our professional playing field?