Someone recently accused me of being blindly pro-physician because I didn’t jump into a chorus of condemnations that were being aimed at doctors. Frankly, it didn’t shock me. In the 40 years I’ve worked with physicians, the respect and admiration for members of the medical profession have deteriorated badly.
Admittedly, many physicians are not immune from the siren song of big money, so the public’s anger over a notion of money-driven doctors is understandable. Witness the streams of newly-minted physicians electing to pursue high dollar specialties over primary care. We have maintained a free-for-all payment environment that makes it easy for physicians to generate big bills full of myriad services. Bills today are longer, less transparent and contain bits and pieces of goods and services previously not itemized and charged.
There are well-publicized, troubling stories about doctors who expose patients to unimaginable harms in the pursuit of profits. These are audacious acts of greedy individuals lacking a moral compass. It is unfortunate that these predators exist and give the profession a black eye.
Untold stories garner less attention – stories about doctors supremely frustrated by impediments to good doctoring. Many of these doctors champion health care that would dial down the hyped obsessions with premature, unnecessary and wasteful care. I work with some of them.
If costs and confusion in our healthcare system are targets, a spotlight should be focused on businesspeople who have seized control of major hospital/health systems and run them like manufacturing companies. Theirs is a domain of maximized profits, efficiencies and peak productivities. In the process, physicians have become cogs in the business machinery. One satirical commentary recently reported about a physician who happened to read a hospital executive business manual focused on “controlling” doctors. Maybe satire? Maybe more truth than satire?
What resonates throughout the healthcare system is a feeling that doctor-patient relationships have been marginalized. Who hasn’t felt that their doctor entered the exam room with a stopwatch? Patients don’t like it – especially older patients who might have a list of ailments to address. Worse, there are doctors with whom patients have never had the briefest of interactions, yet who bill patients vast sums for services delivered while the patient was unconscious. Yes, it happens and there are companies out there that teach doctors how to do just that.
Good doctors want more time for their patients. They don’t want more paperwork (hello ICD-10), efficiency experts running their days or hospital employers leaning on them with production quotas.
Good independent doctors want a fair shake when it comes to insurance reimbursements, not meager amounts compared to large practices with plum contracts. And so important, we need to find ways to allow intuitive primary care physicians to be thorough, comprehensive and paid fairly when treating patients who come to their doctor’s office with a list of medical needs.
Then do we wrest control of our healthcare industry from the profiteering executives who execute business models that penetrate and saturate our neighborhoods and lives leading to cost proliferation? To whom should control be given?
Having advised physicians for a number of years on matters financial/organizational, my first thought would be to avoid turning the wheel over to them to run major systems. Medicine is their forte, not running business empires. Put doctors in charge of patients time and quality care and reimburse them fairly. Most doctors afforded sufficient time with their patients, less bombarded with paperwork and paid rightly for the time and the years of work it took to get there – those will be happy doctors.
Who then? Perhaps somewhere in the fictitious middle lies an evidence-based system that is cost-effectively administered, allows quality doctor patient interactions and pays well.
Maybe that’s what Physicians for a National Health Plan are talking about.