Friday, August 5, 2016
Why corporate health care may just be a temporary fad
As health care increasingly propels itself into the world of corporations and big business, it may seem like the practice of medicine has entered an irreversible new era. Gone are the days of good old Dr. Wilson in his solo private practice around the corner, loved and respected by all his patients and community alike. Nowadays it's all about mega multi-specialty groups, health care mergers, and hostile corporate takeovers.
Being someone who's quite middle of the road when it comes to politics, I'm not anti-big business by any means. Capitalism and globalization have produced innumerable benefits to mankind. Who can argue against companies like Apple, Microsoft and Google being an overall great positive for the world? But at the same time, that doesn't mean that every industry is as amenable to big business as others. The service industry is the biggest example. Humans being humans, we still crave uniqueness and personal relationships. This is something sadly lacking in the corporate world at large, where transience and temporary fleeting interactions are the norm.
Taking restaurants as another example, the most popular and loved eateries in any given town or city are seldom the big cookie-cutter chains, but the restaurants that are owned locally and provide their own special menus and exceptional service. The experiment over the last couple of decades of turning health care into a corporate and big business entity may thus be doomed to fail for a few reasons:
1. Doctors & Patients
This is often difficult for business majors and the corporate world to grasp, but there is a unique relationship that exists between doctors and patients that's outside the realm of the business world. When a patient has a doctor whom they like and trust, that's who they want to go and see. It wouldn't matter one jot if that doctor was wearing a white coat with a shiny corporate logo on it, in a swanky office building that has brand new paint, or whether they get given a slick customer service questionnaire to fill in afterwards. As long as they still get all the other services they need (referrals to the right specialists, timely tests and investigations etc), patients are only interested in seeing their trusted doctor. This being the very essence of health care in its purest form, i.e. the doctor and the patient, all else is up for debate.
2. Business and sensitivity rarely mix
Medicine is an arena like no other. It is a uniquely emotional field, where caring, compassion, empathy and a listening ear still mean absolutely everything. Business in general is not known for these traits, and as dressed up as one may try to make it—business is always about the bottom line. Therefore, unlike in other industries where it's okay and understandable to be worried about money first, in health care and the practice of medicine, whenever the bottom line is perceived to enter the equation—business will always be seen as the “bad guy”.
3. Clash with doctors
As much as the profession of medicine may have found itself in a position where it needs to collaborate with big business over the last decade (and in fact, often ruled over by it now), the truth is that physicians are a smart and dedicated bunch of people who deeply resent that this has happened. We are also well aware of the ethical conflicts that are inevitably created. Unlike in other fields, where corporate goals can align between management and the frontlines, doctors (barring a few unfortunate exceptions) will always be on the side of their patients and never fail to be their biggest advocates.
4. Patients will dictate what they like
As with any industry, it's the “customers” who show what they do and don't appreciate. The minute viable alternatives exist, and patients see an opportunity to be treated in a more unique and personalized way—whether it's direct primary care, a change in policy that allows small practices to thrive again, or a forward-thinking and committed group of local physicians who are bucking the trend—patients will flood to these practices in droves. Out will be the retail clinics and any organization which treats patients like a herd of cows.
5. A possible bubble
Not so long ago, I wrote an article about a 28-year old MBA who told a physician where to round first. The article went a bit viral, and clearly resonated with thousands of doctors. One of the most popular comments to the article, was the theory that health care was in a bubble—leveraged on trillions of dollars of debt, similar to the housing market before 2008. Therefore, when that bubble bursts, we will be faced with absolutely no choice but to go back to medicine in its purest form: The doctor and the patient. The interaction that is most important (both in terms of medical care and also economically).
Hopefully medicine sees a big swing of the pendulum back to where it should be: A lifesaving service provided by dedicated and highly educated professionals, who direct health care leadership and policy. All while being in control of their own profession and putting the patient first. Because when you dissect everything down and really think about it, it's not just the ace of spades that the doctor and patient are holding, but the entire deck.
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
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Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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