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Time Capsule: Think Today’s Healthcare System is Bad? Imagine if Doctors Followed Only Their Own Best Interests

August 30, 2013 Time Capsule 6 Comments

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.

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Currently there are "6 comments" on this Article:

  1. Wow Wow Wow so wrong on so many points – Bottom Line the US Taxpayer does in fact pay to train nearly every single US doctors to the tune of 13 billion a year http://www.ama-assn.org/resources/doc/img/summit-grover.pdf your analysis would only apply to foreign doctors working in the US. I am surprised you don’t know this to be honest and I wonder how many others don’t?

    “They don’t owe us a thing?””” Clearly you don’t know who pays to train US docs? (medical school is different than residency and internship) The US government spends 13 BILLION a year training doctors

    In fact nearly every doc in the US receives their “training’ (different then medical school) at US Taxpayer expense through Medicare funding “which pays for the majority of physicians’ post-medical school training:. CMS bascially pays for the docs salary for their residency and internships to the tune of 100k a year(40 k to the doc and 60 k to the training hospital) for four to 11 years.

    If that was a mortgage of 400k to 1.1 million at a nominal rate of interest they would be paying back about 2000 to 5000 a month for 30 years. That is the logic behind them being paid less to treat those patients – they are essentially paying back the cost of their education – but clearly most people are unaware of that bargain.

    Bottom line the US government via medicare and medicaid pays to train US doctors (not undergraduate or medical school) so that we have doctors to care for the elderly and the disabled.. If they want to make money on the side that is great but they need to remember exactly who paid for them to become doctors

    BTW The Ryan budget attempted to cut this funding so that dont he road your logic could work but not for the next 30 years. They do OWE us and they are essentially public employees but we play a game to make them think they are on their own once out of their training.

  2. I understand that CMS pays for training programs. The premise though that docs “owe” society for that training is flawed. I finished residency in 2000 and along with most of the residents I worked with, the hospital (and society) already got their work out of me. We trained before work hour limits – were in the hospital over 130 hours a week in a q3 call rotation which is insane. My intern year I worked more than double the hours of the average worker and made $30,000 – it averaged less than seven dollars an hour for someone with a bachelor’s, master’s, and graduate degree and over $150,000 in student loan (private school) debt to do all kinds of scutwork in the middle of the night. I can’t count the number of family events, weddings, and funerals I missed because I was in the residency meat grinder. I watched residents have preterm births and get divorced if they were brave enough to get married or have kids at all. One of my class committeed suicide. Luckily I was on the low end (!) of the debt spectrum and could afford to choose a specialty I loved even though it wasn’t lucrative. I love my patients but I hate what healthcare has become. Still every day I put one foot in front of another and take care of my patients to the best of my ability. I could walk away from my practice and make twice the salary as a hospital administrator or as a consultant, but I’m hanging in there. But I don’t owe CMS, the government, or society anything.

  3. The idea that doctors owe anyone anything is ridiculous, period. The hours, the responsibility, what they have to witness daily–oh and get to pay exorbitant sums for malpractice insurance. Then they also get to pay back med school loans–factor all that stuff in and in my opinion they are not paid nearly enough. The hospitals where they perform their residencies benefit from the cheap labor–forget about “training” them–the hospitals take advantage of them having little or no choice and lean on them with shifts that truck drivers are not allowed to work! Nurses are driven to similar schedules, but that is another thread.

    ObamaCare will gut this system even further, making the idea of becoming a doctor less and less attractive in the US. The doctors will be capped at what they can earn, so there will be little or no incentive to stretch to provide care like is done routinely now (squeezing patients in who need care into an already fully booked schedule). Most of the doctors I know truly care about helping people, something I doubt I could do as consistently as they do.

    So before you look at the “rich doctor”, consider what he went through to get there. A Bachelor’s is enough for most people; try med school (first qualifying, then staying in, then graduating from) only to get to become cheap labor for a hospital during a period of servitude. IF the doctor is able to pay off the student loans and survive professionally long enough to develop a private practice, he or she might be lucky enough to cover malpractice insurance and pay for insurance for his or her employees. Taxes take a big chunk, and let’s not forget these doctors have families too, with all the expenses families have. IF the doctor is wildly successful as a doctor, remember the millions of steps they took to get there and be thankful they did….

  4. I have to admit a certain amount of sadness in reading this article and the subsequent comments. The arguments made on both sides are rooted in logic and on that basis, don’t come any closer to answering the question. At a certain level, it was once considered a responsibility of a “profession” that a certain amount of public stewardship come along with the title. Similar to career military or the clergy, the benefit of the profession was provided and defined in a way separate from traditional business terms. I think/hope most doctors still feel this way and don’t want to go the way of another vocation, law, that was once considered a true profession but today, despite some fine examples of public service, is overrun by win at all costs, business only lawyers.

  5. My brother is an attorney, and I was present at his swearing in. Lawyers are expected to do a certain amount of pro bono work, but rarely do once they get into a practice. Whether the workload won’t allow it, or the firm the work for will not back them, too many lose sight of that oath they took when they were sworn in.

    Most doctors I know do a much larger amount of pro bono as well as heavily discounted work for people than is made public knowledge.

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