Doctors are the Cause of the Healthcare Crisis

There’s an awful lot of finger pointing going on, as to whom or what is to blame for our healthcare crisis in the US. In the June 1st, 2009 edition of the New Yorker magazine, physician and best selling author Dr. Atul Gawande makes a case for physicians, and specifically “entrepreneurial” physicians, as the main reason healthcare costs have skyrocketed. Focusing on physicians and hospitals in McAllen, Texas with those in El Paso and other locales such as the Mayo Clinic and Grand Junction, Colorado, the data shows that overutilization of everything from diagnostic testing to surgeries and home care in McAllen caused healthcare costs to be double that in a similar community such as El Paso. The sad fact is that patients in McAllen are no healthier despite all this “extra care” provided.

Maybe the truth hurts, if Dr. Gawande is right. But maybe his conclusion is too much of a gross generalization. Some physicians enriching themselves at the expense of their patients (which I agree is unethical and plain wrong) does not mean that all physicians are guilty as charged. But what about all the other factors that determine the final cost of healthcare to patients, and our country and society in general? Dr. Gawande discounts the effect of unnecessary testing done to “CYA” in case of lawsuits. Tort reform isn’t needed based on his findings. No mention of prescription costs is included in the article. Now doctors are the main, biggest, perhaps sole reason for our current healthcare crisis!

And the article’s conclusion is that “entrepreneurial doctors”, which includes not only doctors performing their own procedures (like getting a little ultrasound machine and doing their own studies) to get the payment instead of the local hospital, but also any doctor that has any other diversified stream of income! If you own your own medical office building and get rent from other tenants, you are guilty! Don’t consider doing chart review for insurance companies or your friendly malpractice lawyer! You’ll be tainted and contributing to the problem. (I’m not sure if authoring best selling books counts against you.)Suppress any instinct to do anything but cerebral medicine, or else you won’t be one of the better doctors!

Isn’t there a middle ground? Aren’t all extremes bad? I’ve written on my blog elsewhere that my personal experience is that having a well-run practice, fiscally sound, leads to better medicine. I’m sure of it. Maybe I need to apply for a double-blind study grant as the principle investigator to prove that point, but I’d like to hear how any other state of practice is better for the patient or the doctor.

I agree that our healthcare system is broken and needs a major overhaul. I know there are bad, inept, greedy, selfish doctors. Bet that true of any industry from banking to journalism and everywhere in between. But doctors have the public trust, maybe moreso than our politicians, and doctors certainly have answered a high calling that demands extremely ethical behavior. Doctors, even entrepreneurial doctors, are no doubt part of the problem and hopefully will be a big part of the solution to our current healthcare dilemma.

So be that better doctor. Behave well. Make ethical unbiased selfless decisions for your patients. Your practice will thrive. Patients will know you’re a top doctor and it will all work out for you.

But stand up for yourself in this debate too! I think doctors need to contribute to the solution, even if it takes painful self-examination and even a change in behavior to no longer be part of the problem. We deserve to be paid a fair wage for our work. We don’t need to apologize if we’re “entrepreneurial”, as long as we are ethical and remain true to our patients and our life’s calling. Let’s hear you!