Speaking of unintended consequences.... In the mid-80's Medicare adopted a new way of determining physician's fees - the so called "relative value scales". They kept tweaking those fees over the years, chiseling one year 5% off one thing, another year 25% off another.... etc. etc. The price control regime kept tightening.
Eventually all those small cuts added up, and by now it is no longer feasible for many - maybe most - primary care docs to stay in practice by themselves. What happened is that they started joining into groups. In time, groups and various "physician management" companies started simply hiring new doctors. I see more and more docs working as employees.
More and more doctors are no longer independent. They no longer have the same say in their workplaces and in hospitals. Bureaucrats and managers are becoming more influential than ever.
Hardly anyone talks about this, but - as a result of government's setting of fees - we are entering a new world, where docs will be employees, along with everyone else. It is already happening. I suppose opinions may differ, but when it comes to making serious decisions, I'd prefer doctors to be independent, and NOT feel that they may find themselves in the street if they don't act as "team players".
I know a doc who ran into a... let's say, a difference of opinions with his immediate boss. He was "written up", and his contract will not be renewed. It so happens that I agree with the boss, and I think that the doc in question was wrong -- but that's not the point. The point is -- the guy took a stand for what he thought was the right thing, and he promptly found himself dusting off his resume. Next time, I suppose, he'll be more deferential.
We are developing a new culture in healthcare, and I'm not sure I like it. |
