Getting sick of corporate medicine
The final Thursday in June was my last day in medical practice. I've had exactly one job in the 29 years since I finished my endocrinology training, and it wasn't easy saying goodbye to office staff, colleagues, and - hardest of all - patients.
I'm in good health and still very much enjoy the challenge of seeing patients with complex cases. It wasn't malpractice or the frustrations of dealing with insurance companies, and it certainly wasn't the Affordable Care Act (Obamacare), which actually seems to be working.
Two and a half years ago, my partner and I sold our five-physician practice to one of the large local health-care systems. The idea was that they would take over the management of our group, which had, for decades, been financially sound and well-regarded in our community. They would bring to the table better reimbursement rates, economy of scale, and the capacity to implement new technologies.
The future of our practice - and the ongoing care of our patients - would be assured whenever my partner and I did decide to retire. We were certainly not alone in abandoning private practice; this is the destiny of medicine in America.
What has actually happened since we were taken over is that our practice has not thrived and, in fact, is in danger of withering away. We are seeing a third fewer patients and we are losing money.
Responsible for this decline is the thoroughly misguided idea that running a medical office is like running any other business. Applying principles learned in business school to a situation where the customer (otherwise known as the patient) is utterly, essentially, and wonderfully unpredictable doesn't work.
Two office visits for diabetes that seem the same on paper can have completely different requirements for time and effort - and emotional investment. Patients know this. Physicians and other providers - nurses, physician assistants, nurse practitioners, medical assistants - know this. Medical administrators often do not.
The essence of effective medical care is an empathetic attentiveness to a single person. Corporate medicine has a very different mind-set.
The administrators that my clinical colleagues and I reported to were intently focused on providing clients for surgeons and hospital-based services rather than necessarily serving the interests of our patients.
The scheduling software was a disaster.
A long-promised upgrade to the phone system didn't happen, frustrating both staff and patients needing to reach their doctor.
New patients now must wait months, instead of weeks, for an appointment.
Patients were fleeing and one of our highly qualified younger doctors left for another nearby opportunity. Office morale has suffered. Middle managers, obsessed with rules and the pecking order, promoted a culture where even carefully considered suggestions from lower-level workers are not welcome and employees are encouraged to snitch on one another.
Change, of course, is necessary in a changing world. Electronic Health Records are a good example. EHR slows doctors down - everybody knows that - but our administrators showed no flexibility and the modifications we suggested to suit the way we really assess patients were dismissed. If the system was appropriate for a family physician, the thinking went, it would work for sub-specialists, as well.
In a practice like ours, where the service offered to the patient involves mostly listening, thinking out diagnostic and therapeutic approaches, educating, and comforting - "cognitive" skills - an extraordinary amount of physician time was wasted on clerical activities required by the EHR. Our new bosses, watching the bottom line as closely as they did, should recognize that time is money.
For years, the computer-generated list of patient appointments waiting on my desk every morning was titled "Schedule for Physician - Andrew Quint." Then Physician became Provider; fine with me. But one day in the last two years - I didn't notice when - it became Resource. Resource. An interchangeable part in a large, inflexible, impersonal system.
Doctors and the others who actually care for patients must rescue medical practice from a corporate mentality that devalues all the caring professions. If we don't, the odds of any of us being treated kindly and effectively when we are sick will go way down.
Andrew Quint is a physician in Philadelphia.