Managed Care May Save the Profiteers but Kill the Doctors

I am a physician, and each day I sense that I am slowly dying.

Mine is not the sudden, unexpected death of a heart attack or a brain hemorrhage. It is an illness of spirit.

Twenty-seven years ago, I altruistically entered medical school in pursuit of a noble cause. I graduated, recited the Hippocratic Oath and became a specialist. As my practice grew, my life became overwhelmingly gratifying. But now, 18 years later, I dread going to work.

What has happened to me?

Is it realizing that, at 48, I too am mortal? Or is it that, having devoted almost two-thirds of my life to helping others, I am now disgusted that society puts greater value on financial bottom lines than on the noble concepts of Hippocrates that originally defined my profession?

I agree that the American health-care system needs a thorough reevaluation. But I emphatically disagree that the engine of medical decision-making should be purely economic.

I do know, however, that none of the “experts” has ever had to accept the unbelievable responsibility for another person’s life that daily occurs in our profession. Nor have they ever experienced that terrible sense of impotency that occurs when, despite all efforts, one of those lives passes on.

Increasingly, though, these same policymakers demand authorizations for diagnostic studies, consultations or surgeries that they don’t understand, certainly can’t spell and have never before heard of in their limited on-the-job training. HMOs, IPAs, PPOs and other “alliances” are forming that, though mouthing concern for high-quality care, are more concerned about their own profit. Patients are herded into these organizations only to later discover that their benefits have been cut. Reviewers are denying medically appropriate care, yet monies saved from reducing professional fees are rarely returned through reduced subscription rates.

With less efficiency but more insurance, business and governmental regulations, remaining providers become more harassed and disillusioned. When physicians become more concerned about their own economic survival than the welfare of their patients, shortcuts, overbooking and quick answers occur just to keep those practices alive.

Current physician frustration comes more from this intrusion into patient care than from income decline. The business community, encouraged by a socialistically oriented administration, doesn’t necessitate doctor-patient confidence. By removing the decision-sharing process from the providers, these new plans amputate the very individualism and intellectual stimulation that initially brought us into our fields. And without the ability to exercise the disciplines of our professions, is it any wonder that some stop caring?

With an increasingly smaller patient pool, specialists may just as inappropriately perform general practice work, with equally disastrous results. As the spiral of professional frustrations and “managed competition” continues to rise, blocks of physical therapists, speech pathologists and even psychiatrists will disappear.

Malpractice attorneys will prosper.

To survive financially, physicians are already selling their practices to large business interests and accepting guaranteed salaries. My once proud and respected profession is simply becoming another job.

So, for those of us who wanted nothing more than to fulfill the noble ideals of Hippocrates, there is little left to do but mourn. I am tired of fighting this new health-care system and fear that I am giving up.

Doctors seem ill-equipped to fight society’s economic demands. We can only hope that our patients will ask enough questions to the formulators of these new policies so that we can all more realistically examine our health-care standards.

One hopes that with such an examination, we will not allow medicine’s high quality of care and individualism of character to die that slow, painful death of spirit that, in the end, well may kill us all.