Vigorous work and determined dedication are minimum requirements for excellence in medicine. Being the best doctors we can be means working long hours on a daily basis, in addition to covering nights, weekends, and holidays on call. It means constant studying to keep up with the latest scientific advances. On top of that, add the tasks of running our own small business as the majority of physicians have done in the past. The work is demanding, but when we can be our own boss, and know we are providing a valuable, and valued, service, it’s well worth our time and financial risk. The honor of sharing the intimate, intensely human experiences of our patients’ lives is immeasurable.
Now pile on reams of government regulations and paper work which add to overhead costs and subtract from time with patients. Toss in threats of felony charges for billing errors and ever-shifting carrots and sticks to get us to practice the way the politicians think we should practice medicine, instead of the treatment we and our patients determine to be in their best interest. Top it off with the rising risk of litigation and malpractice premiums, and is it any wonder that more and more physicians are choosing the path of employee?
Working as an employee is a reasonable and legitimate option. But when political manipulations of the business of medicine drive this choice, we need to look closely at what is going on. Is it really a move in the right direction to have physicians less independent?
The primary function of regulation in healthcare…is to constrain decentralized, individualized decision making….No longer is the physician, paternalistically committed to the patient, the driving force in medical care.
Today, this isolated relationship is no longer tenable or possible….The traditional medical ethics, based on the doctor-patient dyad, must be reformulated to fit the new mold of delivery of healthcare.
A recent article in the New York Times relates how the shift from small business owner to employee affects a physician’s politics. But that is far from the most important change that will occur because of this shift. What we really need to pay attention to is how it will affect the practice of medicine itself.