Thursday, August 20, 2009

Are Doctors the Villains?

Can I get an amen for Marshall Ackerman, a Washington DC-area surgeon, for his defense of physicians in today's Washington Post?

Lamenting that physicians seem to have been "cast as the villains" in the healthcare debate, greedily ordering up unnecessary tests and other services to line their own pockets, he says:

"How many physicians who are not radiologists own their own MRI machine, CT scanner, PET scanner or other sophisticated diagnostic equipment to which they refer their patients? Why would President Obama blast pediatricians for doing tonsillectomies for profit, when any intelligent person knows that pediatricians do not do surgery? They care for sick children and refer them to ear, nose and throat specialists when surgery is needed. Why does no one seem to be aware that surgeons have functioned under a "global reimbursement" system for more than 35 years? Surgeons are paid a set fee for the care rendered for surgery or fracture care for a fixed period (frequently 90 days) regardless of how often they see a patient or how long the patient remains in the hospital."

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I don't entirely agree with Ackerman's apparent conclusion that the entire reform effort is a sham, or that the system would be better left alone. Although he says we should "start considering the real flaws and strengths of our system and how to improve it," he offers no specifics along these lines so I don't know what he thinks we should do.

But his defense of physicians is dead-on. He notes that he was was paid $1,000 for a total knee and hip replacement is 1971, when he began practice. Today, 38 years later, he is paid $1,600 for the same procedure. That's a loss of $3,659 on an inflation-adjusted basis. Meanwhile, "our staff has doubled over the past 40 years to enable us to handle the growing stream of government and insurer mandates." Maybe THAT'S to blame, just a wee bit, for the high cost of care?

We're heading straight for oblivion if we do nothing about healthcare. So something must be done. But I wonder how many of you -- whatever side of the debate you're on -- are feeling unfairly blamed for healthcare's costs. There was a lot of debate in this space when I took the president to task for his ill-phrased attack on pediatricians. Even beyond that, though, have you noticed examples of physicians being "cast as villains" in this debate -- either in public statements or in your own encounters with friends, patients, whomever. To what extent to people seem to misunderstand the nature of healthcare, as a business?

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