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The Devolution of Medicine: Turning Health Care Into a Business

Beneath a three-column headline in my local newspaper was a barely-edited press release.

That’s not unusual. With the downsizing of newsrooms, there’s more room for wire service soft features and press releases. But this one caught my attention.

SystemCare Health in New Jersey promoted a graduate of a college in my town to the lofty position of Senior Director of Doctivity.

I checked the dictionary—“Doctivity” didn’t exist. I checked WebMD, the website for amateurs to learn the meaning of unpronounceable medical terms—and how to recognize their symptoms and treatments. Nothing there.

That left SystemCare Health’s website, which spewed a barrage of buzzwords and useless gibberish, the kind that people in marketing and business think will impress those who speak fluent English.

The company says it works with major health systems and medical colleges, giving them insight and “strategic brand platforms, service line business building programs, and breakthrough creative ideas so our clients experience real market-moving results [to] increase physician productivity, streamline operations and strategically acquire new patients.” I assume there is little difference between strategically acquiring new patients and an Army sniper strategically acquiring his target in combat.

After wading through the mission of the company, I plunged into the swamp of Doctivity, which the company claims is “woven into a health system’s culture to create a repeatable process that provides visibility and accountability for the time it takes a new physician to break even [and] eliminates functional silos.” Since “functional silos” are probably what exist in field of cow manure, I was able to reaffirm my initial impressions about the company, and moved forward.

Forward led me to learn that the company “delivers a personalized business plan for every new physician so they can reach their financial goals faster,” and that “Physician productivity is at the forefront of most profitability discussions.” Unfortunately, somewhere in those left-over functional silos, “It can take 18-24 months or more for a new physician to reach a break-even point (where they are covering their salaries).” But, with layers of Doctivity, which SystemCare Health says is an “innovative business approach that improves physician productivity,” physicians “are hitting their financial goals faster.”

The psycho-marketing babble splashes website visitors with explanations— “Internal processes sometimes are burdened with lack of resources as well as market and operational constraints to successfully improve new physician productivity and strengthen retention,” and because of Doctivity, “Physicians reach their financial goals much sooner and better understand their new organization, their business and how the organization intends to market them to build a successful practice. Happy doctor = happy patients.”

That last sentence, surgically cut out of a fortune cookie, could mean that SystemCare Health brings clowns and comics into physicians’ offices and operating suites. Physicians who are laughing at uterine cancer, multiple sclerosis, and aortic aneurysms will lead to patients who are so happy about their conditions they are willing to pay their physicians even more so everyone is happy. It could also mean that SystemCare  Health might apply “synergy” with pharmaceutical companies to assure they bring plenty of happy food to meetings with physicians. It could also mean productivity increases with the better use of computers and software, which requires physicians to look at screens more than they look at patients. Possibly, happiness is that SystemCare Health has someone on its staff whose job is to make sure that physicians, who can get depressed at workloads and corporate demands, are able to get the proper mood elevators to improve their happiness quotient.

Under the Doctrine of Doctivity, health care has evolved from care and compassion to the surgical sterility of a business model, where liquidity, maximizing profits, and return on investment become the fabric and glue of health care practices.

It’s a model where doctors in corporate health care systems are just like factory workers who help provide their corporate bosses better returns on investment that are contiguous with raising the bottom line. Like some workers who are paid by how many widgets they create every hour, or how many bushels of fruit they pick, these health care workers increase their own productivity by seeing more patients every shift. To increase their own productivity, physicians become more “efficient,” seeing patients every 10 minutes; maybe 30 to 40 a day. It’s not unusual for physicians to have a 5,000 patient case load. Spend too much time with a patient, and you lose that productivity. Take time to research a patient’s symptoms and consult with other physicians and you lose   income. But, if you refer your patient to a specialist or order more tests, both you and the system will be happy with additional income. Get those patients into your exam room; move ’em in; move ’em out.

Physicians in some systems who take too much time with patients get reminders about being focused. They don’t get reminders that spending more time with patients, sometimes just chatting about hobbies, the latest films, or the family, can help a physician better understand a patient’s issues and problems. And since it’s been decades since physicians made house calls—too inefficient—they don’t see or understand how a patient’s home or lifestyle might affect that patient’s illness.

Most physicians, even those who take lessons from a Doctivity specialist, care about people. Most didn’t go into medicine to be part of the country club set. But when corporations set up Doctivity-induced programs, even the best physicians reluctantly sacrifice the art and science of medicine, possibly forsaking the principles of the Hippocratic Oath, to the business of medicine.

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Walter Brasch is an award-winning social issues journalist. His latest book is Fracking Pennsylvania, an analysis of the history, economics, and politics of fracking, as well as its environmental and health effects.

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