We have to ask ourselves how are we going to take care of 32 million more patients in 2014 with a limited number of physicians to care for them. Better yet, how are we going to do this and save money doing it.
Thanks to our central regulators, they have already figured out how to do this: forced productivity. The term itself brings to mind images of outer Siberia or Chinese sweat shops. Lower costs and expect the workers to do more to make the same income. Perhaps you haven't heard this term in our President's health care reform speeches.
But it's out there as a lynchpin in the brave New World of medicine. I heard this term listening to a recent lecture by banker Steven Lipstein, the new Vice Chair of the Board of the Patient Centered Outcomes Research Institute (PCORI) established under the Patient Protection and Affordable Care Act during a recent lecture at our institution. He is also President and CEO of BJC HealthCare in St. Louis, MO who also serves as Chairman of the Board of Directors of the St. Louis Federal Reserve Bank.
But as I listened to Mr. Lipstein I wondered, how and when will forced productivity end?
How much forced productivity can doctors tolerate before they snap. How many hours can they endure when no workday or geographic restrictions are in place for them while residents and medical students saunter home after an eight-hour work day? How much forced productivity can they endure to repay their huge medical school loans?
Most importantly, what debts are incurred by "forced productivity gains" to patients? If patients think their doctors are busy now as they stuggle to get an appointment or feel rushed when the do get an appointment, just wait.
Mr. Lipstein understood the principles of the new health care climate well when he explained how we got to where we are today. What he doesn't understand at all, however, is the unintended consequences that are likely to occur as a result of these changes.
You see, doctors don't keep bankers' hours.