An investment banker recently told a doctor, “I’d love a job where I didn’t have to constantly think about money.”
Oh, how wrong he was.
In a recent essay in The New York Times, cardiologist Sandeep Jauhar talks about the difficulty divorcing revenue from medical decision making. While moonlighting, he writes that, “It is hard not to order a heart-stress test when the nuclear camera is in the next room. Palpitations? Get a Holter monitor — and throw in an echocardiogram for good measure. It is not easy to ignore reimbursement when prescribing tests, especially in a practice where nearly half the revenue goes to paying overhead.”
But despite the fact that more doctors are pursing MBAs along with their MDs, the majority willfully remain distant from the business side of medicine. For the idealistic few, or for those who feel that patient care is the only thing that matters, the business of medicine has created, what Dr. Jauhar refers to, as a “a palpable sense of grieving.” Indeed, as one cited physician comments, “You can’t survive with your head in the clouds.”
So, can you really separate the businessman from the doctor? Not in American medicine.
Related posts:
- Doctor as businessman
- Average salary of a solo primary care physician
- Baseless medical quality efforts
- Can doctors resist the temptation of money?
- Doctor salaries: The free-market experiment
- The Medicare cuts are looming
- Should a doctor be board-certified?
{ 1 trackback }
{ 11 comments }
This is such a tragedy.
I am a Emergency Physician, the son of a General Surgeon. Over the years I have watched my father– a very good man who loves his patients and his craft– be taken advantage of by unscrupulous HMOs, administrators, and insurers.
Younger physicians know that practicing medicine these days without business awareness is not only unprofitable, it is dangerous and leads to career destruction.
It is sad that it has come to this. A group of physicians who, like me, have are very disturbed about this change, has developed a conference to help physicians learn how to use their medical training to adapt to other career areas. Details of this event can be seen on http://www.MedFusionConf.org .
Medicine as my father knew it is dead and in it’s place is a bureaucratic nightmare by the same name.
I believe that there is a difference between a physician who runs the business of the practice and a businessman. The physicians, vast majority of them, are not business savvy. They are not good about understanding the profit margins etc… They do run the practice business as they have to pay the bills. Independent practices have no clout in negotiating with third party payers.So it is getting paid whatever the insurer pays for one’s work. As time has gone by, some of the physicians have understood that ordering and performing some of the ancillary studies will augment their incomes. Don’t forget that Stark laws prevent you from doing this carelessly.
I don’t think this is true in all health systems. At Intermountain Healthcare (okay, they’re my employer so I’m biased), I see the health insurance arm and the health provider arm working together to lower costs and improve outcomes. Doctors, researchers, and health insurance representatives work together in clinical teams to implement goals in each area of medicine. And patient education is a big part of it (okay, I’m a medical writer and that’s my job, so I’m doubly biased).
Majority of physicians no matter where they work care about patients but private doctors have to be aware of business part as well. I think Private physicians generally are acutely aware of profit margins and they need to be savvy to improve their bottom line. I know private specialists who pick every single new referral even when they have coverage on weekend because they get better billing on new pts.If there is incentive for quality over quanity it will benefit everyone involved, though tough to measure must be tried. Bundled payments may address some of this drawback.
I don’t trust doctors to do what’s best for me. How do I know if I really need that surgery or my doctor is trying to increase his bottom line?
There are forces at work that will drive many physicians out of medicine and most certainly dissuade many talented young people from careers in medicine.
Is there any medical situation on the planet where business decisions aren’t considered. Come on.
UK physicians are private. Same as Canada. They are their own business. There are medical services that are rationed in their system. The physicians rationing would be free to provide the services for free, I’m sure. That would help to shorten their waiting times.
Well, until they go bankrupt.
Nevertheless, the decision to arguably undertreat in a system like the UK or Canada, where someone is put on a waiting list, is every bit as much of a business decision as a USA (Sandeep Jauhar) decision to arguably overtreat.
Kevin,
And, I thought all those extra tests were ordered because of “defensive medicine.”
Apparently, you only peddle that little lie when medmal reform is on he agenda.
Truly a very sad reality that cuts deep into the heart of the practice of medicine, in addition to bad news for patients.
The money-seekers are everywhere, behind every bush. They masquerade as regular doctors, usually claiming that they just need to house, feed, and clothe their families. Yeah, right.
Yet, once you dispense the money to them, they surreptitiously divert the spoils, spending it all on attorneys.
The attorneys tell the doctors that they just need to house, feed, and clothe their families with all that money.
Yet, once the doctor gives them the money, they go and spend it all on preferred shares of stock in medical insurance companies.
The insurance company buys the hospital you work in, then the building that you live in. Now you can REALLY speak up at work about all those issues of quality and fairness that make your conscience cringe with shame.
There’s nothing like a free market to “clean things up”!
The funny thing is these should be boom times for the American physician. The largest and wealthiest population bloc in our history is getting ready to need a lot of care. If physicians had a different payment model that rewarded them for their time, recognized degrees of skill, etc. it would be a wonderful, wonderful time financially to be a doctor.
Instead of revamping their payment model though, physicians and their lobbyists spend the majority of their political energy attacking lawyers and as the self congratulatory post (which you can’t comment on) from the AMA a couple up indicates, rearranging the deck chairs on the sinking ship that is the last vestiges of free market healthcare in the US.
“A fanatic is someone who redoubles his efforts long after he has forgotten his aim.”
Comments on this entry are closed.