THE DEPROFESSIONALIZATION OF PHYSICIANS

(Published nationally in Psychiatric News, February, 2000)


Back in the last millennium when I was a young doctor, becoming a physician meant that one had a “calling”, something quite different than “going into business.” In those days, being referred to as “doctor” meant you commanded respect and were esteemed. Back then, the purpose of insurers like Blue Cross and Blue Shield were to see that their clients’ claims were paid. And in those days, the purpose of the hospital was to provide care for the ailing patient until s/he was well and could return home healthy.

Times have changed! CEO’s and other “bean counters” and business people of all sorts have hijacked American medicine and run it as if it were a manufacturing plant. Their “calling” is to make a profit, and the purpose of the insurer is to deny claims. The hospital’s goal, once the procedure or treatment is completed, is to get the patient out of there as soon as possible.

The latest tactic in the health care industry is to supplant the physician with all sorts of “physician extenders”, much like “beef extenders”, I guess. The physician’s care is becoming limited to doing the procedure or supervising the treatment. There is no need for the doctor to have a relationship with the patient--the “extender” will do that!

The art of medicine is dead. Even we psychiatrists, specialists in forming therapeutic relationships, talk more these days about neurotransmitters than about the angst of mental illness. Calling a physician’s office is now less of a personal experience than calling an airline to get a plane reservation. At least the person making my reservation talks to me politely and takes time to explain things. My doctor’s answering machine, in contrast, tells me to hang up and call 911 if I am having a life threatening emergency; otherwise I am instructed, after pushing many numbered options, to leave a message which may be responded to within 24 hours.

Physicians have been deprofessionalized. We are now all just “providers” in a massive health care industry which is increasingly impersonal, detached, and profit driven. Forget about even calling yourself a physician--your patients won’t know the difference between you and your “extender” anyway.

Fortunately for me, my career is in its late stages, and I am still able to practice the old fashioned way. I have a small one-man “cottage industry.” I try to provide personal attention for my patients, answer incoming calls when possible, return peoples’ messages promptly, and (of all things) even do my own psychotherapy. But I fear, as do my peers, that there will be no doctors left in the future to take care of us with the personal attention, patience, and understanding that once was common practice.

Don’t get me wrong, I appreciate much of this new high-tech age in which we live. I love the ease with which the internet connects me to information, and I value the convenience of my cellular phone. But I’ll take the physicians of yesteryear any day over today’s “providers.” Those doctors did have a calling and did know how to practice medicine as an art form. They knew how to comfort and how to ease suffering, and they understood the importance of a therapeutic relationship.

The tragedy of American medicine falling from its Golden Age, to what it has now become, is clearly a product of capitalism at its worst. When medicine is governed by health care planners whose only concern is profit, then the number of people who die because of premature discharge from the hospital amounts to a simple calculation of potential malpractice losses versus salaries saved. But if the person who died unnecessarily happens to be your loved one, the result is actually incalculable! Perhaps if every business person or insurer working in the health care industry today was required to work on an oncology unit, a hospice, or a psychiatric facility for a period of time, they would appreciate the nature of medicine rather than seeing it as just a business.

Medicine was never designed to be a business, and it never has been a good business, as measured by business parameters. Yet, one of the greatest accomplishments of twentieth century America, has been the nearly doubling of the human life span. This occurred, not in the context of worrying about every dollar spent, but by persevering in the development of medical science and improving the practice of medicine.

We are no longer struggling with recessionary pressures in our economy as we were 8 years ago, when the dismantling of American medicine began for the sake of controlling inflation. With the explosion of wealth over the past several years, maybe we can get back to quality in medicine, and let physicians run the show again. Business people can return to running businesses, and we’ll all be better off!

Hugh R. Winig, M.D.