But medicine for people has quickly given way to medicine for business.
Business needs results. Business need productivity. Business needs profit. And profit in the increasingly competitive world of medicine is getting harder and harder to come by.
To assure these business needs, medicine has hired legions of support personnel. These include administrators looking for ways to remain "value-added," collectors to assure the cash flow, insurance plan negotiators to cut the best deal, quality assurance and safety officers (you can never be "too safe"), database operators adept in last-year's technology, concierges to make it all seem happy, survey takers to under-sample opinion, and negotiators adept at keeping the price spread.
To lower costs, patients are made outpatients, personnel ranks are thinned, and beds are closed.
Yet for the most part, it has worked because doctors have stayed true to their calling.
But what if that calling dies?
What if the insurances hassles grow too great or the income doctors receive fails to cover the cost of their education? What happens?
In truth, little right away. Given the time commitment, it's hard for doctors to pull the plug entirely. Many doctors don't complete their training until their early thirties, and by then, they likely have families and kids, and if they are lucky, a home. So they hang in there. They do the best they can. Like most Americans, the cut back, budget, and make do. But as their hours grow and incomes dwindle, some of the rose-color in medicine turns to grey. They still love what they do, when they can do it, but if there is less reward, there is less effort. For some, mediocrity will replace exceptionalism. For others unwilling to bow to mediocrity, the desire to stay late to squeeze another patient in dissolves.
This morning's revelation of the latest physician cuts proposed by the insurance industry should give us all pause, because if it's true, you won't hear a word from doctors.
You just might not be able to see one.