Saturday, March 24, 2007

Traveling Salesmen

With the advent of the Electronic Medical Record, physicians have become the traveling salesmen for hospital systems.

In earlier days, it mattered that you were near your records, so you could consult them to review critical information from earlier treatments and review response to therapies of your patient. Now, with the advent of the Electronic Medical Record, it matters little where a physician is located – he can instantaneously review his patient’s medical record, xrays, EKG’s and a host of other tests anywhere there is internet access. Bills are submitted for reimbursement before patients leave the operating room. Information moves at the speed of light.

Hospital systems, in the era of declining reimbursement per patient visit, realize that growth requires expansion: increase the numbers of patients seen in your system to offset the decline in reimbursement. Initially hospitals responded by increasing office hours to the more convenient nights and weekends – marketing their efforts as “responding to the patient’s needs.” Certainly, this effort was welcomed by many of the busy patient professionals with insurance. It was a win-win for many patients and hospitals alike. Doctors, too, could see the increased revenue by working more “patient centric” hours – but at a price to their own family lives.

Now that virtually every daylight hour is covered by clinics feeding hospital systems, a new tactic emerges to continue growth – expand geographically. For now, doctors can work at multiple geographically separate facilities and have access to all of the information they need. In fact, many are encouraged to open new clinics farther and farther from the Mother Ship in an effort to reach the health care system’s tentacles into ever-expanding regions. The consequence? Doctors cannot be in two places at once.

When a patient at Location A has a problem after a procedure or treatment and the treating doctor is at Location B, the treating doctor must rely on a colleague to manage the issue until he can return. Doctors, then, become interchangeable to the patient. And while the professional aspects of what we do remain important (as do our professional identities), the sad reality is that we are becoming interchangeable commodities in the health care system.



twilite said...

True but sad indeed! "...we're becoming interchangeable commodities in the health care system."

Anonymous said...

Dr. Wes, in a post I made over a year ago on hospitalists, I made exactly that point - that physicians are not interchangeable. When patient care continuity is so badly broken that even the physicians begin to see themselves as "interchangeable," then we know that healthcare truly is in an ever deepening coma.

We just have to hope that the coma doesn't turn into a "persistent vegetative state."