Dr. Richard Feldman: Corporatization isn’t good for patients, doctors

The corporatization of medicine removes much of the essential autonomy of physicians. According to the Physician’s Advocacy Institute, almost 75% of physicians in the United States are now employed, with half of all physician practices owned by hospital systems (for-profit and not-for-profit), large insurance companies, private-equity businesses, hedge funds, large physician-owned corporations and others.

Employed physicians, especially primary care doctors, are mainly evaluated and paid on the basis of productivity. The more patients a provider sees, the more revenue generated and the greater worth the provider has to the corporation. Quality care and patient satisfaction are relatively small parts. Ever wonder why your physician has very limited time to listen and address your medical concerns? That’s likely why.

Medscape Medical News reports that 10% of U.S. physicians are either employed by or work under the control of the parent company of UnitedHealthcare—just one of the insurance companies employing physicians.

Dr. Robert McNamara, an emergency physician and co-founder of Take Medicine Back, is quoted in the same Medscape article: “To have the doctors now working for the insurance industry conflicts with a physician’s duty to put the patient first.”

The business of medicine has become complicated, expensive, financially risky and challenging for private-practice physicians. Corporatization provides capital investment, greater financial stability, business expertise and market leverage for reimbursement and attracting patients. But a price is paid.

Corporatization wouldn’t be necessarily bad if it operated on the highest ethical and moral ground. But it doesn’t. Employed physicians are increasingly pressured directly or indirectly to alter their medical care to maximize the bottom line. Corporations taking control of clinical operations is not always consistent with preserving the traditional healing role of the physician and the time-honored doctor-patient relationship.

It is commonly thought that half of physicians are “burned out” from long hours worked, loss of practice control, productivity pressures, and the burdens and complexities of contemporary medical practice, much of which is exacerbated by corporatization.

On top of burnout, many physicians suffer from “moral injury,” which is well-articulated in a New York Times Magazine article, “The Moral Crisis of America’s Doctors.” They’re struggling, discouraged and frustrated that they have violated their physician core values in fulfilling the expectations of a corporate-dominated, profit-driven health care system that values revenue over providing the best care to sick, vulnerable patients.

Patients are often denied the care they deserve and need. Physicians under the productivity gun are unable to spend sufficient time with their patients and to be sensitive to their needs. The article explains that physicians “feel complicit in the betrayal of patients.”

The corporate takeover in health care causes ethical and moral dilemmas for providers. Physicians are trained in an ethos of service. The needs of patients always come first, and financial benefit should not be in the equation.

There are a few bright spots. The corporate model of “value-based care” and the “direct care” model of private practice provide more emphasis on quality and personalized care.

Legislation loosening corporate control might help. But ultimately, until our health care system drastically changes from volume-based to quality-based, nothing else will change.

As my colleague Dr. David Blank wrote me recently, “Physicians seem to have lost our place as the captains of the ship. I hope we don’t get stuck just rowing down in the galley, chained to our oars.”•

__________
Feldman is a family physician, author, lecturer and former Indiana State Department
of Health commissioner for Gov. Frank O’Bannon. Send comments to ibjedit@ibj.com.

Click here for more Forefront columns.