Physician autonomy and patient interactions in corporate health care

Have you noticed that when you try to make an appointment with your primary care physician, you have to wait much longer these days to be seen? And when you do finally walk into the exam room for the appointment, it seems the countdown clock is already in motion. Have you also noticed that the face you last saw opposite you for your previous check-up is not necessarily the same one you’re seeing today? What’s going on here, folks? Welcome to the wonderful world of corporate health care!

Over the last couple of decades, a metamorphosis has been taking place in health care. One by one, primary care practices are being absorbed by large corporate health care systems. The “Marcus Welby, MD” practices of the past are, for the most part, non-existent. At first glance, one might ask, what’s wrong with that? The new office seems to be better equipped and some new faces are making up the staff. But we need to take a closer look beyond the pretty new sign that greets us at the front door to begin to understand what’s going on.

The independent physician who once had full autonomy over their practice and interactions with patients is now an employee of the health care corporation. Their day is structured by the guidelines set forth by the corporation that employs them. There are quotas of patients to be seen daily since the corporation’s chief goal is to keep money flowing into the coffers so that there are enough funds to keep expansion projects going at full tilt. Ignoring the fact that there don’t seem to be enough physicians to fill current positions, let alone the upcoming ones. But wait, does the corporation need MDs or DOs to fill these positions? Why not simply use nurse practitioners or physician assistants? They wear white coats and name tags. The average patient won’t be able to tell the difference, so what’s the harm? Forget the fact that their medical training and experiential history lag far behind that of MDs or DOs. Instead of MDs, DOs, NPs, and PAs working as a team, the ploy of the corporate administrators might be to simply go the more cost-effective way. I am not saying that there aren’t excellent NPs and PAs who provide excellent care, but they shouldn’t become a replacement for the care given by an MD if that is your choice.

The burdens placed on the primary care physician loom heavily. Not only must they meet corporate dictates, but also governmental regulations. Throw into the mix haggling with insurance companies to get the best possible course of action for their patients and you have the perfect mixture for physician burnout … physicians leaving the profession that they have given so much to. Their “flame,” their inner drive for the profession they have sacrificed much for, has been snuffed out not by choice, but by the environment they must work under. The problem is multifaceted. Our doctors feel like they are simply cogs in the corporate wheel. They feel that they have lost any autonomy over the manner of treatment for their patients. Many times input from physicians regarding improving the structure of the doctor-patient interaction and their daily format has been largely ignored by corporate boards. But who knows more about the day-to-day job of being a physician … the physician or the board member?

The doctor’s day is composed of hurriedly getting through their daily quota of patients and performing an assortment of clerical tasks that could have been assigned elsewhere. A plethora of checkboxes on computer screens. There is no time during the day to have meaningful discussions with patients, thereby leaving both parties feeling short-changed. No opportunities to forge bonds of trust between the two. The physician wants to do more for their patient … the patient feels underserved and unheard. A lose-lose situation for both. But remember, the line must be kept moving through the exam room.

Something is not quite right. We need, as patients, to become more aware and informed about what’s happening in health care. The current system is unraveling right before our eyes. Physicians and patients need to form a united front before we all end up standing in line in front of one of those Big Box stores to receive our health care. But hey, maybe we can pick up an extra box of tissues and cough drops as we wait in line to be served.

Michele Luckenbaugh is a patient advocate. 

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