Eve is here. Our readers regularly receive updates on drug illegalization, primarily from the patient side, but sometimes from the healthcare provider side. A big factor is insurance. Obstacles such as prior authorization and other gatekeeping that delay or unduly limit treatment and narrow networks that exclude certain professionals. But the other thing is the corporatization of health care, which we’ve been writing about for a decade. It’s not just about cost-cutting, it’s also about standardization, which proponents claim will improve care without or contrary to evidence.
The result of all this, though not often mentioned, is moral injury. Articles about early retirement for doctors sometimes make a point of mentioning burnout caused by conflicts with insurance companies, especially staffing shortages post-COVID-19. However, they often do not include sufficient moral injury to feel that one is violating ethics by being forced to practice in a substandard or even dangerous manner.
I came across a small example yesterday. I always have my blood drawn in the lab because my doctor’s nurse often puts me in pincushion form. I always ask butterfly needle.
Today at LabCorp, the lab tech said they don’t have it. She had been ordering them since August, but none had been supplied. She said LabCorp offers a similar gauge needle instead, but it’s clearly cheaper than the Butterfly and has many uses, especially for children, the elderly, chemotherapy patients, and those who need multiple “stabs.” (She did not elaborate on the latter). This wasn’t about saying “no” to patients. She was clearly upset at being asked to do her job using unprofessional tools. She seemed humiliated. She said she asked all patients to file a complaint with LabCorp about this matter.
Please increase this stingy humiliation throughout the US healthcare system.
This small but very typical example shows that business owners and managers do not care about the company’s business, even when health and lives are at risk. All that matters is profit.
Written by Joel Eisenberg. It was first published in angry bear
When I was a kid, I thought becoming a doctor was the pinnacle of achievement for anyone interested in science. That changed when I entered university and became interested in research. I realized that I didn’t have the temperament to be a doctor (maybe a radiologist or a pathologist) and became a lab rat. Although I spent my career as an undergraduate medical school professor and taught thousands of first-year medical students, I had no interest in practicing medicine.
When I began my faculty career in 1987, there was a lot of money flying around in medical schools. At the time, insurance companies paid premiums for patients attending university tertiary care hospitals and clinics. But within a decade, managed care became mainstream, and medical schools across the country were in the red. My university sold the hospital to Tenet while it was still profitable. That proved problematic, so they eventually bought it back and sold it to SSM, which better fit the university’s Jesuit Catholic mission.
The medical school’s basic science curriculum was shortened to accommodate more clinical rotations. Meanwhile, career prospects for graduates are evolving. Nurse practitioners and physician assistants take over duties previously performed by physicians and physicians. AI is more accurate than human radiologists in diagnosing images. Private equity is taking over clinics and community hospitals, draining their resources. This is an eye doctor in Kansas City.
“Medicine is going to hell. I’ve been asked to write some editorials and it’s so depressing and sickening. My own group, owned by six doctors, Sold to private equity (PE) two years ago. Since then, five of us have left. You know the drill: Fired the local manager and put him in charge. We have now reduced the number of personnel, shortened contact time with patients, increased the number of patients per day, and increased the number of surgeries, with the golden rule of “increasing revenue and increasing profits to enable sales.” , directed to increase revenue. Generate the test. Additionally, due to legalization, all major eye care will be transferred to opticians, and ophthalmologists will only perform surgeries. This is true even for patients who have been seeing MD for 30 years and prefer MD rather than OD. The partners say no specialty has seen a decline in reimbursement more than ophthalmology. Younger doctors didn’t want to buy in as partners, and older doctors didn’t have an exit plan. In fact, one of the partners died and they couldn’t raise the money to buy her out until she was sold to a PE.
“Academics and accomplishments have gone out the window. The medical students and residents I interact with are like snowballs, with a sense of entitlement and intellectual rigor that says, ‘Do it for me.’ In ignorance, for some, standards have been drastically lowered, and for others, raised in violation of Supreme Court rulings. You can go online and learn about “workarounds” for forming classes along “fair” lines. ”
Recently, an MD/PhD who completed his PhD in my lab contacted me via email. He initially held a faculty position at the University of Hawaii School of Medicine. But things have changed.
“I was still in academia and rose to the rank of associate professor, but then in hospitals people with an “MD” were seen as machines that generated fungible bills (dollars). , it became increasingly difficult because they could remove all protected time unless you were a licensed medical doctor. own NIH fund (which is difficult in Hawaii as support is very limited). So a few years ago I took the plunge and started a private practice (with a more flexible schedule). This actually helps subsidize the limited teaching and research that I still do pro bono.
Psychiatry is fun in some ways, and I’ve been involved in teaching psychiatry residents how to translate individual genetic discoveries into meaningful clinical decisions. And geriatric psychiatry, which deals with dementia behavior, continues to be interesting as there is much to learn as we go into the field. Most doctors are trained to think out of the box, so my doctoral work with you has helped me think more critically and be open-minded in accepting new discoveries. (This is like the most important and enlightening thing I learned when I was a graduate student). So I always enjoy teaching my MD students how their textbook knowledge is outdated.
What a tragic waste of a physician-scientist.
The medical profession may no longer be the meal ticket it once was. The only constant in the world is change, and the economics of health care is driving change in medical practice.
