Warning — we are entering inflammatory territory and to read further may incur your outrage!
I’ve been following some very disheartened conversations about the Business of Medicine on a private physician-only bulletin board, along with a vitriolic (maybe it’s just vibrant??) discussion over at the Happy Hospitalist here and here (the latter outbursts were triggered by the report that Michael Jackson’s cardiologist was on the MJ books to the tune of $150,000 a year to be on call 24/7.)
Seems we are resorting to name-calling in some instances!
There are those, both physicians and members of the public, who express outrage at the “greedy ways” of physicians. I suspect this is their moment in the sun to vent long-standing grievances against some doctor who once did them wrong or some colleague who is apparently living a better life than they.
There are those that rue the notion that medicine and business have anything to do with each other and grouch incessantly about how they “just want to be left alone to practice medicine.” Nice … if you can afford it or find some other sucker to take care of the business needs of bringing in patients, running practice, clinic or hospital operations and getting paid somehow!
And then there are those who are obliged to defend the physician as a long-suffering victim of a bunch of nasty circumstances. And it’s often the physician (or his or her irate spouse) doing the defending.
I’m sticking my neck out here.
Will you quit being simplistic?
Here are a few facts, some of which you may want to dispute, but most of which I think you’ll agree are fairly accurate.
In the USA, we have
- health insurance companies whose fiduciary responsibility it is to maximize shareholder wealth
- technology whose advances are outstripping our ability to determine their clinical usefulness
- a great deal of redundancy associated with IT systems that cannot “talk to each other”, and with healthcare providers who cannot access existing information (lab tests, imaging studies etc) and who opt to repeat the tests instead
- a liability environment that fosters the practice of defensive (AKA C-Y-A) medicine
- a labor environment that demands that a physician business owner be savvy about handling employees
- declining reimbursement to physicians and hospitals for services rendered, with promises of further cuts
- a reimbursement model that rewards doing more (i.e. procedures) and ignores the value of thoughtful deliberation after in-depth discussions or of prevention education
- direct-to-consumer marketing tactics by some of the most profitable entities in healthcare — pharmaceutical companies. Now even medical device companies (as seen on TV) are getting into the act
- a huge decline in the numbers of physicians who are opting to become primary care physicians, with an impending shortage
- a growing physician disillusionment with and abandonment of clinical practice
- a demanding public that has grown accustomed to any and all care at whatever cost (okay, so I don’t have a study to prove this but I know this in my bones!!)
- unrealistic expectations by patients and often doctors (those ones guilty of flogging the patients as they totter towards death) at the end of life. Again, I know this first hand from my days on our hospital Ethics Committee.
- oh, yes … and what about those insurance company and drug company profits. Did I mention those?
I am all for the profitable existence of every item on this list, providing it adds value and furthers the goal of delivering appropriate timely healthcare to all who need it.
So I say to each and every “business component” of our healthcare system …
Yes, to entrepreneurial physicians who run savvy, customer-friendly practices and who invest in staying up-to-date with the latest proven thinking and treatment options
Yes, to hospitals that house and treat the ill in a dignified manner
Yes, to lawyers who provide excellent service to both physician and patients when it is truly called for
Yes, to technology that enhances productivity, helpful communication, and optimal health
Yes, to insurance companies that honor a mission to protect those who’d be otherwise unable to pay for their health care
Yes, to patients who recognize the need to invest in their health by wearing helmets, giving childhood shots to their kids, and tossing the cigarettes. And who understand that sometimes tincture of time, not antibiotics, is the cure!
Yes, to pharmaceutical companies and medical device companies that compete to develop and deliver valued-added therapies
Yes, to physicians, patients and families that respect the trajectory of life, fight valiantly to save it when appropriate, and give terminal illness its due honor when the time arrives
Each and every one of you deserves to win.
Okay – now maybe I am the one being simplistic!
Economic system in which goods and services are exchanged for one another or money, on the basis of their perceived worth. Every business requires some form of investment and a sufficient number of customers to whom its output can be sold at profit on a consistent basis.