Medical Leaders Launch Grassroots Doctors' Alliance

Marcia Frellick

November 25, 2020

Physician leaders have launched a grassroots nonprofit called Osler's Alliance, created to reverse the erosion of the physician–patient relationship. On Monday, they held a virtual town hall to issue a call to action.

Last year, Eric Topol, MD, founder and director of the Scripps Research Translational Institute and editor-in-chief of Medscape, wrote a piece published in The New Yorker, "Why Doctors Should Organize."

In it, he explained the need to unify the nation's nearly 900,000 practicing doctors to bring back the doctor–patient relationship that existed before the business part of medicine took over its soul.

"Such an organization wouldn't be a trade guild protecting the interests of doctors," Topol wrote. "It would be a doctors' organization devoted to patients."

"Once a Precious, Intimate Relationship"

Osler's Alliance, Topol said, wants to draw together the nation's doctors, who come from different backgrounds, specialties, and political leanings but agree that the way they interact with patients is not what they envisioned when they decided to devote their lives to medicine.

"It used to be a precious, intimate relationship. And it's eroded over time," Topol said earlier this week. "That's largely been because we haven't stood up, and now is our chance."

In the last couple of decades, he said, "there's been a growth of healthcare people but they're not on the front lines. They're not physicians and nurses and healthcare professionals," but people who promote the business of medicine.

Bridging an Unmet Need

The group, named for Canadian physician William Osler (1849-1919) — widely recognized as the "father of modern medicine — notes on its website that the United States' largest physician group, the American Medical Association (AMA), has a membership of just 17% of practicing US physicians. That leaves 83% of physicians unrepresented.

Meanwhile, suicide rates for physicians are higher than for any other profession, burnout is passing 50% in some specialties, and daily demands of electronic health records (EHRs) and other administrative duties continue to top the list of physician frustrations.

Another organizer of Osler's Alliance, Esther Choo, MD, MPH, an emergency physician and professor at Oregon Health & Science University in Portland, described physicians' widespread daily feeling that "this can't be the way it's supposed to be," but also a lack of empowerment to make changes.

That's where the numbers come in, she said. A massive group of physicians standing up against practices could force change.

The first step, Choo said, is to break down the fundamental mission into "bite-sized advocacy."

That might entail advocating for answers to why increased documentation demands are necessary and how, specifically, they help the patient rather than dutifully complying with directives for more charting.

Topol added that advocacy might mean pushing for solutions that could liberate physicians from a keyboard.

"There's a technologic solution that we should have had by now," he said, "which is synthetic notes from voice — speech to text. It's already been shown to work really well in many different venues and in different specialties."

COVID-19 Tipping Point

COVID-19 has underscored other examples of physicians not being in control in the way they deliver patient care, particularly when it comes to prioritizing personal protective equipment (PPE), the speakers said.

Choo noted that sometimes change can't happen without a tipping point. She said the additional stressors of the pandemic have made it clear: "This is far enough."

Leana Wen, MD, MSc, an emergency physician and visiting professor of health policy and management at George Washington University's Milken School of Public Health in Washington, DC, pointed out that COVID-19 didn't create the cracks in the American healthcare system, "but it did amplify and unmask existing disparities and these structural inequities that got us to where we are."

So often, physicians feel burned out because "we want to help our patients, but when they come to us with issues that we cannot solve between the four walls of the hospital, we begin to feel helpless," Wen said.

"This is why coming together in a group like Osler's Alliance is so important," she said.

The town hall moderator, Emily Silverman, MD, an internist at Zuckerberg San Francisco General Hospital in California and creator/host of the podcast "The Nocturnists," noted that asking physicians to unite in advocacy is not something traditionally taught in medical school.

"These are not muscles that physicians are used to working," said Silverman, who is also a founding member of the alliance. "[Advocacy] is not our default state."

Membership in the group is not about money, the leaders emphasize, which is why it's only $5 a year. But signing up builds support and allows access to chat streams and information in a broad network.

Silverman asked what it looks like on the other side, when the doctor–patient relationship has been restored.

"When you start seeing advertisements for health systems that say, 'We give the gift of time to patients and clinicians,' " answered Topol, "then we'll know we're turning the right corner."

Topol is editor-in-chief of Medscape. Choo, Silverman, and Wen have disclosed no relevant financial relationships.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News and and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

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