A poem about the painful absurdities of practicing in a fee-for-service model. Published on Doctors’ Day 2023, in celebration of my impending freedom from this broken system.

FFS, you atrocity
With wRVUs
Cruelly concocted by CMS
Encoding suffering with ICD-10
And compounding it endlessly
With Z codes for SDOH
And 7 characters to specify
Episode of care

How I do translate
The sequelae of
Acute on chronic burnout,
Caused by the system itself?
With time devoted to
complex medical decision-making
ever exceeding the maximum amount

How many 25 modifiers
do I need to show my work on the
opioid-addicted patient with chest pain
and a COPD exacerbation
who has an EKG,
breathing treatment,
in-house labs,
a flu shot,
smoking cessation counseling,
and an I&D for that abscess on his leg,
all in one visit?
Oh and by the way,
he’s also suicidal.

We’re an ACO now
Which means I actually got
“dinged” for that encounter
Because I didn’t order the colonoscopy
he’s due for
Never mind that I saved his life
by listening to him finally disclose
the depression he’s hidden all these years
That’s not what being “accountable”
is about, now is it?

A coder who did not take a single premed class
chides me for failing to
document how many minutes
I spent on problems versus prevention
As if those two things could be separated
And she wonders why I spent so much time overall
on that patient’s care,
yet I couldn’t meet all the metrics?

With your CPT and HCPCS
Distracting me from what really matters
You’re an alphabet soup of misery
Sickening patients and physicians alike
You can take your prior authorizations
and shove them up your
bureaucratic behind
Or in your language:
Better seek a 45915 for that T18.5
As for me, I’m out!