Spring 1999

Editor's Note

We Can't Have it Both Ways …

Whenever physicians congregate, be it staff meetings, educational seminars, or social events, you can’t help but overhear grumbling about government interference in medicine, HMOs influence in medicine or Corporate influence on our practice and lifestyle. However, at the same time, we only need to look around to see physicians clamoring to sell their practice to hospitals or large corporate management firms. We see young physicians looking for employment contracts and benefits instead of practices. And we see old physicians retiring early rather than deal with the challenges to traditional modes of practice.

Unfortunately, we can’t have it both ways. We cannot abdicate the management of the business side of medicine and yet continue to expect the practice of medicine to follow our vision of how that should be done. The future of medicine as we know it depends on physicians maintaining control. If we sell out to hospitals we should not be surprised if our practices become clearinghouses to fulfill their needs. If we continue to allow HMOs to contract with our patients we shall have to get used to a business entity telling us how to practice medicine. And if we continue to join large for-profit management companies then we shall live with serving the bottom line instead of the best interests of our patients.

So what is the answer? It is true that for the most part physicians are not good businessmen. No doubt we need to hire the expertise to function in this complicated milieu of health care delivery. But the secret to success is control. We must not abdicate control to organizations and individuals who are not motivated by the patients best interests.

Direct physician contracting with business and government is certainly one way to eliminate the intrusive controls placed on us by HMOs. With the current widespread public dissatisfaction with HMOs it is clear they will not survive as the health care delivery system of the future. That fact looms as the opportunity for physicians to resume control of health care and their own destinations. If we don’t seize this opportunity, however, large hospitals and for-profit corporations are already jumping into the breech with their direct contracting plans using their base of acquired clinics to insure health care delivery on their terms.

As has been oft quoted, "Change is opportunity." If we put our heads in the sand and refuse to believe that public demands in health care are changing and see that as an opportunity to once again assume control then someone else will design our future for us. History should tell us that. If all we look at is the salary and benefit package and don’t ask the question, "Who’s in charge?" then we are doomed to live life as employees with no more influence on our destinies than the ill-fated characters of the comic strip Dilbert.