A quick Friday afternoon roundup: whiney physicians, channeling Switzerland, demonizing the elderly

Here are 3 topics that caught my eye today:

First, a physician recruiting firm trumpets the news that 1 in 3 physicians plans to quit within 10 years. The physicians cite health care reform, “corporatization” of medicine and low compensation as factors. The finding is presented as a big deal, but to me it’s a yawner. It’s easy to tell a pollster you’re planning to quit because you don’t like the pay or working conditions. It’s quite another to deliver the same message to your boss and spouse, and even harder for most physicians to go out and find a high-paid gig outside of medicine. Plus, the poll gives no comparison data –maybe people in other professions are even more likely than doctors to quit.

The advent of managed care was a big turning point for physician autonomy. But many of the docs practicing now were already aware of managed care before they signed up for clinical practice. In any case they’ve had at least 20 years to get used to it. So I don’t see why this should all of a sudden become a big issue.

Second, a Washington Post op-ed by a health care investor points out that other countries –like Switzerland– spend a lot less than the US on health care and get a lot more bang for the buck (or fruit for the franc?). He encourages people to break away from the easy political posturing that has Republicans howling about death panels and Democrats pouncing on any Republican cutbacks in Medicare. I tend to agree with him that innovations in cost-cutting should be embraced.

Finally, a commentary in the USA Today repeats the usual ignorance about the dangers of older drivers. “Perhaps it’s only my imagination, but it seems that I’m increasingly hearing about older drivers who have lost control of their vehicle and crashed into other cars.” Her solution: “more uniform and regular testing of elderly drivers.”

I’m glad she at least recognizes that this may be her imagination –or more likely a fixation by youthful editors on any crashes involving the old. But as I’ve written (Putting the brakes on the Boston Globe’s demonization of elderly drivers), the facts are a little murkier than the perceptions. In short:

  • Despite all the press attention elderly drivers don’t crash a lot compared with other age groups
  • Elderly people in crashes are more likely to die –because they are old and frail, not because their crashes are more severe
  • The percentage of crashes involving elderly drivers is actually decreasing over time
  • There’s no evidence that road tests will really predict who will be involved in crashes
  • Seniors will be inconvenienced, embarrassed, and humiliated by the road tests. Since 90 percent pass anyway, is it reasonable to subject them all to this requirement?

3 thoughts on “A quick Friday afternoon roundup: whiney physicians, channeling Switzerland, demonizing the elderly

  1. Roy M. Poses MD

    Maybe by “corporatization” of practice the physicians did not mean the influence of managed care.

    Dealing with badly run, bureaucratically intrusive, irrationally paying managed care is bad enough when a physicians does so in his/her practice.

    However, I suspect corporatization means having to literally work for a corporation. That could mean working for a big, ostensibly non-profit hospital system. Such systems are increasingly run like big businesses. Worse, it could mean working for a for-profit hospital system or other kind of for-profit corporation, even one ultimately owned by private equity.

    Look here: http://hcrenewal.blogspot.com/search/label/corporate%20physician

    Working in such a corporate environment, often subject to an incentive plan that drastically depends on “productivity,” that is seeing as many patients per unit time as possible, may seem to require intolerably divided loyalties. How can a physician put the patient’s interests first, that which our oaths require, when the boss says the bottom line comes first?

    Reply
  2. David E. Williams of the Health business blog Post author

    Thanks, Roy. On the flip side (and anecdotally, I realize) I’ve spoken with plenty of docs who like being on salary in a larger organization, since it means they don’t have to focus on managed care negotiations, billing, HR, etc.

    Private equity owned groups aren’t automatically evil, at least in my mind. An enlightened boss/owner is going to treat docs with respect.

    Reply
  3. Roy M. Poses MD

    Certainly, it is possible that big organizations that employ physicians as practitioners can be run by people with a long-term perspective and who prioritize patient care over short-term revenue.

    But it is increasingly unlikely, in this era of “financialization,” that is, of putting short-term revenue ahead of all other goals.

    Reply

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