Will The Last Doctor Turn Off the Light When Leaving?

In 1971, at a Los Angeles Practicing Law Institute program devoted to "health law", an academic speaker talked about the passivity of physicians with respect to the Medicare program. He told us that chiropractor and podiatrist organizations lobbied aggressively to have their members participate in the Medicare program, with fee schedules which were beneficial to them, while physicians and their organizations took a disengaged stand.

I have never understood the passivity then (and now) shown by physicians (the AMA was actively involved in trying to scuttle the initial Medicare legislation, predicting accurately, that the financial justification for the program was far off base), nor the political and business passivity shown by physicians as HMOs, PPOs and insurers played a variety of hard-nosed games which not only cut appropriate services to the public and their patients, changed medical practice to a factory/industrial model. and absorbed billions of dollars of "administrative overhead."

As more physicians work in groups run by lay management, are owned by hospital and other entities in which physician opinions are not particularly respected, and as business economics trumps professional judgment and standards, physicians continue to passively accept what has been meted to them. County medical societies and national physicians have chosen to spend time, energy and resources in fighting about which specialty gets the most beneficial treatment, rather than the state of the profession and the care which physicians and others in health care provide.

At one time, university medical centers provided leadership. But their lay managements have been accepting of the same strictures as physician organizations and have proved to be more concerned about generating profitable patentable ideas and products and selling revenue enhancing services then developing solid high quality systems of health care. Academic faculty missions have been subverted; teaching is less respected than publishing and generating institutional financial return.

Hospitals follow the industrial model. Just as skilled factory mechanics have been promoted to high-paying foreman jobs, promising young physicians are selected for a variety of directorships which gives them the choice of complaining and losing personal income and stature or keeping their mouths shut and not rocking their boats. Dissenting physicians may be labelled as uncooperative and, in a subversion of the medical disciplinary system, gotten rid-of.

We should not plan a return to the "good old days" when we watched patients die from infections, heart disease, cancer, obstetrical complications, metabolic disease and organ failure. But it's time for those who are in the health care trenches every day to speak up: health care decisions cannot be left to politicians, business people and economists. The lights are dimming now.