Blog | Tuesday, September 20, 2011

Doctors as laborers


Thought question: Who does your doctor work for?

You, right?

But does your doc work for herself or is she an employee? If the latter, is she an owner/employee, or just a hired gun?

You may have read elsewhere that doctors who are in business for themselves, a proud bunch, are finding it harder to survive in the highly competitive, costly and increasingly burdensome health care industry.

Flat/decreasing revenue + rising overhead = burnout and/or business failure.

Due to this equation, as well as generational shifts in how doctors are choosing to structure their lives and practices, more doctors than ever (especially those in primary care fields like pediatrics and both internal and family medicine) are taking on the mantle of employee.

And given current unemployment numbers, we're darn grateful to have jobs, and well paid ones at that.

Yet with the security of a job with salary and benefits comes a loss of autonomy, which is one thing if you work for a medical group or a hospital, which have the resources for marketing and infrastructure.

But what if the corporate boss is an insurance company?

United Health, among other market-based health insurers, is gobbling up doctors' groups to in an effort to deliver more cost-effective care to its insured patients by "managing care on the front end."

Optum, a United division, made a big splash last week by purchasing the biggest independent physicians' group in Orange County, California, in the largest such deal to date.

"A price was not disclosed," reads the Wall Street Journal article on the announcement.

I'm all for practicing the best possible medicine in the most cost-effective manner, but to me this gives too much leverage to the purse at the expense of the professional.

And where does the patient fit into all this wheeling and dealing? What about choice? The freedom to choose where you go to the doctor? How can you be certain your doctor is working for you when there are corporate dicta to control costs?

Increasingly, I worry that doctors are simply a "means of production" in the world of corporate medicine. This must be why those yeoman docs holding out in private practice continue to buck the trend.

This post by John H. Schumann, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.