Idealistic Doctors

I know the heading sounds like a contradiction in terms. When was the last time you met with a doctor who struck you as idealistic? Yet that’s the tag I feel like applying to Peter Salgo, a physician who wrote an op-ed in today’s New York Times, "The Doctor Will See You for Exactly Seven Minutes". The author is a physician and professor at Columbia, and bemoans that "the doctor-patient relationship has become frayed." He says the problem is caused by "business jargon" becoming commonplace, most notably referring to patients as "customers" rather than "patients." If your doctor is treating you more distantly, like a customer, he advises seeking out another doctor.

I hate to be the bearer of bad news, Dr. Salgo, but the problem is a bit more complex than that. Most Americans are assigned to "networks" by their insurers, so if the patients seek out different doctors, the new ones are working under the same rules as the old ones in terms of how much time they can spend with patients and how their productivity is measured.

The main problem from doctors’ perspectives is that most are "wholesalers" instead of "retailers." That is, the insurance companies and HMOs engage the doctors as service providers, and pay them at heavy discounts over published, or retail, rates. The insurance companies collect the retail prices as the monthly premiums collected from employers and consumers. The biggest margins go to the retailers, the insurance companies and HMOs,  who will continue to squeeze doctors in order to try to increase those margins. It’s basic business.


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