Corporate medicine use doctors as pawns

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Ken Fisher, MD, who is an internist/nephrologist in Kalamazoo, Michigan, a teacher, author ("Understanding Healthcare: A Historical Perspective") and co-founder of Michigan Chapter Free Market Medicine Association. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

What is the corporate view of physicians, and in particular, hospital employed physicians? A revealing report from a recent joint meeting of the American Medical Association (AMA) with hospital CEOs was published in Health Affairs Blog, March 28, 2017, titled, Physician Burnout Is A Public Health Crisis: A Message To Our Fellow Healthcare CEOs.    

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The group recognized that physician wellbeing is vital to the delivery of good cost-efficient care, which is certainly a true statement. As such, they voiced concern that physician mental health is diminishing and that physician burnout is increasing, as reported in recent studies. They stated that this is becoming a national healthcare crisis and wished to address the causes to fix the problem.

Ken Fisher, MD

Several issues, which are causing increasing rates of burnout far greater than in other professions, were discussed. The CEOs considered a critical issue to be the loss of control over physicians’ practice of medicine. This is truly astonishing, as hospitals have been voraciously buying physician practices and making them part of their corporate structure, resulting in physicians no longer having the final word on their conditions of practice. 

Even more damning is that hospitals and the AMA have favored and supported the major reasons for physicians accepting these buyouts: ill-conceived federal policies.  Beginning with the HITECH Act (part of the 2009 stimulus package), doctors and hospitals were required to use poorly designed, excessively expensive, extremely time-consuming, “certified” electronic health records (EHRs). The expense of just this program has forced many physicians to give up their small business and become hospital employees. This law has also caused financial difficulty for smaller hospitals.  

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Additionally, the Affordable Care Act (ACA) and the Medicare Access and CHIP Reauthorization Act (MACRA) have added additional bureaucratic demands on physician time and effort, greatly diminishing direct patient contact. These federal actions were supported and even encouraged by the AMA and large hospital systems. This has led to an impersonal time restricted and demeaning style of medicine for most, especially self-employed physicians.

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Many physicians wishing to avoid these problems have adopted cash practices. The CEO/AMA group ignored the issue of physician suicide, a serious issue recently discussed by Dr. Pamela Wible.

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The group focused on “the leadership characteristics’” of a physician’s immediate supervisor (a non-physician) who would be important in diminishing physician burnout. This is an amazing and telling comment. These CEOs and the AMA look upon physicians as a resource to be managed like any other cost center.  

To them, it is NOT the physician and patient that are needed to determine the work environment in which to deliver the best possible care as the solution to physician burnout, it is the hospital’s corporate structure. This is the corporatization of medicine that leads to impersonal, mechanistic care. The irony is that this type of care leads to poorer results and greater cost. Because we are all different, we need individualized care delivered in an attentive and caring environment, not a corporate one.

Hospitals are removed from competition via ill-conceived certificate-of-need laws and have successfully lobbied Congress to maximize their financial position allowing them to buyout smaller hospitals and physician practices. The AMA, via a special deal with Congress, is the sole proprietor of physician billing codebooks. These two special arrangements are examples of cronyism at its worst.  

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The issue of physician burnout is REAL; the solution is NOT through hospital CEOs and the AMA. They are part of the problem! The solution is for physicians to be able to devote their full energies solely to the wellbeing of their patients by opting-out of the demands of all third-party contracts and not becoming hospital corporate employees.