Is Medicine No Longer A Calling?
As I sit here in a medical innovation conference – I find myself becoming more and more angered by one of the speakers. A man with an MBA and fancy title from PriceWaterhouseCoopers is lecturing us about how doctors are essentially money-grubbing, change-resistant, quality-care avoiding “pains in the you-know-what,” obstructing progress in healthcare reform and blocking technology adoption.
His lack of understanding of the complexity of medical care was breathtaking. And yet, he expresses a sentiment that I’ve witnessed all too many times. Here are a few choice quotations:
“Doctors only make money when you’re sick, so they have no incentive to make you well.”
“Tell me two things about a doctor, and I’ll tell you what kind of medicine he practices: where he went to medical school, and what year he graduated.”
“Doctors never change how they practice medicine. They get into a routine and never innovate or adopt new approaches.”
“EMRs will dramatically improve the quality of care provided by doctors because when we aggregate all their outcomes data, we can pay for value and incentivize them to to the right thing for patients.”
As I typed out my responses to each of these statements, I realized it might be better to have you readers respond instead. Yes I just deleted a large chunk of text!
It just makes me incredibly sad to think that the noble profession that called me to serve the sick and suffering is being trashed so regularly by speakers at medical conferences. As I make house calls with my primary care partners in rural Virginia – we take delight in binding up wounds, offering vaccines to shut-ins, and providing medicines to those in need. There may be 18 years difference in our medical school graduation dates, but Alan Dappen and I both use UpToDate to inform our practice decisions, and we consult with one another and our patients about what next steps would be best for them – to keep them healthy and thriving.
I know that we care deeply about our patients’ wellbeing, and we don’t need any incentives to do right by them. I bet that’s true for most PCPs, because medicine is still a calling.
But with attitudes and approaches espoused by people like Mr. PWC’s becoming more common, I bet that fewer and fewer people will heed the call.
So sad.
What do you think?
Wow…that is sad. Sad because he has such a black-and-white view of the world, or more to the point, such a uni-dimensional view of doctors. Are doctors immune to economic incentives? Of course not. But the vast majority of doctors clearly don’t fit the stereotype he is perpetuating. The med students and doctors I know are motivated by a complex set of factors, and at or near the top of the list is the desire to help people and make a difference.
I can’t help but wonder, why does this man have such a chip on his shoulder? Was he rejected from medical school? Bad experiences with particular doctors? Are inflammatory remarks good for drumming up business? What are *his* incentives?
I agree that his perspective is rather skewed. Sadly, it’s part of a fairly common sentiment that I keep hearing at various healthcare reform meetings that I attend in Washington, DC. I don’t understand how we got here – but some people involved in HC reform really see docs as the bad guys. Very sad.
Val, responding to PWC (aka Professor of the Whining Corp) can’t be done in a comment or even a blog post. It would take an entire blog to counter his assertions. We have to hope that he is a minority view of health care reformers. Otherwise, medicine the profession is at risk of becoming a trade.
We know why we practice medicine. But, will the next generation of physicians practice for the same reasons? Will the ‘calling’ we heard still be audible once the health care reform dust clears? http://www.MDWhistleblower.blogspot.com
I have just a few thoughts from a systems engineer whose wife is a primary care doc in solo practice.
Sure doctors are change resistant, they should be after the abuse that they’ve received from IT snake oil salesman who have promised much but delivered little in the past. And I’m coming at this from mostly an IT perspective but tempered by the fact that I’m applying IT to my wife’s solo practice so I actually have to stick around long after a fancy PWC consultant will have gone on to his next engagement. IT standard practice differs substantially from medical practice and IT is filled with programmers and managers who simply do not listen. This leads to an absurdly high failure rate for IT projects. Now normally this doesn’t get people killed but in medicine it does. There is an entire other set of IT practices that are used in mission critical applications where lives are at stake. I do not believe that EMR development is routinely using these sorts of much more expensive practices.
If the entire country were well doctored, a reduction in sick patients would be cause for financial concern for mercenary doctors. Since it is not, even the most amoral of established doctors just stops turning down new patients for a bit when they cure a few established ones. After all, new patient codes are more lucrative than established patient codes so all else being equal, curing patients actually gives you a better net than not curing them and turning away those who wish to join your practice, at least in primary care. And primary care physicians will not particularly like to refer to specialists who are milking their patients for fees instead of curing them.
This entirely ignores the social status and psychic satisfaction of actually curing patients. These two factors only strengthen the financial incentives.
The cult of centralization and bigness is foundering all throughout society. PWC doesn’t do well in tending to the small operators in any field so they and their direct competitors are going to be wedded to the centralizing impulse far longer than is healthy. It’s infuriating in any branch. In other words, it’s not just you.