The Doctors Club

Vatsal Thakkar, a psychiatrist, recently wrote of the perks doctors are afforded in everyone’s favorite instrument of social justice – the New York Times. Dr. Thakkar speaks effectively and correctly about a broken health care system navigated best by pulling the ‘doctor’ card. Some on the progressive left have seized on this blatant disregard for egalitarianism as yet another example of a broken healthcare system, despite the fact that a two tiered system is exactly what they have been building over the last eight years.

flying cadeucii

To be clear, there has always been special treatment accorded fellow doctors and nurses – it has just become more obvious as the gulf between the haves and the have nots in health care has grown.  Make no mistake – this is absolutely a function of multiple strategies that have created winners and losers in the healthcare space.  The problem, of course, is that patients and physicians have ended up on the losing side of this equation.

In an effort to reign in costs, the federal government decided long ago that it was easiest go after the neighborhood private practice physicians that were practicing in that dastardly fee for service construct.  Being a small practice neighborhood physician has never been easy – it requires a special commitment to be available for your patients on a constant basis day, and night. The financial rewards were considerable, though I would argue on a per hour basis these physicians were paid at a level more consistent with electricians than hedge fund managers. As regulatory burdens increased, the amount of time spent performing non-revenue generating tasks like prior authorization reviews began to cut into physician incomes.  It started to make less and less sense to be on call for patients for 360 days of the year, and doctors began to turn to lower paying, but safer and more convenient hospital paying jobs.  While this made physicians unhappy, the real burden was borne by patients.  Instead of having a direct line to a doctor who knew you well, who would see you the same day or next day for an emergency, and then follow you into the hospital to direct your care – now you had to speak to a covering physician who didn’t know you, wasn’t invested in you, and was quick to direct you to the emergency room and hospital where yet another team of uninvested emergency medicine and hospitalist shift workers lay in wait.

Not content with the Comcast level consumer service that had now been implemented, bureaucrats next decided to curtail costs by shifting costs to consumers in the form of high deductibles and premiums in the the hope that the patient would exert downward pressure on health care costs.  That has not happened.  As Propublica reporter Charles Ornstein found out when he needed antibiotics for his son, or as journalist Steven Brill discovered when he needed emergent cardiac surgery, patients are in a poor position to negotiate prices for health care when they need it most.

In this world where risks and cost are now more than ever the patient’s to bear, is it any surprise that those with money, or influence would exert whatever levers under their control to navigate this system?

The solution from some is to no doubt provide ever more, ever better regulations, or work harder to deliver us universal health care.  The inconvenient truth the control oriented free-lunch-for-all universal healthcare proponents won’t tell you is that cost controls in this system come via rationing.  One of the indignities Dr. Thakkar speaks about in his piece is having to endure 6 weeks of back pain before insurance would approve a back MRI.  In 2010, the average wait time for an MRI in that health system beyond compare, Canada,  was up to ~12 months. There is even a helpful website you can visit that will let you know how long you can expect to wait for cancer surgery, cardiac surgery or other imaging studies.

A better solution to the current system plagued by physicians who answer first to hospital systems, insurance companies, pharmaceutical companies and regulators would be to restore the primacy of the individual beholden only to the patient: the independent physician.

<em>Anish Koka is an independent physician in Philadelphia who writes about the growing barriers between patients and physicians. Follow him on Twitter @anish_koka