Killing Medicine, Killing Us

Ballooning medical bureaucracy does both.

Since the 1970s, the number of physicians entering the workforce has remained relatively constant. The number of administrators (who are handsomely paid) has risen almost 3,000%. This is not helping patients.

Doctors and their private practices are increasingly being eaten up by hospitals. In fact, the number of physicians employed by hospitals grew by more than a third between 2000 and 2010. There are a number of factors behind this shift, but, like most shifts in the healthcare industry, it all comes down to money, not care.

Medicare pays hospitals and hospital owned practices more for the same service than private practices, as much as 70% more. Employing doctors also allows hospitals to more easily funnel patients into their other facilities and services. Having doctors on staff also puts hospitals in a better position to negotiate with insurers.

As employees of hospitals, doctors and the medical decisions they make increasingly work at the whim of hospital administrators, whose primary aim is often not patient care but profitability. Estimates say that 80% of healthcare costs derive from decisions that doctors make, such as what medicines to prescribe and what procedures to recommend. There is a strong financial incentive for government, hospitals, and insurance companies to restrict the ability of physicians to make independent decisions.

One method being used by administrators to seize control from doctors is making healthcare incomprehensible to physicians through arcane coding and billing systems and complex information technology. Studies estimate that doctors spend just 12% of their day with patients; the rest is spent processing forms, dealing with electronic medical records, and other administrative duties. The unstated goal, according to an article by Dr. Richard Gunderman, is to train physicians to understand that fealty to the hospital is the center of their professional life, not the doctor-patient relationship.

All of this makes life for doctors working at hospitals tedious, frustrating, and grim. Recent surveys show eight out of ten doctors are “somewhat pessimistic or very pessimistic about the future of medicine.” Doctors today are more likely than any other professional group to commit suicide. Doctors, after years of expensive and extensive education and training, now describe themselves as “technicians on an assembly line” and “worker bees in the factory of the administrative overlords.” Independent judgement is further reduced by the threat of lawsuit, which also leads to many unnecessary tests and referrals to specialists.

Is it possible to reform this dysfunctional system? Yes, it is. All that is needed is to legalize patient driven medicine, as recommended in the next article in this week’s Pulse.

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