I recently heard a doctor talk about the business side of medicine. She discussed costs of opening a practice, marketing, partners, etc. Most medical students don’t have much of a business background, and so the information was informative and applicable. From the business side of things the talk was absolutely great. However, the talk left a bad taste in my mouth (not because of the free pizza either…), because it showed me the conflict of interest in running a business and treating sick patients.
I had no problem with this doctor, I feel that she was confident, compassionate, and most likely a great physician. Like I stated earlier, I also think that the business concepts and models she presented couldn’t have been better stated by a business professor or CEO. However, I struggle with the fact that simple business-smarts and compassionate, comprehensive care appear to be wildly incompatible with each other. There is a balance that private-practice physicians must find, and obviously many find this balance quite successfully. However, I don’t think most people understand the sticky situation doctors are placed in.
This doctor is affiliated with two clinics, one in a nice part of town and one that dealt primarily with Medicaid patients. She said outright that she spends more time with patients that have private insurance than those with Medicaid. The reasoning for this was twofold:
- She stated that the patients who are more well off expect more out of the physician, are more educated on their condition, etc. Thus, they require more time.
- A physician sells his/her time. She calculates her time to be worth a certain amount an hour, and she subtracts all of her overhead from this number.
If Medicaid pays half of what private insurance will pay, then she will spend half as long with a Medicaid patient as with other patients. The clinic that treats primarily Medicaid patients was built as inexpensively as possible and was designed to see as many patients in as small of a space as possible. At first, the thought of this made me irate. How could you do this to patients?!
Then again, what business owner would disagree with this? Why would one willingly accept lower pay for the exact same service? Who among you would take a massive pay cut when you could easily make more money? Doctors do not make what they used to, and I don’t think that I can accuse them of exploiting patients in this situation.
That said, I still feel this practice is wrong. However, I honestly don’t know what the solution is. Personally, I am ok with not receiving the same health care as Steve Jobs. He has a tad bit more money than I do, he can afford more Ferraris than I can, and I think that he should be able to pay for better care. I am ok with this, but I am unsure where to draw the line at the other end of the spectrum. Do I deserve better health care because I am fortunate enough to be on private health insurance? As a society, we currently seem to agree (for the most part) that basic health care is a human right (this could be a whole textbook, but I cite the fact that we don’t turn anyone away from the ER as the best example of this). What exactly defines basic health care though? If I am going to pay more can I get better health care? Is it wrong then for physicians to spend less time with patients who are paying them less?
I have struggled with these ideas, and I don’t know what the right answers are. I think it is unreasonable for private practice physicians to be expected to provide the absolute best care possible to every patient, while trying to cut costs and maximize profits just like any other small business owner would. I know that many physicians balance this successfully, but I can only imagine how difficult that would be. I don’t know how to avoid this precarious situation and I find it difficult to think of other occupations that deal with this conflict so closely.
Latest posts by Mark Munns (see all)
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