I have been taking a vacation from blogging as I try to get through a very busy academic quarter. But my last blog, “My Son the Electrician” elicited a lot of comments and I have always wanted to follow up. And today I see that the Chicago Sun Times has generously quoted me, in particular noting how I liken physicians to entrepreneurs. Lest anyone get the wrong impression, let me briefly explain what I mean.
Like entrepreneurs, physicians launch their careers by making large investments – up to ten years of post-graduate training. Such investments do not come with a guarantee. Entrepreneurial physicians – those who own their own practices or work in small partnerships, must build their practices and maintain relationships with other physicians. All successful physicians, whether entrepreneurs or employees, enjoy personally and professional satisfying careers and comfortable, sometimes more than comfortable, incomes. But only physicians entrepreneurs have ultimate responsibility for their practices and their patients.
This is what defines entrepreneurs – risk takers who assume full responsibility for their successes and failures. I have no doubt that with that added responsibility comes harder work and greater professional fulfillment.
The era of the physician entrepreneur may be coming to a close. For any number of reasons – the costs of maintaining a practice, uncertainty about future market conditions, or a waning desire for the long hours and administrative tasks that come with entrepreneurship – most new physicians are opting for employment at large hospital systems and multispecialty medical groups. As employees they will continue to care for patients and save lives, but they will no longer have ultimate responsibility for their successes or failures. The physician-patient relationship cannot help but evolve, and not necessarily for the better.
My wife saw the Sun Times article today and reminded me that she has recently experienced just what I have been writing about. After a long search, she had finally found a primary care physician whom she liked very much. Last month, that PCP, who is affiliated with a large local hospital system, informed her patients that she was moving her office to be closer to the parent hospital. I am sure this makes business sense for the hospital system, but it means a 30 minute commute for my wife and for many other patients. The PCP will have to rebuild her practice. Had she owned her own practice, had she been an entrepreneur, I am sure she would put her heart and soul into the effort. But who would blame this PCP/employee if she lets her hospital system build her practice for her? Unfortunately for my wife and many others, the hospital system does not have a heart or soul. That PCPs’ relationships with her patients is bound to change.
So you see, I have nothing but the highest regard for physician-entrepreneurs. After all, the iconic Marcus Welby, MD was an entrepreneur, and no physician, fictional or real, had a bigger heart or more compassionate soul. As our healthcare system moves ahead, let us mark the passing of the physician-entrepreneur as a signal moment, one when the physician-patient relationship that members of my generation came to know and cherish, headed into uncharted waters.
David Dranove, PhD, is the Walter McNerney Distinguished Professor of Health Industry Management at Northwestern University’s Kellogg Graduate School of Management, where he is also Professor of Management and Strategy and Director of the Health Enterprise Management Program. He has published over 80 research articles and book chapters and written five books, including “The Economic Evolution of American Healthcare and Code Red.” This post first appeared at Code Red.