Maybe medicine isn’t really a business after all

Is anyone else frustrated with the business of medicine?  I guess that’s a stupid question.  But really, when you were training to become a physician, what were your goals?  For me, I wanted to have a career that was meaningful, interesting, and at the same time provided a good living for myself and my family.  Growing up, I was always told to strive to become a doctor or a lawyer.  Neither of my parents were either of these, but it was touted as the ultimate in success.  So that’s what I did.

I went through the brutality of med school, internship, nuclear medicine residency, and then radiology residency.  When I passed the boards and began practicing radiology, I felt like all of my wishes had been granted.  But as time went on, Medicare cuts (and the generally bad economy and higher unemployment rate ) were starting to have a huge impact on our bottom line.  In fact, since 2007, our revenue is down over 30%, and with no definite end in sight.

I also realized that a large number of the non-medical people we would meet through my children’s school were in business for themselves.  They lived in bigger houses than us, drove nicer cars, and did not have any of the financial concerns that we did.  They didn’t have to pay back any of the school loans that I owed.  They went on great family vacations that I could not offer my own family.  They could send their kids to more expensive schools than I could.

I don’t mean to sound ungrateful.  I still make a better living than most, and I am able to help people while doing it.  I am also able to do something I love, something that is interesting.  But from a financial and business perspective, it is not really what I had envisioned.  And speaking of business, try explaining the business of medicine to someone who is in real business.  Give it a try.

It goes something like this.

I work a job where I am the boss, sort of, where I can tell technologists what to do, but I don’t employ them.  So I can’t hire good ones and I can’t fire bad ones.  I am the expert on what is best for the patient, but I don’t make a lot of the important decisions.  I am paid for the work I do, but I am expected to provide a cost-effective, minimalist approach (crazy, right?).  I am required to provide care, even if the patient can’t pay for the service.  Oh, and the doctors who are on the medical staff must serve on the various committees, but they don’t get paid for the time, other than potentially in political capital.

Needless to say, I get extremely blank stares from others who know how to run an actual  business.

So maybe medicine isn’t really a business after all.

Geoffrey L. Fey is a radiologist who blogs at Radiology Review.

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  • guest

    Medicine is a business, all right. It’s just not a business model where the workers who do the actual work are making the profit.

    • Patient Kit

      That’s true of a lot of businesses — that the people who do most of the actual work, don’t see much, if any, of the profits. Personally, I don’t think healthcare should be, primarily, a business any more than education is (Through high school in this country, anyway, we do have a vast public education system). That doesn’t mean I don’t think doctors should be fairly compensated for the important work they do. But as long as our healthcare system is driven by the profit motives of insurance companies, pharmaceutical companies, hospital corporations and their investors, healthcare is a business in the US — a big business. And that’s not good for patients or doctors.

      • guest

        I couldn’t agree more. The other consideration is that our society has become so skewed that business owners hold a considerable amount more power than they used to, and so are able to treat their employees badly if they choose. In most other businesses, that’s just bad for the worker (and for society, but in ways that are too subtle for a lot of us to appreciate.) In the business of medicine, it’s bad for the workers but especially bad for the patient, which is tragic.

        • Deceased MD

          Why is it we’re the only ones that see this so clearly?

          • SarahJ89

            What I’m seeing is that doctors have been demoted to middle managers. The ones I grew up with were small business owners.

          • guest

            Actually in some healthcare systems we have been demoted to factory workers. Or indentured servants. Relatively well-paid indentured servants, but still…

          • SarahJ89

            Yes. The middle-manager thinking is because middle managers are held accountable but given little or no power over the very things that would enable optimal results. Sound familiar?

          • Deceased MD

            well put.

  • California Insurance

    Maybe medicine isn’t really a business!! Matter of thinking! Thanks Geoffrey for sharing such a nice article.

    • SarahJ89

      Yeah, I liked the out-of-the-box thinking.

  • Deceased MD

    that’s nice to hear that you think MD’s are thinking of the pt in Peru. What is it like there?

  • Deceased MD

    sort of a relief to hear that things may be such a struggle but at least not a business. Although I am sorry it is such a struggle to get the basic tools you need. I wish you the best and hope things improve. Do you plan to stay in Peru?

  • SarahJ89

    Thanks for joining in.

  • Deceased MD

    that’s beautiful!!

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