Why does Ezekiel Emanuel have such a low opinion of physicians?

A study in JAMA suggested that physicians feel that other players (lawyers, insurance companies, hospitals, etc.)  are more responsible than doctors for reducing healthcare costs.  Furthermore, they are hesitant to promote reforms that eliminate the current fee for service payment system.

Although I would bet the no one would be surprised by these findings, a scathing editorial by Ezekiel Emanuel and Andrew Steinmetz caught my eye.  Before I get to the particulars, I would like to make a few (hopefully mostly uncontested) observations:

1. Physicians are some of the most educated, hard working individuals in American society. Very few professions require a four year doctorate, plus a minimum of a three year apprenticeship.  After finishing our training, we have long hours, take phone calls over night, and work many weekends.

2. People, by and large, don’t go to medical school to make a fortune.  There are many other professions that are more economically worthwhile with less debt incurred. Based on the GPA requirements, these applicants could likely choose almost any profession.  Medicine is a passion and calling.  Those who do not feel so drop clinical practice fairly quickly.

3. The daily job of physicians is to investigate, consider, and choose between incredibly complex and different avenues, and then take action.  We are trained to see the subtleties in both the written word as well as during patient presentations.  This is a thinking man’s sport.

So when a large majority of educated, capable, and thoughtful people proclaim an opinion, one would think it would be wise to pause, consider, and evaluate before wholeheartedly dismissing the group as a bunch of weenies.  Unfortunately, Emanuel and Steinmetz think differently.  They proclaim:

The findings … confirm this ingrained human behavior by showing that physicians are hesitant, if not unequivocally opposed, to taking bold steps to re-engineer incentives in the system — steps that may well have the most meaningful effects on controlling costs ...

I couldn’t agree more. Yes, thoughtful physicians who have been led astray before, are not jumping into the arms of governmental change.  Let us ponder a few questions.

1. Have any of the finished Medicare demonstration projects ever had positive results?
2. Has pay for performance in the past, on balance, shown a financial or quality of care improvement?
3. Is there any proof that ACOs or PCMHs will improve the quality or cost of care?
4. How is the government doing so far at balancing the budget in general?

As physicians we learn to use scientific evidence to support our theories.  We have been burned time and again in medicine by using logic above data.  After careful consideration, moving forward “boldly” but foolishly may do more harm then good.  Ezekiel’s fantasies about healthcare are unsubstantiated.  Show us the data, and we will follow willingly.

The editorial continues:

This is a denial of responsibility … Of course, physicians do not want to be blamed for the country’s major problem. But can they really be both the captain of the healthcare ship and cede responsibility for cost control to almost everyone else?   Ultimately, what this survey tells us is that physicians acknowledge that health care costs are an issue, but they are not yet willing to accept primary responsibility and take definitive action to lead change.  The rejection of transformative, bold solutions to address the seriousness of the cost problem is indicative of much bigger problems ahead of we don’t start seeing more leadership from the physician community.

It’s simple.  If you want us to be captain of the ship and take on all the responsibility, then you have to actually listen to our opinions.  Rehospitalization policies, pay for performance, and meaningful use are all untested ideas that have made both our, and our patients’ lives, miserable.  EHRs have never been shown to improve quality or cost of care.  Study after study is starting to show that rehospitalization rates are extremely difficult to modify.

Most importantly, our lives as primary care physicians have deteriorated greatly in the last two years.  The amazing amount of paperwork, the denials, and the computers are sucking our attention away from real life, difficult, patient problems.  Ask any patient, they will tell you that the office environment has deteriorated.

Finally, Emanuel and Steinmetz warn:

Unless physicians want to be marginalized — unless they are willing to become just another deckhand — they must accept and affirm that they are responsible for controlling healthcare costs.

I guess he doesn’t realize that we feel as if we have already been marginalized.  But “deckhands” we are not.  If we decide decide to jump ship, whose going to steer the boat?

Maybe Ezekiel Emanuel will.

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.

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  • ReepRN

    I’m thinking that administrators, lobbyists, device manufacturers, pharmaceutical companies, non-compliant patients, insurance companies…might have a wee bit of responsibility for controlling healthcare costs. Oh, and lawyers….legislators….government agencies…..

  • kjindal

    “I guess he doesn’t realize that we feel as if we have already been marginalized. But “deckhands” we are not. If we decide decide to jump ship, whose going to steer the boat?”
    Of course Ezekiel won’t. He’s already patting himself on the back for realizing long ago that it’s much better to be a critical overseer of actual practicing physicians, than to see & treat patients himself. The editorial made me cringe too – it’s unbelievable he doesn’t see his own hypocrisy. If he wanted to contribute, he could always see patients, at least part-time.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Great post. That little editorial rattled lots of folks, including myself, http://onhealthtech.blogspot.com/2013/08/new-medicine-first-show-me-money.html but for a slightly different reason.
    The only two things that surveyed docs seemed to be completely at odds with, were ending fee for service (i.e. corporatization) and outright rationing scenarios, which makes me wonder about the nature of the ship he wants staffed with captains.

    • openyourmind

      Give me a break – yes, doctors are the only “noble ones” who care about these things. Makes me sick.

      • Guest

        So what happened to you to make you so bitter and doctor hating?

    • rtpinfla

      Read your blog post. Very nice explanation of the issue.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Thank you.

  • ErnieG

    Excellent post. How are physicians responsible for controlling costs when medicine is now a big corporate business with the large players-gov’t, hospitals, pharma, insurance– determining value? Emanuel is more than ready to blame physicians for the future failure of medicine. How can a large large gov’t attempt at regulating health care succeed in reducing costs, when it can’t even balance a budget, nor pass a law that its own gov’t agencies are even capable of conforming with? I mean really, if gov’t agencies under executive control can’t conform with Obamacare, they get a pass…but everyone else?

  • Gibbon1

    Most shocking thing about healthcare is doctors appear to have no real idea how much the drugs, tests, and procedures they order cost,

    Seriously, a doctor can order a test to cover their butt and end up consigning their patient to eating peanut butter and jelly sandwiches for a couple of months, lose their car, or get evicted.

    Ever get an estimate from a doctor?

    • kjindal

      if a doctor orders, for example, an MRI then why shouldn’t the patient deal with their insurer & the MRI facility their insurer participates in to find out costs? The doctor may recommend a particular facility because he/she is familiar with them, but the insurer is the one who decides which one(s) the patient may use.

      • Guest

        Not everybody has (or wants) health insurance that pays for all routine care. And when you’re paying for your own care, out of your own pocket (or HSA, as the case may be), it’s frustrating to be expected to basically sign blank checks for anything and everything, and only find out how much of a hit you’re going to take AFTER the test or procedure is done, or AFTER you’ve showed up at the pharmacy and found out that the drug your doc prescribed is going to cost you a month’s rent.

        I do agree that it’s not really the doctor’s job to tell you what third parties are going to charge you for whatever tests/procedures/drugs he orders, but it should be easier to find out from SOMEONE, because the lack of price transparency is really frustrating. And doctors should probably have SOME idea about drug pricing, so that they don’t write really expensive scripts when there’s a cheaper one available, simply because they’re used to the fact that most of their patients have Someone Else pay for their drugs and so don’t care about cost.

      • Steven Reznick

        That makes sense from a financial perspective but different centers perform different quality of films. The center makes a difference.Often we will order a film which accompanies a patient to a specialist for review and we are told the cuts are not thin enough or the view isnt appropriate or that center’s machine’s detail isnt sharp enough and they then want to repeat the study. There certainly should be transparency and patient’s aware of the costs and pros and cons of one center vs another but who exactly should bear the cost of that. As for the question of the referring doctor benefitting financially by ordering a lab test or imaging center at one facility as opposed to another, the Stark laws long ago eliminated most of that passive income

    • Kristy Sokoloski

      Yes, I have gotten an estimate from one of my doctors before. And it’s because they were able to have someone get the information for me on cost and give me that information.

    • T H

      The reason I, as a physician, do not know the price of what I order for you, as a patient, is because I don’t know what kind of deals your insurance provider has made with 1. the labs, 2. the radiology groups, 3. the pharmacies, and 4. the hospitals. Each insurance has its own deals.

      I have enough to learn and know and sort through already. I provide the best, reasonable care I can. If I think of cost, it is in medications and prescribe off the walmart $4 pharmacy as a can and by prescription plan if I cannot – if you even know what the plan is and if the plan has bothered to send me an updated coverage list (which it hasn’t).

      Here’s my estimate: it’s going to be more than I want you to pay, more than you want to pay, and the insurance company execs are going to make more than you and I put together AND it is going to pay its dividends to stockholders on schedule.

      • Guest

        So you don’t deal with any patients who pay out of their own pocket? It’s almost like the whole system is set up to work AGAINST those who try to take direct responsibility for their own healthcare costs.

        • T H

          I work in an ER – even those who pay out of pocket do not pay me: they pay the hospital. Generally, it’s quite the premium.

        • drgn

          Now you’ve got it. It is incredible but unless you are part of an insurance that negotiates a lower fee, an individual is taken advantage of by the system and can pay quite a premium for services. The less you have, the higher the fee. make sense???

    • Guest

      Concur! I’m a physician, and I once asked for the price of a procedure (in case my insurance didn’t cover it). Not one person in the office could tell me. I told the biller “I just want to know if it will be $400 or $4000 so I can prepare.” No answer. Extremely frustrating.

      What rocked was that it ended up being covered by insurance and was a $20 copay. But why must it be a game of chance like that?

      • Mike Trene

        Imagine going in to a restaurant for a meal and their policy was that they wouldn’t tell you whether it was $10 or $10,000 until after you’d eaten?

  • Anthony D

    “Unless physicians want to be marginalized — unless they are willing to become just another deckhand — they must accept and affirm that they are responsible for controlling healthcare costs.”

    This happens when you have the media and a vast majority of citizens that believe that doctors are coldharded, greedy and only care about their bank accounts. Is it any wonder why were downgrading the medical degree and consider them as heels!!!

    So many will play the smallest violin for these healthcare workers!

    Plus, when you have a country that its run by the physicians rivals (lawyers), they feel they got them in the palm of their hands!

    • openyourmind

      Anthony,
      You have to realize that for years, doctors were marching around like they were someone special, barking at everyone, and acting immortal in general (all wanting to read the House of God or whatever that book is). This is not all of them – just too many. Well, patients are worn out with it. We are customers and they are service providers. They are going to give us our money’s worth or someone else is. They have had COMPLETE control of the system until now. So look in the friggin mirror. They had their chance and did no better than anyone else is doing. So it ain’t gonna hurt to let someone else take us the rest of the way down. The “physician led” thing is a crock. As I said, it’s BEEN physician led in the past and the only thing that accomplished was more “physician bread”. So, nope – no more doctors in charge – they had their turn.

      • buzzkillerjsmith

        Have physicians run the HC system into the ground? There is a good case to be made that we have. Greed has played a big role, but I would submit that tunnel vision has just as much to do with it. We focus on our patients, which is after all our job. We neglect externalities.

        Note that tunnel vision and the self-serving bias are big factors in many if not most difficult societal and even global problems. Perhaps we docs are above that? That’s laughable to this doc–and to you.

        It is the responsibility of society, with input from us and pts, of course, to set the parameters of medical care in this country.

        The real question at this particular time is whether CorpMed will do a better job than we did. That’s also laughable to me. And the pts are not in the driver’s seat any more than we are.

        • openyourmind

          Can’t argue with any of that. I guess we will see if someone else does a better job – they will have to.

      • Steven Reznick

        It may be an American Medical Association thing, it may be an American College of Physicians thing but the actual practicing physicians who see patients on a daily basis have been far too busy caring for patients to be involved in health care policy over the last 25 years. Yes they have written their elected officials and lobbied their county medical societies but for the most part they have been left out of the process. Health care has been changed for the worse by non physician middle men and women including insurance companies, employers looking for the elusive quality or more bang for the buck, the hospital industry, manufacturers of medical equipment and supplies and large pharmaceutical corporations. There have been physicians along the way who rode the economic coat tails of medical equipment manufacturers for their own personal gain but the majority of practitioners caring for patients day in and day out have had little or no input. The new health care bill was written by politicians, insurance experts, pharmaceutical executives , health care policy and economy gurus who have never treated a patient in their life and representatives of large employer based health care insurance providers . The same consumers who blame physicians might consider the last time they asked their doctor to alter the diagnosis on the fee ticket so that their visit was covered. How about the patients that want an uncovered unproven diagnostic test they heard about on AOL or Facebook or the nightly news and asked their doctor to put down a diagnosis they didnt have so the tests cost would be covered? I am not absolving hard working physicians from total blame. I am saying the dysfunctional system that has evolved has most of societies input.
        Ezekiel Emanuel gets press time because his brother was the White House Chief of Staff and the mayor of Chicago and his wife writes for the health section of the NY Times. I am sure he is a well meaning individual on salary at a university center and outside his own home never had to construct a business plan, deal with hiring and firing or overhead costs or day to day patient care in the office , the hospital and after hours?

      • PoliticallyIncorrectMD

        So, you start your argument commenting on the book you have not even read. Perhaps you can lead the system you don’t even understand. Who needs expertise, experience or education. Lets just point fingers and find somebody to blame (selfish greedy doctors). This will get us far.

        • openyourmind

          I don’t need to lead the system. I have EXPERIENCED it. I didn’t say you were selfish or greedy. I said you used the system to your advantage. AND, I’m not blaming you. You just want to be the leaders (AGAIN) and you cry on this blog about it all the time. Well, you HAVE BEEN the leaders and it got us nowhere. So your turn at bat is over. And concerning expertise and education you mention – my point exactly!! So you are the only one with those qualities because you made it through medical school? Who cares?! Tired of it! Nobody thinks you are as important as you do. There are plenty of others with more management expertise and other qualities that you do not have. So now, because you didn’t in the past, you HAVE to work with others. Sorry ’bout your bad luck. Your strutting around and blowing through patient days are over. You actually have to SIT DOWN and listen to people and their worries and troubles and treat them like human beings not human animals. Now I am not pointing the finger directly at you – just your profession. You have lost patient respect by your own hand. Own it.

          • PoliticallyIncorrectMD

            Next time your insurance company refuses to pay for a life saving procedure or medication you desparately need, you can thank your plan administrator with “more management expertise and other qualities that your doctor does not have”. But in the end, it is your doctor who will spend hours on the phone with your insurance to get things approved, only to be accused of not having enough time to listen to patient’s concerns.

          • openyourmind

            You guys and your tunnel vision. For healthcare management and planning, you aren’t the (only) qualified ones. Are you saying you are? A medical degree confers omniscience? I understand your hassles. I have them too in my life. Yours are no more important than mine. And I love how you always throw that “lifesaving” in there when there is nothing else to say. You doubled down with “lifesaving” and “desperately” (check spelling). If it is that critical and urgent, I will get it and it will be reviewed later. You make it sound like you are sitting on the side of the road with a giant cell phone contacting an insurance company while I am bleeding in a car and no one else can do it but you!!!! Ahhhhh! Enough with the dramatics. You guys aren’t listening. Sick of it. You always make it sound like you “just can’t win.” On phone with insurance company? No time for you? Spend time with you? No time for my family. Always something. Well, guess what, it’s always something with me too. I need more than 24 hours. You see me on here whining because of that? Nope. No one cares anymore about your poor busy day. We are busy too. You condemn any profession but yours and assume patients are children. The whole world isn’t listening to you anymore.

          • PoliticallyIncorrectMD

            You don’t want listen to physicians “whining” – do not come to the forum ran by physician for medical professionals. You do not like doctors – avoid them, get some be-your-own-doctor books, Google your symptoms, order any medication you want on-line from Mexican pharmacy, let the natural selection work.

          • openyourmind

            Thanks for the advice doc. But no thanks. I think I’ll pay you (or as you will whine, my insurance company will pay you) and you will just do your job and provide me a service. You have years of training and I think I will put it to good use. Yes, you are worth my money. Now just do your job. Thank you very much.

          • PoliticallyIncorrectMD

            Sorry, I am not a Psychiatrist.

          • Kristy Sokoloski

            As for your statement that no one cares about the poor busy day of our physicians, well, I have to tell you that there are people out there that do care. I am one of them. I care very much about how my doctors are feeling at the time I see them. I can see the fatigue in their eyes when it gets to a point where they feel like they are ready for a nap, or aren’t feeling well. They are human just like you and me. And because of that very fact, I will at times ask them how they are feeling and how their day is going. Just like when they ask me how I am doing (I know that they are asking this to see how things are going with treatments that I am on, but I also know that from the humanistic standpoint they want to know as well), I want to know how they are feeling as well because I genuinely do care about how they are feeling physically.

          • openyourmind

            Why? Do you ask your plumber this? the guy sacking your groceries? Are you so enthralled that you cannot see? Obviously they are human. They have always expected but don’t deserve special treatment. It’s just that now everyone is removing the scales from their eyes. And they are seeing. Doctors provide a service. Sometimes it’s lifesaving. Most times it’s not. It’s your job. Like I might clean a toilet, you might clean a wound. No gold stars. Just hunker down and do your job.

          • Guest

            Yesterday afternoon I brought sweet tea down to the workers who were fixing a broken concrete pipe in the drainage ditch at the bottom of my driveway, because it was so hot and they’d been out there so long. I also usually remember to ask my electrician (whom I see rather a lot of, living in a very old house with antique wiring that we’re gradually updating) about his wife and children. I’ve asked after the guy who delivers my dad’s oxygen before, when he’s looked tired and beat. And I also try to make a point of asking my doctor how she’s going, especially if I know it’s been a long day for her. I also brought her in some of my home-made organic dog biscuits when I’d heard that she got a new puppy. And…..?

            No, doctors aren’t gods. But they’re human, and it costs us nothing to treat our fellow humans with a bit of decency and kindness, no matter who they are or what their “station in life”.

            You’ll feel much freer and happier if you get that chip off your shoulder, I think.

          • ErnieG

            I think you opened your mind so much, it fell out.

          • openyourmind

            Again, diversion. No responsibility and no admission. Typical. And a predictable lame comment.

          • ErnieG

            Yes, and your comments are typical for a cretin masquerading as a sentient being- equating the relationship between plumbers and homeowners, and between physicians and patients. These relationships are governed by very different, legally established rules. You obviously believe you’ve been hurt by a physician, which has skewed your marbles. And yes, I am just as predictable as you.

          • PoliticallyIncorrectMD

            Bravo! Very funny!

          • T H

            I find your tag name ironic.

      • Kristy Sokoloski

        One of the reasons that it is thought that doctors have a “God” complex is because these same customers/patients are the ones that put them in that position to begin with.

        • openyourmind

          Holy cow – it’s still not the doctor’s fault! Now it’s the patient’s fault! Come on guys – this article really isn’t too far off. Entitled and afflicted. So revealing.

  • drgn

    Well in a way he is right. THe RUC panel of 27 specialists and 4 PCP’s elected by the AMA has been directly related to rising costs. But that is a serious minority of the rest of us that oppose that. See the Keppler article here on KevinMD if you haven’t already. A democrat Jim McDermott i believe is trying to address this and was making headway but no longer.

    Unfortunately, immediately after the RUC articles broke in the WashPost, WashMonthly and Time, Modern Healthcare reported that the AMA deployed an army of lobbyists to defend their policy position with Congress. Is Emanuel unaware of this?

  • suger

    I come from an educational background and spent many years in both private and public education. What I always find so interesting now that I work in the medical field is that all professionals regardless of their particular calling simply want to do what they went to school to learn how to do. For educators it’s teach and for physicians it’s treat patients. The problem is that the systems in which we provide these services are so complex and are run by highly paid administrators who work with vendors to provide the materials, buildings, financial structures, etc. in which to operate. If this post were on an educational forum you would hear the same mantra from educators…all we want to do is teach. On a medical forum it’s …we just want to treat patients. Unfortunately it isn’t as simplistic as that. When we educate the poor, or treat the uninsured it gets messy. When you are trying to raise educational standards across the board or elevate the playing field for medical care, for better or for worse it involves a cacophony of voices, opinions, and players. Teachers are in the same position as physicians. They work tirelessly for the good of those in their care, have very little say in what goes on around them, and always end up feeling compromised by the decisions that others have made for them. It is the unfortunate reality of working a highly skilled profession providing a service to the public that everyone is entitled to, and having it run by people other than those doing the work.

    • openyourmind

      And your work is just as important, perhaps more important, than a physician’s or other PCPs work. You teach for lifelong learning. Sure people are grateful when their life is saved. That is sometimes a single life-changing event. We forget to be AS THANKFUL OR MORE THANKFUL for lifelong life-changing events – a child having a clean toilet in school because of a janitor, clean streets because of a city worker, a clean patient because of nurse aide. No difference in importance in these wonderful people and a physician. They all provide life-changing services. Now, suger, unbelievably, the down votes will come pouring in because someone dares to compare one of these professions to a physician – or worse yet, disagrees and holds one accountable. It doesn’t matter. This blog is read by so many people; regular people. And they read, watch replies, feel pain, and have their “preconceived” ideas being reaffirmed by reading those replies. So I take the crap, but in the long run, it helps eyes open and the job ultimately gets done.

      • ErnieG

        Predictable, straw man argument from a self-declared martyr/victim
        who took one for the cause. The problem
        with health care is not about lack of gratitude, or determining social worth of
        humans. Physicians and patients are people, and just like some people can be
        a-holes, some patients and physicians can be a-holes, and I know for a fact
        that a-hole patients and physicians exist. You may feel the problem is that doctors are
        a-holes—but that is your view that I can’t change—but that is unlikely to be
        the cause of health care problems.

        The problem, as perceived by many physicians and sharp
        non-physicians, is ultimately about the relative roles of physicians, patients,
        third party payers, service providers, and government in health care. Many physicians are deeply concerned about the
        industrialization/corporatization of medicine, and how that is deeply changing
        the patient-physician relationship, something that did not start with
        Obamacare, but it clearly headed towards deeper change. Dr. Emanuel seems to believe that physicians
        have some responsibility for health care cost, (which may be partly correct),
        but assumes that they can somehow take lead of that. Rather than point out, as Ms. Gur Arie states
        in her blog, that physicians feel that that the problems with health care costs are
        more complex, he takes a pot shot. Hence, openyourmind’s rabid bites.

        • openyourmind

          You and I agree. It’s not the physicians for the most part. As a patient I see their unwillingness to “open their mind” and consider whatever alternatives are necessary to take care of me disgusting. Any discussion about getting care to people in whatever form is blown apart by self righteous physicians. I see a couple here who try to consider all the alternatives, but for the most part, if the doctor isn’t in charge, then the whole thing is completely unworkable. We have some kind of non-doc in our city that does a fine job. If the guys on here had their way that person would be run out of town on a rail, shot, hanged, who knows? That’s not sensible or normal. It selfish self preservation. Hence my rants. The “father doctor knows best” is tolerable or accepted anymore. You guy won’t work out reasonable solutions so I’m bitching about it. And making sense. To everyone but you. But I have a doctor. I love him, respect him, and am thankful for him. He knows exactly how I feel. And agrees. So that’s where I’m at. None of the doctors here give a crap. If I’m nice or nasty, if I don’t say things they agree with I will get blasted. So who gives a crap? I’ll just unload because it doesn’t matter anyway.

          • ErnieG

            So, like the Sith, you have revealed yourself…driven by some
            drivel about how no one gives a hoot, “so what the hell, I’ll throw a few shots”…
            a troll in guise of a knight. It is precisely because many docs give a hoot
            about what lays ahead that many physicians are deeply troubled about issues brought about by thoughtful bloggers like Ms. Gur Arie. You make sense to me, but only as patient that has perceived some type of wrong doing, or like a foaming dog makes sense—because he’s got rabies.

  • bill10526

    “Study after study is starting to show that rehospitalization rates are extremely difficult to modify.”

    The basis for the policy is that medical people game the system through readmission. This presumption of ill will is very popular; look at the claims that BP put profits over safety when BP worked very hard on safety.

    But it is patients and lawyers game the medical system through malpractice extortion; look at the breast implant debacle a few years ago. And the mandate of the ACA is needed because proplem like me will forgo insurance until they know they need care.

    The most extreme presentation of the scapegoating was the holocaust. But the same mechanism that permitted that disaster plays out every day in American culture. The current disfavor of capital punishment is all that kept 4 innocent men from being killed at Penn State in the community madness fueled by prosecutor misconduct, self serving media, and greedy lawyers.

    Our President, an otherwise good guy, has the sickness with his calling for accountability and his willingness to assume bad motives on how the Sandford Florida handled an obvious case of self defense. George W. Bush used this dark aspect of American culture with his calumy about saddam hussein having magic WMDs. And no-child-left-behind scapegoated teachers for educational outcomes.

  • Karen Sibert MD

    Another excellent post, Dr. Grumet! You’re entirely right about Emanuel. Witness the column he wrote last year in JAMA suggesting that medical school should be shortened. His goal, clearly, is to downgrade physicians to the level of mid-level practitioners so that the government can feel justified in mandating the practice of medicine by protocol rather than by educated medical judgment.

  • Leonard Kish

    Docs, for the most part, don’t control the business model of health care, which is what’s needed for change. While they may be willing beneficiaries of fee for service, it’s clearly the administrators who run the show. It’d be great to see the administrators, patients and physicians work together to figure out a business model that’s consistent for each stakeholder’s goals.