The Business of Medicine

My life as a physician began 35 years ago when I graduated from medical school. I treated patients and was compensated with a salary and benefits. It may be my failing memory, but there seemed to be very few administrators back in the 70's and 80's. The directors were actual doctors and nurses. No MBA or MHA was needed to be a boss. Recent events have highlighted the current paradigm of health care. The triumvirate of Government, Insurers, and Hospital Administrators control health care.

The cost of health care in the USA is out of control. Tests, and procedures pay. Primary preventive care doesn't. A physician with $250,000 in loans will be much more likely to choose gastroenterology (scopes pay) than primary care internal medicine. Private health insurers are run by highly paid executives whose goal seems to be the denial of care to their subscribers. Folks stay in jobs they hate because they are afraid of losing their employment-tied health coverage. The new job's insurance may not cover a pre-existing condition. So called "Obamacare" tried to make coverage less capricious and more transportable. It did not change the ever increasing cost of health care.

The other big trend in health care is consolidation. I work for a company that owns multiple hospitals. My services are based on a contract that was more than 12 pages in length. There are expectations of continuous improvements in the timely provision of care to our clients/patients. Health care is a service based industry. We, the providers, will be judged by meeting or exceeding standards and expectations of the industry and the consumers.

The city of Lowell, MA witnessed the consummation of the very long courtship between Lowell General Hospital and Saints Medical Center. The later has been unsuccessfully trying to find a partner for many years. My employer was a recent suitor but was jilted at the altar. As a resident of the Greater Lowell area, I have an interest in how this merger will play out. The financial problems at Saints (bond rating in the junk bond range) would seem to give the larger and solvent LGH the edge to deciding how services will be divided between the two "campuses". Redundancies must be eliminated to make the deal financially advantageous for both partners. I fear that some of my friends' jobs, at both facilities, will be phased out as the merger progresses.

MGH "buying" Cooley Dickinson Hospital in Northampton, MA was also in the news recently. Baystate Medical Center in Springfield will lose business because of this affiliation. Partners, the 800 pound gorilla of Massachusetts health care, seems to be on a perpetual mission to add more hospitals to its portfolio.

I am just an old ER doc; 32 years and counting. I like my current position. I work with a group of nurses, techs, secretaries and physicians who provide high quality health care in a small community hospital. My coworkers are bright and friendly. They have made me feel welcome. We are also consumers of health care and pay for our insurance, co-pays, and deductibles. Buckle up folks, it is going to be bumpy road to the future for health care in America.