Thursday, January 26, 2006

Breaking News: Doctors Go on Nationwide Strike

And the Word Gullible is not in the Dictionary

Every so often there is a rally cry coming from the physician's lounge or during a medical staff meeting for a doctor's strike. It usually begins with the usual diatribes about the current dismal state of affairs in our Healthcare System. "Decreasing reimbursement. Increasing expenses mostly due to the rising malpractice insurance costs. Greedy lawyers forcing patients to turn against us. Insurance and pharmaceutical company CEO's making millions ." This is soon followed with a call to organize and go on strike to "show them". If we somehow overlook the ethical dilemma of doctors forming picket lines and going on strike there is an even more pressing reason not to pursue this course of action. It won't work. Striking is an Industrial Age solution to an Information Age problem. The solution to these problems will be achieved by a better understanding of the age in which we live.

Specialization and Power

Once again we have become victims of our own success. It started with the Flexner Report in 1910 which criticized the wide variation in Medical School education that occurred at the time. By standardizing medical education the heterogeneity of practice patterns was reduced and the quality of medicine improved. Over the latter half of the 20th century medicine experienced some of the world's greatest advancements ever seen on this planet. With these advancements came the need for greater specialization. To understand, develop, and apply these great achievements required individuals to focus their practice of medicine into a more and more defined niche. Specialists became more highly valued for their services which pressured them, along with the assistance of newer advancements, to sub-specialize. Procedurally oriented specialists and sub-specialists became the most highly valued of them all. Many developed competing interests with each other and there in lies one of the obstacles to any meaningful effort to organize. If your competition wants to go stand in a picket line while you treat the sick people in your community that only improves your standing in that community. There is another reason why specialization discourages widespread organization and that is because as we become more specialized we tend to lack common interests. Rheumatologists rarely cross paths with a Trauma Surgeon and neither can see how they can help each other's cause. Specialization increases specialty autonomy and power but decentralizes the power base of physicians as a whole group.

Parts is Parts

There is another factor at work here which is also a derivative of the Flexner Report and that is the positive benefit of medical education and training standardization. The high tide raises all boats and that is what the Flexner Report did for medicine. This spirit spread to the residency and fellowhip training programs and lives on in the mission of the American Board of Medical Specialties (ABMS). This has the effect of allowing for personnel who are "interchangeable". That is not a word Physicians like to use but I believe it is a concept that patients use. Patients don't care where you trained or even where you ranked in your Medical School class. Some might ask if you are board certified but really most are only concerned with whether you accept there particular health insurance. That is not a failure of a Healthcare System; it is a success. The differences that physicians detect in the quality of healthcare are not as big a concern to the consumer as we would like to imagine. As we all know differences exist but to the average patient so do costs and that drives their decisions as much as it pains us to hear that point. Striking, for more pay or whatever, will only serve to alienate patients even more.

This is not the Age of Aquarius, Is It?

The key to solving the problems of today is to understand the age in which we live. I believe we are undergoing a transformation from an established paradigm for delivering healthcare to an emerging paradigm for delivering healthcare. If you have read any of my other posts you are probably sick of hearing this by now but it is worth repeating as it may hold the key to solving our healthcare crisis. This emerging paradigm predicts that our Healthcare System will appear different but will be better as a result of the change. As the patient-physician relationship is the cornerstone of the established paradigm this is were the greatest change will be generated. The physician/provider of the future will play a much different role. In doing so, physicians will change to meet the needs of the future. That change is occurring now.

You Don't Have a Real Job, Do You?

The supreme irony of this change is that physicians will ultimately become more organized and achieve more power as a result of it. I know what you're thinking, "Terry did you actually read any of what you just wrote? And by the way have you gotten a job yet?" Ok, ok quit giving me a hard time, the answers are yes and no. (But not necessarily in that order.) What I mean by that is organization and power will be held within the context of the emerging paradigm not the older established paradigm. Let me explain.

Are You Team Worthy?

Physicians of the future will function in a very different capacity than they currently do. Standardization of medical training allowed for development and specialization within healthcare. With specialization comes decentralization of a central power base for all physicians but increases it for specialties. I think this trend will continue. We gave up power as a group to achieve it as specialists. I think the next step is to transfer some of the power as specialists in order to achieve it personally. Professional autonomy will give way to personal autonomy. Physicians of the future will need to be more flexible and adaptable. This will provide greater freedom of choice. They will also relinquish control of their individualistic practice styles to make way for a team approach for delivering healthcare. The patient-information axis will become the cornerstone of the Healthcare System and it will be the Multidisciplinary Healthcare Teams that will be charged with administrating that care when call upon to do so. Since standardized Physician training will decrease heterogeneity for knowledge and skills, the ability to adapt and fit in with the team will become a priority for team fitness. The niche a team fills will be the basis for organizational growth and development for both the team and the team members. This may seem like a wild idea but I believe this system is changing for the better.


Greedy Trial Lawyer said...

Were you on drugs when you wrote this piece? It makes no sense.

The bottom line for most physicians is how they can make more money. That is the reason they chose medical school in the first place.

If your article is meant to let doctors know of the coming financial good times you have certainly used some very clever codes.

Trauma One said...

The points of the article are:
1)It is highly unlikely that physicians in the US will sufficiently organize anytime in the near future and go on strike, as some think we should, as a means to challenge the "greedy trial lawyers".
2)Specialization, while good for patient care and physician's pocket books is one of the obstacles to large scale organization. I don't think doctors are as unified on how to approach the healthcare crisis as people think.
3)As Jack Welch once said, "Customers guarantee jobs, not companies." Put another way, patients guarantee the future jobs of anyone in healthcare, especially doctors. Customers use cost to make decisions. If something comes along that can deliver a product or service at a reduced cost that is what customers will choose. (Think Walmart) This includes the services provided by doctors and lawyers.
By the way:
No drugs, just clean honest living. Do you know what that is?
Also:What does a "greedy trial lawyer" care about doctors striking?