03 Mar Physicians are bad at business – really?

I don’t know about you but I am tired of hearing “well you know, physicians are so bad at business”. Now let’s be honest and examine the following exchange between yourself and your beloved physician:

YOU: Hi doctor, my left leg got caught in a bear trap while deer hunting and it hurts like crazy and smells something awful for some reason.

BELOVED PHYSICIAN: Well, my dear, it is clear to me from my examination of your leg that gangrene has set in since you took so long getting to me and we now have the following options:

For $299.99, I can cauterize your wound but that would leave you at risk of further infection that you may die from
Or for $599.95 I can amputate your leg at the knee, but that does not include cauterization and you will suffer a lot of pain and possible infection that may kill you
Or for our daily special, I can do the amputation and the cauterization for an everyday low-low price of $695.95, which will give you the best chance of survival
What would you prefer?
YOU: (trying to do the math as your life hangs in the balance) Well, gee, doctor, that daily special sounds like the best deal so I think I will go with that

So how do you feel about this exchange? What do you think of your beloved doctor – business savvy or not? I bet you would prefer he/she took care of you regardless of the “business” aspect of the transaction. Well we are in luck – that is exactly what these amazingly caring and intelligent individuals are gifted for and get trained to do. That is exactly what their passion is. That is exactly the reason they are not focused on the “business” aspect of the transaction. And anyone that mistakes their focus on patient care for a lack of business acumen is missing this most important point.

Let’s face it, as these fine and caring individuals have been busy over the decades focusing on finding better ways to take care of our health, the business side of the healthcare industry has been also very busy. The mess on our hands we all complain about that i sour healthcare system is not the creation of the physicians. They would never choose to increase the complexity and burden of administrative overhead and diminish their clinical autonomy. That would be insane and we can safely agree that active physicians are not insane. That’s what we have the medical boards for; to keep an eye on such things. So, it is not the case that physicians are “bad at business”. It is rather the case that the healthcare “industry” is focused on taking away the fair share of economic benefit from the physicians, for its own benefit. At the same, the “industry” is working hard to constrain their clinical autonomy. Which one of these motives is more damaging to our nation, I cannot say. But I can say with certainty that reducing the clinical autonomy of physicians in any way and by any means is not just short-sighted, but dangerous.

How do we constrain the clinical autonomy of physicians? Let me call out the most common methods we as a nation employ to accomplish this dangerous mission, not necessarily in the order of their impact on the outcome:

Tort Laws that drive up the malpractice insurance costs. Who benefits and who loses?
Different reimbursement for same patient & procedure based on practice vs. hospital. Follow the money trail.
Complexities of insurance company “games” to reduce and delay reimbursements
Ill-conceived and executed policies such as ACA – although the “intent” may be noble
Our national obsession with “perfection of the human body” and “living longer than our shelf life”
If one thinks honestly about these factors combined, it is no wonder that physicians have been forced or wrongly convinced to abandon their lucrative independent practices and run for the perceived shelter of employment with a hospital. The fact that it is a short-term and false protection may not yet be known to the physicians. I fear what will happen when they do find out in a few years. I fear for them and for the rest of us that need them to take care of us.

Physicians in private practices should not have to be business people, as explained in the fictional exchange above. They must remain focused on healing and be able to trust the rest of us to take care of “the business of healing”. If this is not the case then it is our collective failing, not theirs. Let’s be honest and do the right thing. Physicians should never have to choose between clinical autonomy and financial prosperity any more than you and I should have to choose between amputation or cauterization.