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POLICY: A Riposte to Physicians Who Post on THCBBy the Industry Veteran

The Industry Veteran joins us this afternoon in the latest in THCB’s series by guest posters, following up on excellent posts by veteran financial journalist  Maggie Mahar and orthopedic surgeon turned talk show host Eric Novack. The Veteran found Eric’s comments on the health care system inspiring — to put it mildly. They set him to thinking about the true role of physicians in the healthcare system and in society at large. Needless to say, as always on THCB, his words are his alone.     
    
   

On this sunny morning I thought I might take time away from more productive pursuits to answer some of the typically narrow minded and self-serving posts of the physicians who attend THCB in the same way that dogs raise their hind legs at convenient lampposts.  The object of my opening disdain is someone by the name of Dr. Eric Novack.  Alas, Maggie Mahar demolished his drivel in a more cordial manner.  Novack’s transparently phony views suggest an analogy to Samuel Johnson’s comment about a dog walking on its hind legs.  Physicians writing about politics, health care economics or social policy are similar to this canine trick in that it is almost never done well; the wonder is that it is done at all.

Other physicians seeking to foist their miscreant views on THCB usually content themselves with illogical or poorly informed letters that disagree with some of my posts.  I don’t wish to be too caustic in responding to their blatant ignorance.  After all, they spent years performing brute rote memorization and other, low cognitive tasks, so their distorted thinking is a product of their trained incapacity.  While it isn’t terribly useful to disparage plumbers for being poor cooks, the pipe cutters who consider themselves master chefs despite an inability to boil a potato do merit some contempt.

A few themes of disagreement and bewilderment emerge from the physicians’ posts.  One chap, for example, asks about the “de-skilling” reform that I urge upon medical practice.  I realize that memorizing bones and ways to add carbonyls to benzene rings doesn’t leave much time for understanding history, so I’ll try to provide a remedial lesson.

In the late 19th and early 20th centuries, the pace and substantive nature of industrial production was largely directed by skilled craftsmen on the production floor.  This situation stymied the interests of managers who considered matters of volume, configuration, quality and cost as matters for their control. Their solution, as implemented by Henry Ford and others, consisted of the assembly line for which workers with far less skill could be inserted or removed as interchangeable parts.  Labor historians have actually documented many periods of de-skilling throughout the industrial revolution.

As applied to medical practice, the process consists of pushing the scope of practice, discretion and competence down the food chain.  Primary care practitioners should do a fair amount of the things that only specialists do at present.  Nurse practitioners should assume responsibility for many primary care functions, PAs should get other responsibilities, and so on.  Other health care professionals such as pharmacists and nurses should also assume more physician responsibilities.  Of course, physicians for years have berated such “assembly line medicine,” “therapeutic triads” and other labels for the process, despite the fact that studies have shown it produces better outcomes and lower costs.

Other affirmers of the Hippocratic oath who seek to recoup the costs of their medical education from their first four patients find fault with my call to feminize medicine and increase the number of foreign medical graduates.  They claim that even now, 50% of practitioners are women and most hospital physicians are FMGs.  Their figures are possibly correct, but their claim is equivalent to saying that Hispanics, blacks, Asians, poor whites and the aged infirm run the US because there are so many of them.  I merely ask these disingenuous posters to examine the ranks of service chiefs at major teaching hospitals, the senior faculty at top medical schools and the key opinion leaders who speak on behalf of the Big Pharma companies at medical conventions.  Only small percentages of these big, swinging schwanzes are women or FMGs.

A few years ago I systematically examined the reasons for this paucity of women in the medical profession’s key positions.  Basically, the motivations and the personality profiles of influential physicians approximate those of senior executives at the largest 1000 companies.  The desire for wealth, status, power, ego and other forms of self-aggrandizement predominate.  For some of the same reasons that the numbers and influence of women in the corporate boardrooms remain small, their sway in the medical profession is also puny.  In most cases, women are just the working stiffs and peons of the profession.  That stratification of medicine won’t do.  I’m talking about making medicine a feminine profession in the same way as elementary school teaching, nursing and public librarianship.  That will incentivize you egocentric males and the small number of female-impersonating women in the profession to ply your greedy ways in business without the special dispensations that society grants to physicians.

Finally, I don’t know whether I’m amused or nauseated by the posts from physicians who seek to justify their claims to unconscionable incomes by citing the many years they spent in school and the related costs.  Along the same line, a cardiologist at the American College of Cardiology meeting told me that the country should guarantee cardiologists a starting salary of $250,000, at a minimum, because they had to forego the enjoyments of their years between the ages of 20 and 30.

Well, according to the logic of THCB’s greedhead physicians, veterinarians sure get a raw deal because they spend quite a few years in training and receive only a fraction of MDs’ salaries.  Of course PhDs really take it up the sphincter, with all the years they spend in graduate school, a series of post-doc positions in indentured servitude, and then some really chancy prospects of even getting a job.

The lesson here is not like memorizing the steps of the Krebs cycle or the twelve cranial nerves, so I’ll take it slowly for sawbones readers.  No mnemonic devices or acronyms are required. 

One’s income in a market economy is not based upon years of schooling, contribution to society (whatever that means), or any other assessment of intrinsic worth.  Instead, labor is a product that seeks its economic rent in a competitive market and, like any other product, it captures whatever willing buyers will pay for it.

Of course, if one’s profession obtains a legal monopoly through state licensure and then chokes off the labor supply, buyers in the market will have to pay more for that particular labor.

Alas, the day proceeds and I can waste no more of it instructing arrogant, ignoramus physicians.  I charge by the hour and since I don’t make the return on equity of a Big Pharma company, I see no need to coddle your swinish asses.

As a parting shot, I see that Dr. Novack identifies himself as an orthopedic surgeon.  This information reminds me of an old axiom that made the rounds in the pharmaceutical industry several years ago.  Before the prevalence of Ken and Barbie reps, the ranks were smaller and populated by pharmacists and others with graduate degrees in the health sciences.  Many of these sales people used to complain about the fact that they needed to dumb down the detail presentations so drastically for some specialties.  That’s when one wag passed around the story about the procedure used by residency programs for selecting new people.  According to his apocryphal tale, teaching hospitals would take the bottom 10% of med school graduating classes and if people in this tier could bench press 200 pounds or more, they were taken into orthopedic programs.  Those unable to push the bar to arm’s length went into OB/GYN.  I suspect Dr. Novack had two nurturing nurses spotting for him and they raised the bar from both ends.  —  Industry Veteran

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25 replies »

  1. “Oh, my, how this is funny. The responses here by all the thin-skinned, ego-ballooned docs merely prove the Industry Vet’s point. Bravo, Industry Veteran, for laying the bait and allowing the supercilious twits to ensnare themselves. You made my day.”
    The only twits here are you pencil necks that sit behind a desk all day. You and the “Vet” are probably fat, bald and out of shape. Sucks to be you.
    I am heading to the gym with the ortho doc to pump some iron. It is hard getting all the babes and making all the money.

  2. I’m an orthopedic surgeon. I defy Industry Vet’s venemous generalizations about docs in many ways.
    Just want to lament that IV’s excellent points are lost within a self-serving vitriol (and not really funny, IMHO) that tends to turn folks off. Off in the sense, that they lose interest in following childish posts that may contain good info, or lost in anger and ego defensive posturing as you can see in the above. I like the freedom of this blog, yet when it denegrates into annoying harangues designed to cheaply grap attention (like a loud fart in an elevator), I just can’t wait to get out of it and on with it (I’m going to go pump iron, count my money, and dream of being a pundit).
    Namaste

  3. Industry Veteran, where are you????
    He does this every time. Starts an inflammatory thread, and then runs away.
    A true coward

  4. Having read the IV’s post and it’s commentary I am reminded of my sentiments after evenings of “debate” in a college dorm populated by sophemores. No enlightenment or resolution….just a lot of intesity fliging words at each other. Sure makes me wonder what a guy calling himself a veteran gets from this; but I now understand better how the sophomores gained practice on their way to becoming veterans…yet it seems the aqusition of wisdom is still pending.

  5. Oh, my, how this is funny. The responses here by all the thin-skinned, ego-ballooned docs merely prove the Industry Vet’s point. Bravo, Industry Veteran, for laying the bait and allowing the supercilious twits to ensnare themselves. You made my day.

  6. once again, “industry veteran” spews out ridiculous nonsense, and is nowhere to be found to defend his idiotic rant.
    We have a term to describe these kinds of internet posters: TROLL

  7. yesterday I saved someone’s life. I wonder if “industry veteran” has ever done that. Perhaps his MCAT scores weren’t high enough.

  8. “Labor historians have actually documented many periods of de-skilling throughout the industrial revolution.”
    De-skilling creates a machine driven, mind numbing, automaton, boring workplace. Not I think what I would like to see in medicine. Think what cash registers that calculate your change have done to enhance the math skills of check-out clerks. We need more thinkers not more machine minders. Memorization does not create thinkers any more than computers do.
    “As applied to medical practice, the process consists of pushing the scope of practice, discretion and competence down the food chain. Primary care practitioners should do a fair amount of the things that only specialists do at present. Nurse practitioners should assume responsibility for many primary care functions, PAs should get other responsibilities, and so on. Other health care professionals such as pharmacists and nurses should also assume more physician responsibilities.”
    On my recent trip to Canada and talking to a close friend who is a hospital system CEO, she is trying to get exactly what is stated in the above quote; a team approach to healthcare management, particularily cronic disease care. Her biggest stumbling block is the unwillingness or mindset of the doctors to work in a team environment. They are not team players by large, or I think not trained as team players. Women however have a better sense of cooperative work to solve problems, while I think docs only look at it as infringing on their god given turf. Gotta love that testosterone.

  9. Hi all from the UK where I’m hiding out at my sister’s wedding–hence all the guest posting.
    No, I’m not “The Industry Veteran”–that’s very clear. I do know how he is, & he does have a great deal of health care industry experience. I give him and anyone else who wants it the ability to post anonymously–so long as they tell me who they are. That’s a policy that you can read by clicking on this link
    In his case if his various clients knew what he was saying (not so much in this post but in various others) it would probably mean the end of his career.
    I happen to think that he writes very funnily, but I also appreciate that he can be pretty insulting–but those he insults are big boys (and girls) and are free to either openly or anonymously return fire (or not–that’s their choice). I happen to think that his perspective is amusing and provocative, and adds to the blog. As do many of the commenters and contributors I feature, and I thank all of you for coming and posting.
    But these opinions are his own!

  10. Well I thought it was funny, but then maybe that’s because I knew too many grade-grubbing pre-meds in college.
    But I think it’s funny to see people say that doctors are the only ones that add value in the healthcare system. I thought they always complained about their administrative burden and wished that other people could take more of it off their shoulders so they could spend more time on patient care. Which is it?

  11. I’m sorry to ruin this love-fest, but The Industry Veteran certainly adds value. His throwback of medicine to the industrial revolution is something economists have been doing for years. Could it be that he knows something? I’m sorry, but as long as someone is adding value (with fact or humor, the latter of which no one here seems to have thus far), there’s no reason for this hostility. This is a blog on the internet. He’s a poster. He’s speaking his mind, and in an entertaining manner at that. And not all of what he says isn’t serious. Some of it is very serious…and very true. As I said, physician licensing is something that’s been debated by economists for years.
    There are quite a few authors throughout history who have had things to say, that, well, didn’t bring as much many roses as tomatoes and throwing-knives. So they hid their names. So what? If you don’t like it, say so and leave it at that. In the pure Millian sense, we have to respect the vocal minority. The tryanny of the majority is convenient…but every once in a while that minority is right, which is why it’s so important to keep them around, no matter what they have to say. This is a debate.
    And I’m sorry, if I were you all, and if someone like Jack Daniels (um, not his real name, I hope) can spew verbal violence in all caps while making a citation mistake and get not one of you to seriously target _him_ on the same grounds you’re targeting Veteran, I wouldn’t be ready to tell Mr. Holt how to run his blog. (Mr. Holt; I think you’re doing a fine job). Indicentally, Holt is giving you all a place to vent…and that adds value in and of itself.
    The point is, even Jack has a right to speak his mind. I’ll make fun of him, and he might make fun of me, but should he be banned? Of course not.
    Do I agree with everything Veteran has to say? Nope. Do I think he should allowed to post, even without revealing his identity? Yes, absolutely.

  12. Complete and utter crap …
    What goes around comes around, buddy …
    Notice how many people you have supporting you?
    There’s a reason.

  13. IV- when one does not have an argument… attack the messenger.
    I would be more than happy to have a point by point debate with you about health policy… on two conditions:
    1. no anonymous posts
    2. another ad hominem attack and the debate is over
    Since I am 110% certain you are incapable of following these simple ground rules, I will go back to enjoying my vacation.

  14. Jason D:
    If the AMA had any balls they would take the US Gummit and Medicare to the SCOTUS and have them strike down the 2 year opt out rule which is Unconstitutional. Private contracting b/w patients over 65 years of age and their doctors should not be limited.
    I beleieve in 1999 Congress passed the Balanced Budget Amendment Section 4507, which allowed private contracting – – but only if a doctor withdraws from ALL Medicare for ALL patients for a period of two years. This is total BS and the AMA or someone (AARP) should take this issue to SCOTUS and get it changed. Clearly Unconstittutional.
    pgbMD

  15. “One’s income in a market economy is not based upon years of schooling, contribution to society (whatever that means), or any other assessment of intrinsic worth. Instead, labor is a product that seeks its economic rent in a competitive market and, like any other product, it captures whatever willing buyers will pay for it.”
    Wow this is really a foolish statement. Only an idiot would argue that healthcare is a free market. Medicare controls 50% of all healthcare dollars and has sufficient market play to dictate reimbursement anyway they want to. Thats NOT a free market, therefore your argument holds no merit.
    Are you advocating that Medicare/Medicaid be repealed? Because thats what you’ll have to do in order to have a free market in healthcare.

  16. “Of course, physicians for years have berated such “assembly line medicine,” “therapeutic triads” and other labels for the process, despite the fact that studies have shown it produces better outcomes and lower costs.”
    This doesnt make any sense. You say that nurses should be allowed to do doctoral duties, but the studies you are referring to analyzed ONLY a team appraoch to healthcare.
    Thats NOT what you are advocating. YOu are not advocating teamwork between doctors and nurses, you are advocating that nurses REPLACE doctors. There is NO EVIDENCE showing that model to be anything more than dangerous.
    The best healthcare, proven time and time again by many studies, occurs in a teamwork model. But your agenda doesnt fit that profile.

  17. Such anger. Where does it come from? Could The Industry Fool be the pinheaded loser that got caught cheating in Chem 101 in college and flunked out? Or maybe the guy trying to cheat off my Physics 101 exam that failed that too. There are plenty of them out there that just couldn’t make that first year cut and many of them are jealous. I PITTY him/her.

  18. I’ve been reading this blog for several years. “Industry Veteran” is a shadow identity, not a real poster who will come out and defend his ideals.
    He has not posted a single reply to any thread on THCB, EVER. SEarch thru the archives and you wont find a single response.
    Industry veteran is nothing more than a troll. He posts provocative material to draw people out to argument, and then retreats away and has a good laugh.
    His inflammatory post here is meant to do the same: he wants to draw the doctors out and laugh while they argue and yell.
    Dont feed the troll folks.
    P.S. My personal opinion is that Industry Veteran is none other than Matt HOlt posting under a different name. They obviously share a close relationship, constantly emailing back and forth. My bet is that Matt Holt uses the IV penname to post thoughts that he’s too scared or gutless to own up to himself.
    Even if its not Matt Holt, I’m convinced that “industry veteran” is nothign more than an internet bully who is too cowardly to own up to his own ideas. He cant defend them, thats why you never see him post any responses.

  19. BTW, if doctors work is really nothing more than pure memorization, then we should just get rid of EVERYBODY in the heatlchare system, including nurses, and just have computers do the diagnosis and treatment.
    I think I’ll wait for “industry veteran” to test this new computer system on himself before I try it.

  20. Who is this “industry veteran” and why do his misinformed rantings and ravings deserve any special spotlight on this blog?
    There’s no real analysis here, just a smear campaign by somebody who claims to be an “industry veteran” but based on his complete ignorance of the healthcare system, I have to ask which industry is he really a veteran of?
    I seriously doubt he has any experience in the healthcare industry.
    So come out and reveal yourself. Dont hide behind a mask.

  21. Oops I thought the article was by Matt Holt. Instead its by some no-name asshole called “industry veteran” who refuses to reveal his identity.
    Internet anonymity certainly makes people bold, I doubt he would have posted the same lengthy rant if he actually had to put his real name to it.

  22. I got a better idea. Lets kick out all of the “know it all” assholes like the fool who runs this blog who have never treated a patient or delivered a baby.
    I’m talking about idiots like Matt Holt who think they know how to cure all the ills of the healthcare system yet has ZERO EXPERIENCE IN THE FIELD.
    For far too long, outsiders like Matt Holt and the insurance executives in general have made a killing in profit while offering no real value to the heatlhcare system. Hell in our current system, administrators and “policy experts” like Holt outnumber doctors.
    Quit leaching off the medical field. At least doctors add value to the system. Pundits like Matt Holt do nothing but skim off the top.

  23. I have always wondered whether one of the fundamental problems in health care today is that some folks in the health care management/ policy/ research spheres deep down really dislike physicians, or worse.
    The post above suggests that this may really be the case.
    This goes beyond an ad hominem attack on Dr Novack to a smear of the whole profession.
    We may not be perfect, we may make mistakes, but we don’t deserve this.
    Likening physicians to urinating dogs is hardly a way to advance a discussion of improving health care.
    But that obviously wasn’t the point.

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