Friday, November 22, 2013

When The Carrot Is Removed From the Stick

The field of medicine is one of the most rewarding occupations out there.  Few occupations allow such an incredible opportunity to directly impact the life of a fellow human being and see the amazing results of something you did.  Few occupations are allowed inside the most intimate and vulnerable moments of the human condition.  In a word: amazing.

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.



Anonymous said...

I'm afraid we're still not even at the tip of the iceberg. Just think, 16 percent of this country's economic activity...everything having to do with delivering healthcare and insurance, is under the thumb of federal bureaucrats. And they have yet to fully develop the site, and they knew it when they rolled it out.
There is a theory that is growing in sentiment that this monstrosity was never meant to work, that it was set up to fail in the first place knowing the failure would create such chaos and anxiety in the citizens' lives, so much so that citizens will actually demand a single payer system which is what the powers that be want, but knew people would rebel too much if they implemented it. The President is on tape in an interview stating he prefers single payer. It would not surprise me at all if the above theory were true. It's pretty much how big government operates.

Unknown said...


I think also what happens is that the doctors so taxed send their own children to dental school or into specialties that do not have to take care of sick people. Look for a specialty in Preventive Medicine or Hospital Liasons to come soon.

Anonymous said...

Wes, a not uncommon retort to be found on comment sections of various blogs is for physicians to quit "bellyaching" and "get over it", etc. If it remains (as it once was) a wonderful career, then how does one explain the FACT that a significant majority of physicians advise their children to walk, no run, from a career in medicine? An incalculable investment in time, sweat, and capital to end up a powerless "provider". Where's the logic or sense in that?

And you are correct in noting that the system still works because physicians have mostly "remained true to their calling". This is precisely what Ayn Rand alluded to by the term "virtue". In Atlas Shrugged, a fictitious neurosurgeon used that word to describe a quality physicians were OBLIGED to possess in order to continue practicing, despite enormous pressures exerted from seemingly every direction. So what becomes of the Obama-Emanuel dystopian vision when that virtue is withdrawn, as it will be? Not by malice or sloth, but by an exhaustion of the soul.

Anonymous said...

I'm quite willing to subsidize the education of doctors. (I'm funny that way; I'm a liberal.) I'm also happy to help pay off their student loans. (Again, we're funny that way.) In return, we'd probably need a deal where a new doc would practice for a couple of years in a rural area. I also am happy to pay GPs and other docs at the low end of the pay scale more. (Yes, HORRORS, through government programs!) So how about it? You've got a wonderful career (your words), as an American doc you earn more than any other country's docs, and specialists are generously paid. Can we make it work? If docs are in the top 20%, is it worth it? If not, I have little sympathy. Go work where there is enough money to make your life worth living - in the financial markets. I'm tired of the threats.

Anonymous said...

Oh yes, as to single payer... The commenter above may be right. But it's called unintended consequences. And I'll LOVE the outcome. You guys yell, and scream, and threaten. Meanwhile, folks have learned a lot about how pivate insurance (doesn't) work, and the outrageous cost of healthcare. If ACA fails, next step = single payer. The old system is unsustainable.

Anonymous said...

Consider the physician employers of late--hospitals. They just experienced a 2% sequester cut this year which coupled with next years cuts and expected penalties will result in service line elimination and streamlining--read layoffs.
The hospitals were promised more volume from insured Obamacare patients vs. the uninsured and resultant cost shifting. I am beginning to believe that there will ultimately be less people insured as they deem the price tag too high e.g. for every newly minted Medicaid patient there will be 10 less BCBS patients.
The stick is coming to the hospitals our employers.

Anonymous said...

Watch Vermont. Single payer will be enacted in 2017.

Docs in US are highest paid in the world-by far. Has anyone asked how they manage and US docs can't? Are they leaving their profession?

Anonymous said...

Regarding european physician reimbursement, the pay reported from the hospital/government is dwarfed by the private patients they see on the side away from the social system.
It's just a two tiered system in Europe exactly where the US is heading, also.

Anonymous said...

In a true free market in a country founded on liberty, on freedom, government is supposed to uphold and protect the individual's freedom to make voluntary transactions with another individual. Government has no business dictating prices, the market/people do. As it is government/corporate collusion creates unsustainable "too big to fail" monopolies which dictate who delivers the best product at the best price. Government/corporate collusion has created the whole economic mess, it always has, and now claim to be "fixing" the problem they themselves have created through their collusion. Prices go up, quality goes down.
I have long since come to the conclusion
we were sold out decades ago, that none of the elected work for us. Government dictating the healthcare and insurance business is laughable, and the joke's on the middle classes, working poor and the elderly.
Land of the free? Where? Because over the decades, this country's become FUBAR.