Entrepreneurial physicians under attack
Wednesday, July 1, 2009 at 08:40AM 
Whoa, now wait a minute - this is making me very nervous!
From John Commins' article, for HealthLeaders Media:
...McAllen is the product of a healthcare system that incentivizes physicians to perform tests and procedures and "rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can't spend much time with each, and gives you every incentive to order that extra MRI or EKG, even if it's not necessary. It's a model that has taken the pursuit of medicine from a profession—a calling—to a business."
It is comments like these – suggesting that "medicine" and "business" are mutually exclusive – that make healthcare economist Mark Reiboldt nervous. Reiboldt, a vice president at Coker Capital Advisors, an Atlanta investment banking firm, says the climate in Washington, DC, is making business "extremely disadvantageous for the physician entrepreneur."
Hey Mr Reiboldt, it's making me nervous too!
I get really pissed off when a few bad apples sink the entire boat, or the baby gets thrown out with the bathwater - or some equally stupid mixed metaphor.
Just because some sleazebag doctors perform inappropriate or unnecessary surgeries or do unwarranted studies on their patients to make more money does NOT mean that the spirit of entrepreneurship in medicine needs to take the hit.
Let's get one thing straight here - physician entrepreneurship is not about figuring out how to con some extra money out of the pockets of tight-fisted insurance companies. Physician entrepreneurship is not about scheming up ways to bilk bucks from clueless patients.
That is just sloppy, lazy, work-around behavior.
No different from our buddies on Wall Street or in banking -- and deserving of criticism.
That is NOT true physician entrepreneurship or business.
True physician entrepreneurship is about creativity, inventiveness, disruptive improvement. True physician entrepreneurship has given the world fogarty catheters and fetal heart monitors, diabetic treatments and stethoscopes, Mayo Clinics and blood transfusion technology.
It continues to reward us with new models of practice, EMRs, medical devices, and organized hospitalist or emergency services.
I am particularly distressed by the words of our President, if he in fact did say them: "It's a model that has taken the pursuit of medicine from a profession—a calling—to a business."
Who actually decided that medicine was a calling?
And if for some reason we agree it is, where is it written that this Calling shall be undertaken in a setting that precludes attending to the smooth running of a practice in a business-like fashion, to compete in an increasingly tough market place?
If you, dear public and Mr. President (of whom I am fond, despite such words), want your physicians to heed a Calling, and be your noble servants dedicated to helping you and saving your lives, then please make sure you set up circumstances in which they can:
- spend sufficient time consulting with you without worrying that they will not be able to meet their overhead
- practice without the continuous threat of your lawsuit hanging over their heads and without the ludicrous premiums of their malpractice insurance policies
- pay off their $200,000+ medical school repayment loans without feeling pressure to make more money
- enjoy the benefits of near-mandated new technology such as EMRs without having to beg their banks for a loan
- have the luxury of attending educational conferences without worrying about who is covering their practice and their overhead
- be guaranteed at 6 out of 7 nights of uninterrupted sleep so as to be able to get up in the morning and execute this Calling refreshed and sharp
- be assured that, while overhead increases annually (labor, rent, insurance premiums - all big expenses), they will not be forced to accept yearly cuts in reimbursement rates.
If you can assure doctors of these protections (very un-American I might add!), then I would argue that it's fair to expect them to drop all this "business" nonsense and attend to their calling!
Do we have a deal?
Philippa Kennealy
To add insult to injury, I received this email a few minutes ago:
Breaking News from Modern Physician
Physicians will receive a 21.5% cut to their Medicare payments starting Jan. 1, 2010, under a proposed rule issued by the CMS. The agency is also proposing to remove physician-administered drugs from the formula used to calculate physician payments under Medicare.
Philippa Kennealy
More fodder for the conversation from an essay by Dr Sandeep Jauhar in the New York Times: A Doctor by Choice, a Businessman by Necessity
Reader Comments (5)
Natalie Hodge MD FAAP
I agree about the bad apples rocking the boat. The definition of "business" and especially "entrepreneurship" are lacking. They're completely money-driven in a capitalistic framework, whereas they represent bringing an idea to life and getting your message heard.
If one were to be noticed, he/she must "advertise". If one wants to attract people to a new way of thinking or doing things, they must invest in "PR". Keeping your books so you can stay afloat is "accounting/finance" and overall you're introducing yourself - your personal brand - to the world. However you choose to elaborate, the word "business" is simply an all-encompassing label that suffers from social stigma over the last 50 years.
You mix in medicine and I can understand the negative reactions since patient care isn't supposed to be about monetary gain. But you look at your model, Jay Parkinson's model and realize there are better ways and they too go through the conduit of "business". It is not a bad thing, it's simple the way things get done.
I'm almost reminded of a saying at one of our local Catholic hospitals on whose Board of Directors I served: "No margin, no Mission!"
The same can be said of a medical practice.
The business of medicine as I see it, stresses me out greatly, and I feel woefully unprepared. When I had a private practice, I spent a lot of time worried if I had enough toilet paper for the restrooms and if/when my nurse was going to quit on me.You get no training about these things in med school, and I suspect that some of the personality traits that lead a person into medicine are actually the opposite of what you need to run a profitable business nowadays(cold shrewdness? don't mean to insult anyone...)
I recently got an 'analysis' from my billing company that said if I would document 3 to 6 things about the EKGs I interpret, I could bill the extra CPT for EKG interpretation (I had been documenting the EKG, but maybe only putting "NSR, no ischemic change"---not enough to bill for). I think that stinks. It's gaming the system and has nothing to do with pt care.
I like Obama, and I hope what he meant by that quote was the above kind of nonsense. But your response was correct---we doctors are supposed to have this higher calling and not worry about money or finances, yet it's crammed down our throat on an hourly basis.
Thanks for letting a disillusioned doc vent...
Nancy