Maximizing profit in medicine

Anna Lembke, MD, chief of addiction medicine and professor at Stanford University School of Medicine, has this to say about her profession: “All of health care has become overwhelmed by a hucksteresque opportunism, in which making a buck is the driving force behind practicing medicine.” She talks about the “enormous pressures on doctors today to prescribe pills, perform procedures, and please patients…”

Most physicians today are in practices owned and operated by hospitals or “integrated health delivery systems.” I’m sure you’ve seen such “systems.” Here in Boulder Creek (population 5000) what used to be the Boulder Creek Medical Clinic is now under the aegis of Dignity Health Medical Group, as is our nearest hospital fifteen miles away. This arrangement has transformed medical treatment. Treatment options are often dictated by hospital administrators, the Joint Commission (an accreditation outfit) guidelines, and health insurance companies. Among other things, doctors are expected to “increase productivity”—that is, to meet their billing quota.

As Dr. Lembke says, “The pressure to see more patients per unit time and to bill more per patient pervades all of medicine, encouraging doctors to prescribe drugs.” She receives monthly billing statements informing her whether or not she is meeting her billing requirements. She tells the story of a family medicine doctor who “cherishes” the patients who only need a quick refill: “Those are my easiest patients. They are scheduled for ten minutes, but if I give them what they want, they’re out in five.”

I feel sorry for the doctors working under these circumstances. We, at least, have the choice to opt out.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.