Recently, the New England Journal of Medicine published a perspective by Lawrence Casalino, MD titled, “Professionalism and Caring for Medicaid Patients – The 5% Commitment.”
In the piece, Casalino argues that physicians should commit a portion of their practice to the Medicaid population as a matter of professional obligation. Yet this got me thinking: if physicians don’t respond to the professionalism argument and, instead, insist on being completely market-driven actors, then how can we reasonably lament our loss of public stature?
There was a time when the professionalism in medicine was sacrosanct. I recall a conversation I had with one of my gray-haired mentors from medical school — 20 years ago at this point — describing how in his day, practically all doctors chose to treat poor patients. They considered it to be part of their duty and a way of giving back.
The inevitable transition of medicine from a profession to a business has some clear benefits such as increased attention to outcomes, better access to capital (and healthcare IT), and focus on efficiency (as well as allowing doctors to, well, be doctors), but it also has consequences. Among them, is the continued decrease of physician stature in the public eye. It’s true that much of this transformation has been out of our control, but the end result is the same.
I would argue that one of the main reasons that the public accepts high incomes and prestige for doctors is because we do have a core value of professionalism. Sure, there is recognition of the sacrifices we make to become and practice as physicians, but many others in the workforce sacrifice a great deal and don’t have nearly the same respect from the public or our high average income.
In the eyes of those who hold this view, every dollar that goes to a doctor is a dollar that can’t be used to pay for patient care. If we squander our professionalism, the tide can turn quickly and lead to even greater downward pressure on overall reimbursement.
This leads me to my final thought: Perhaps adding a few more Medicaid patients to the patient mix is smart business? It may be if physicians are thinking long term and not next quarter. If we don’t, we may lose a lot more than lousy reimbursement from one or two patients every few weeks.
Peter Alperin is a healthcare technology and data analytics consultant and former vice-president, medicine and products, Archimedes. He blogs at The Doctor Blog.