Who killed United States medicine?

Physician incomes, when adjusted for inflation, declined 7 percent from 1995 to 2003, while those of professional and technical workers rose. But unlike other professionals — lawyers, architects, authors and economists — doctors’ work is dictated by the policies of insurers and governments. Increasingly, independent physicians, accountable only to their patients and the Hippocratic oath, have been replaced by salaried doctors who are accountable to the hospitals or insurers that employ them. Salaried physicians are closely policed for productivity, leading to ever-shorter and more numerous appointments per day.

Meanwhile, academic medical journals routinely publish studies that supposedly document the cupidity and ignorance of practicing physicians while lauding the virtues of single-payer health-care systems, such as those in Canada or Britain, in which the physician is paid only by the government. German physicians unhappy with their salaries and work hours under this kind of system had no recourse against their monopolistic bosses but to go on strike last year.

Small wonder that applications to medical schools have declined by nearly 20 percent in the past decade. When I ask the many physicians who are enrolling at Harvard Business School for an MBA degree about their decision to switch occupations, they frequently answer, “I can no longer practice medicine.” You might expect that the AMA would fight the insurers, hospitals, government bureaucrats and ivory tower academics who have diminished physicians’ incomes, besmirched their ethical reputations and compromised their professionalism — but you would be wrong. No, instead, at its annual meeting last month, the AMA declared war on retail medical clinics, located in places such as CVS and Wal-Mart.

These clinics do a lot of good: Their convenient locations and extended hours — they are usually open every day — enable ready access so that busy people need not defer important medical care such as flu shots. Their availability helps to unclog crowded emergency rooms, and their prices enable the uninsured to obtain care at reasonable costs.

Yet the AMA is fighting the clinics. The association claims that health insurers allow clinics to waive or lower patient co-payments while forcing doctors to collect these fees. Isn’t the AMA’s beef with insurers, then? No, AMA doctors complain that clinics do not offer comprehensive care and that they disrupt the standard physician-patient relationship. The AMA also says these clinics represent the intrusion of profit-seeking corporations into medicine.

Nonsense. This is all about protecting the doctors’ turf. The AMA’s issue is not profit but pure and simple empire building. The cycle is bringing about the imminent collapse of the medical profession — which gravely endangers our health-care system. We and doctors deserve better advocates.

The writer is a professor of business administration at Harvard Business School and a senior fellow of the Manhattan Institute. Her book “Who Killed Health Care?” was released last month.

Subscribe to The China Post and save 25%. Click here

SharePrintEmail

Write a Comment

Enter your comments - 3000 characters max

Type in image code

Submit

 Receive China Post promos Respond to this email