The Democratization of Healthcare: whither the physician?

Unfortunately for physicians, their grip on power within the healthcare industry is waning and will, with time, decline further as other healthcare professionals become more educated and specialized.

It is, in an economic sense, inevitable.

As a society, we admire physicians for their skill and desire to heal the sick, but as an industry, and a society, it’s time to end physician worship.

Due to the nature of healthcare, we must dethrone the patriarchs of the golden Rod of Asclepius and disseminate their power to nurses, occupational therapists, physical therapists, psychologists, respiratory therapists and other members of the healthcare team.

Why?  Well, several reasons: lack of supply, increased cost, and ego.
According to Dr. Bruce Parsa, a former colleague of mine, this is the future of healthcare:

  • Healthcare reform will expand access, further increase demand, reduce the level of reimbursement, and eventually impact how healthcare organizations and providers are reimbursed for their services.
  • The population is growing, and aging, which will increase demand.
  • The physician (and other providers) supply is aging, which will result in future scarcity for certain specialties and disciplines. Hospitals will continue to buy physician practices and employ more physicians and providers.
  • The financial performance of private practices continues to decline, thereby resulting in more integrated systems of care.

What does all this mean?  Well, let’s break it down.

As demand for physicians increases and the supply of physicians decreases, the cost of per unit hour for physicians will increase, most likely substantially unless the healthcare gap is filled by other skilled healthcare providers, such as nurse practitioners, registered nurses, psychologists, etc.

As a society, we can’t continue to pay physicians substantially higher wages when lessor skilled and educated professionals can do the same job for less.

It isn’t economically viable, let alone practical.  If we don’t artificially keep other professionals afloat in other industries, why should we do it in ours?

Now, let us talk about ego.

“Do you know the difference between God and a doctor?” I do, “God doesn’t think he’s a doctor.”

I know, I don’t mean to be harsh, but all egos, physician and alike, need to be left outside hospital walls.  Unfortunately, physician egos, as we’re all too aware, have negatively affected patient care in the following ways (I’m just using commonsense):

  • If you’re afraid to be yelled at by a physician, you’re less likely to call them when they’re needed.  I’m sorry, but this concept isn’t new, I’m simply restating Jeremy Bentham’s Principle of Utility: people pursue pleasure and avoid pain.
  • If you’re afraid of physicians, you’ll be less likely to hold them accountable, e.g. washing their hands or using alcohol rub as they enter and exit hospital rooms, write scripts using ineligible handwriting, promptly answering their pages, etc.  If physicians are seen as anything but your equal, you’re considered to be less equal.  And when this happens, injustice happens.
  • If you’re afraid of physicians, you’ll be less likely to trust them.

I could go on and on, but I’m not going to, as there is no need.  My point isn’t to lambaste physicians, as my uncle is a physician and I have worked with many hardworking, intelligent, and moral physicians.  However, I’m not going to let them off the hook either, they need to adapt to change, and we need to make change happen.  We have no choice.

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