CHANGING PATTERN OF MEDICAL PRACTICE, CORPORATE MEDICINE, AND INEQUIY IN MEDICAL CARE

“A man need not have grown old in the practice of medicine to bear witness to its having underdone considerable change.”  - Peter Mere Latham

Nothing remains the same in life. Everything is in continual change in nature. Changes must be one of the basic laws of nature however, not all changes are good. Then I must raise an important question - can we identify, prevent or modify harmful and unwanted changes before they occur?

I believe that existing and mostly inborn humans’ character flaws and greed makes it impossible to completely prevent harmful changes in life.

Let’s take medicine, medical practice and administration as an example to see how and why changes occur. Changes for advancement in medical sciences through the activities of honorable research scientists, dedicated clinicians, clinical experiences and teachers have been and will remain as an integral part of medicine.

But I am not sure I can say the same thing about the practice of medical science and arts of medicine by all medical practitioners, by giant medical corporations, health insurance companies, HMOs and big pharma.

A recent interesting article appeared in NEJM Journal watch (July 1, 2022) addressing the changing patterns of internal medicine practice among practicing physicians. Investigators using Medicare claim data, ABIM data (1900 – 2017) assessed 68,000 board certified physicians whether they practiced as a hospitalist, an outpatient only or mixed practitioners.

From 2008 to 2018 changes occurred in their practice patterns were as follows:
Hospitalist increased from 25 percent to 38 percent,

OPD only physicians increased from 23 percent to 40 percent,

Mixed practitioners decreased from 52 percent to 23 percent.

We must raise another important question here - why are physicians changing their practice pattern?

Depending on my own 40 year of clinical practice experience, without any hesitation, I would like to say that it is because physicians lost independence and autonomy in their thinking, medical decision making, patients ’advocacy, doctor – patients’ relationships, hands-on medical care, and increasing non-medical bureaucratic paper works requirements by multiple sources that made practice of medicine no longer a loved and an enjoyable career.

 Among these sources governmental rules and regulations, politicians, required electronic medical record (EMR) keeping which reduces hands-on medical to a minimum, giants multibillion dollar health care companies, HMOs, huge hospital chains CEOs, drug companies, pharmacy chains all telling doctors what they can and can’t do.

Corporate medical care taking over healthcare in America, gobbling up primary care practices, opening their own primary care practices in their own facilities employing nurse practitioners and/or PAs instead of doctors for less salaries and more profit for themselves and for their shareholders by applying strict business practices while ignoring every patient’s human right to decent medical care, thereby creating a deep inequity in medical care. Financial concerns of health care corporations always overtake patients care concerns. Profit oriented corporate health care in America delivers the most expensive but not necessarily the best health care in the world.

Under these circumstances many physicians are forced to change their practice patterns for less money, or some burn-out and retire early.

So, what can be done to remedy this quagmire? As I see it, creating a universal health care or “Medicare for all” which is administered by an independent government agency without middleman is the only solution.