Doctors are giving up on private practice, assimilating into Big Medicine
The COVID-19 epidemic has accelerated a growing trend among doctors toward corporate medicine and away from private practice. The personality and priorities of doctors had already been undergoing a metamorphosis. And, just as we have witnessed the collapse of small businesses across the country from the politization of the disease, many independent physicians have lost their practices as well. American entrepreneurship in medicine is another casualty of the government's response to COVID-19.
What survives the crisis is a Big Business/Big Government cluster of health care delivery "systems" where doctors can find safe harbor. Older doctors who remember when hard work and good service made them a better living are tempering their expectations and joining up, no longer having to deal with the opaqueness and complexity of billing and collections. Younger doctors with lower expectations and a greater desire for a regular, less rigorous schedule have already adapted to the new normal.
In Star Trek, the Next Generation, the great assimilator is the soulless Borg, a space-traveling "hive" that integrates and incorporates other civilizations' technology and workforce to survive, unable to create on its own. When encountering the Borg, the doomed victims are warned that "resistance is futile." Will medical care dispensed through these health care giants approach the quality, accessibility, and overall service of a private practice?
Having been exposed to employee physicians at the Veterans' Administration hospitals and varied employee physicians at competing health care entities in Atlanta, Georgia, it is easy to see how owning a practice versus working for a conglomerate changes a doctor's attitude. If a clinic day is light in private practice, the doctor will let it be known that he is available for consultation and see how to get more traffic through his office. When a day is light with the Borg, the "worker bee" doctor blames the entity, throws their hands up, and leaves early for home. There is no reason to work late, come in early, or evaluate efficiencies and costs. The physician has no sense of ownership.
Many doctors in 2021 are seeing patients only when gowned and gloved and with eye protection, with a seeming aversion to the physical exam. Keep in mind that this is all done for a virus with an overall 0.6% mortality rate. But the fear is reinforced by the health care systems, with doctors working in outpatient clinics being told to stay home because giving care is too dangerous.
In 1983, when undergoing surgical specialty training at Grady Hospital in downtown Atlanta, we were all too aware that we were being exposed to a new virus transmitted by blood that had a nearly 100% death rate. We were not told to stop seeing patients because of the risk of contracting what would later be called AIDS. We were the front line for the care of the poor, and it was our duty to protect ourselves as we could, use common sense, and attempt to save lives in the "war zone" of our famously bloody city. We graduated with a sense that we had been tempered through a crucible, and we wanted to conquer the world.
Those were different times with different priorities and different personalities.
In its best episodes, Star Trek would give lessons in the benefits of freedom, free will, and individualism, all tenets of the American identity. "Perfect" societies that have taken away choice, eliminated evil, or abandoned their flesh and blood bodies are exposed as soulless and barren. The heroes would display the advantages of living "illogically," with the ability to choose one's path in life being preferable despite the uncertainties and failure that may result.
This surrender of physicians to collective work is greasing the path toward socialized medicine. The left will continue to use the crisis of COVID-19 to push its agenda. The end result will be the biggest Borg of all: a federal takeover of medicine. It will be "free" to all Americans and non-Americans. No one will acknowledge that quality of care, availability of access, and lesser cost cannot coexist. People will find out that a doctor without any incentive to work will not have any sense of ownership in the process.
Unfortunately, there is no Captain Picard to remind us of what is good about American entrepreneurship in medical care and how soulless and barren our care will trend as a result.
Image via Pixnio.