Race to the bottom: The myth of low-quality care in America


The McDonald’s cheeseburger is an icon of America. Admit it, you know you love one. A guilty pleasure to say the least, but as far as cheeseburgers go, it is far from the best. In reality, if you were to taste test all cheeseburgers, the McDonald’s burger would probably rank near the bottom. The beauty is that no one cares, and they sell these things by the millions. Why? Because they only cost one dollar.

Value is a two sided coin; cost and quality. We tolerate poor quality if the cost is low, and we will pay high prices for something we consider to be a premium. The problem comes when there is a mismatch.

Do we really have a quality problem in American health care, or is it really a cost problem? Health care costs are astronomical, with the United States spending far more than any other country without better results. Everyone knows this. We need to correct the mismatch.

The problem is that we already provide excellent quality of health care. You can get the best health care in the entire world in these States United. We have the best doctors, the best medical schools, the best researchers. People from all over the world want to bring their tough cases to this country because they know the U.S. is the best.

It just costs way too much money.

Why then are we always discussing quality of care? Where did we come up with the idea that the front line health care providers are the cause of our quality/cost mismatch? As if only those doctors stopped providing substandard care, then everything would be OK.

The response from our government has been a never ending train of “quality metrics.” Any analysis of this system reveals it’s clearly about cost, not quality. The government has created a zero sum game, forced every physician in the country to play ball, with the final result being a dramatic reduction in reimbursement for care, claiming that it is because physicians are providing poor quality.

Discussing the problem in terms of low quality puts the blame of a high-cost health care system on physicians, and the myth has serious negative consequences.

First of all, physicians are a small percentage of the absurd cost of our healthcare system. Pharmaceutical companies, large profit driven hospital systems, the health insurance industry, and plaintiffs attorneys are the main contributors of out of control costs. Focusing on physicians is missing the forest for the trees. Go look at your health care bills. The physician charges are usually the smallest, and often quite reasonable.

Secondly, forcing physicians to focus on meeting “quality” metrics ironically leads to lower quality care. In Emergency medicine, quality has been erroneously equated to speed. According the the government, the faster I see somebody, and perform all of the necessary computer clicks, the higher quality of care I am providing. In my experience, the opposite is true, seeing too many patients too fast equals mistakes.

Most importantly, the creep of paperwork and regulatory burden associated with these metrics has turned practicing medicine into a miserable profession. I am just finishing residency, and by all accounts, should be entering my prime working years, and yet all I can think about is the day when I only have to work a few shifts every month. Having finished this long journey to becoming a physician, my dream is to barely work as one. This sentiment is shared by a large chunk of my generation. We are not lazy, or entitled. We are just miserable. In these days of physician wellness and burnout, the obvious cure is the one doctors are most likely to seek; just stop working.

If we keep this up, twenty years from now, when there aren’t enough physicians willing to put themselves through the gauntlet of practicing medicine, this country really will have a quality problem.

Eric W. Toth is an emergency medicine resident.

Image credit: Shutterstock.com


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