The last couple of decades have seen a dramatic shift of power and clout away from individual physicians and towards administrators and the business side of health care. In many ways, physicians have nobody but themselves to blame collectively; because for any large and respected group of people to surrender so much autonomy so quickly, a lack of strong leadership must always be a factor.
So many different reasons for this sea change can be discussed, but the consequences are very palpable. To name but a few, we’ve seen the relentless push towards consolidation and mass employment of physicians, a rise in mandates and bureaucratic requirements, and a general explosion in the number of administrative folks while the number of physicians appears to be shrinking! Then there’s the more subtle changes that the medical profession has also allowed to happen right under their noses, such as the refusal of many in the hierarchy to even call doctors by their true job title anymore — instead labeling them only as “providers” (a subject I’ve written about including an open letter to the AMA and all State Medical Boards).
Speaking as someone who maintains a large network of physician friends and colleagues across the country, some of the stories I’ve heard about what happens nowadays are astonishing. Fortunately, after a few bad experiences, I’m now part of an organization where the relationship between physicians and administrators is probably as good as it can be. But from what I see, this is a rarity.
I relate one recent story in particular. I have a very close friend in the Midwest who is quite a brilliant doctor. He went to a top US medical school and got stellar USMLE scores. I’ve known him for years and am proud to have trained with him. He is sub-specialty board certified, but decided to practice hospital medicine.
He told me that his group, which is essentially run by non-clinicians, is completely (and unsurprisingly) focused on the bottom line only. Administrators aggressively monitor their physicians’ whereabouts and try to review all of their patient interactions (mostly how it pertains to billing). To cut a long story short, he told me that the administration for some reason or another wanted him to round first on a particular floor. He didn’t think it was the right thing to do for patient care (apparently another floor frequently had patients who required closer and more immediate attention), and it culminated in him basically being scolded by a 28-year-old MBA who informed him that he had to round on that particular floor first, like it or not. Needless to say, he didn’t take too kindly to this interaction and that particular experience persuaded him that the time was right to move on.
This story bothered me on multiple different levels, as I’m sure it would any self-respecting physician. First and foremost, how did the medical profession surrender so much to the business of medicine that a situation like this could happen? I wonder what our more esteemed colleagues in perhaps their 50s and 60s would have done twenty years ago if a 28-year-old MBA had dared tell them where to round first? Secondly, how did that young man feel so empowered to scold a highly qualified physician and feel so convinced that “he was the boss”? And thirdly, perhaps most worryingly, is this the future of medicine in the United States? If so, is there any way that physicians can wrestle back a bit of control over their own profession to avoid situations like this becoming the norm? Because if we can’t, and the practice of medicine is no longer led by doctors, it’s not only the doctors who lose.
Patients will too.
Suneel Dhand is an internal medicine physician and author of three books, including Thomas Jefferson: Lessons from a Secret Buddha. He is the founder and director, HealthITImprove, and blogs at his self-titled site, Suneel Dhand.
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