Time Capsule: Think Today’s Healthcare System is Bad? Imagine if Doctors Followed Only Their Own Best Interests
I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).
I wrote this piece in May 2009.
Think Today’s Healthcare System is Bad? Imagine if Doctors Followed Only Their Own Best Interests
By Mr. HIStalk
Everybody gripes about the US healthcare system’s high cost and low value. Rightly so, but it could be a lot worse. Here’s a thought I had today:
Imagine how bad it would be if doctors weren’t willing to follow the Hippocratic Oath.
I see doctors as falling into two camps. Some went to state medical schools at taxpayer expense. I figure those docs owe the rest of us, kind of like military academy students who have to repay their debt by serving in uniform once they graduate.
However, bunches of new MDs and DOs went to private med schools. They don’t owe us a thing.
Imagine the strain that doctors could place on the healthcare system if they took the course of action that benefits them the most, no different than a lawyer or accountant would do. They might refuse to:
- Treat patients who can’t pay cash upfront.
- Work for free serving on hospital committees or taking ED call.
- Work nights and weekends.
- Use someone else’s information systems, like CPOE.
- Use EMRs and interoperability technologies just because someone else wishes they would.
Doctors should be able to do whatever they damn well please and not feel guilty about it. If a doctor doesn’t want to take Medicare because it’s a money-losing pain, then blame Medicare, not doctor. If they shun using an EMR because it cuts their productivity, blame the vendor. If a hospital can’t survive without free doctor labor, then maybe it should fail or maybe the system is flawed.
If I were a cynical doctor watching my income drop, I would ditch the niceties and do whatever benefits me the most. I wouldn’t hurt patients, but I would focus on the activities that provided the most income or satisfaction, no different than most other professionals. Why not take advantage of the system that everyone plays in?
I’d start a boutique practice, cherry-pick the cash patients, and tell the insurance companies to stick it. I’d work 9 to 5 and tell patients to call the ED if they have an off-hours problem. I would get some humorless MBA to figure out how to run my practice like a factory, identifying those particular widgets that are the most profitable, then crank those out efficiently and soullessly. In any other field, this would be considered admirable and efficient.
Most importantly to this discussion, I would look at technology the same way a big company looks like plant equipment: it better pay for itself fast. Why else would I want it?
That sounds crass and cold, doesn’t it? So what? Doctors shouldn’t be expected to make sacrifices that other professionals don’t. Rightly or wrongly, we don’t have a charity-based healthcare system – it’s a business. Companies in business choose their means of production carefully. That’s why there’s a free market (or at least was until EMRs were mandated).
Doctors are soon going to be punished for using the technologies that provide them benefit if they’re not the ones Uncle Sam says are best. Next thing you know, professors will be fired for using overhead projectors instead of PowerPoint, accountants will be fined for doing calculations by hand, and lawyers will have to select only government-certified suits.
Thank goodness doctors haven’t wised up to the fact that they hold astonishing power over whether the healthcare system fails or keeps limping dysfunctionally along. Better hope the labor unions don’t whisper in their ear.