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