Urologist: Health care’s ‘corporatization’ has fueled current crisis

Chicago-America is facing a health care crisis and physicians, including urologists, and the health care organizations for which they work, are an integral component of both the cause and the solution, according to Scott MacDiarmid, MD, a Greensboro, NC urologist.

Addressing the 2018 LUGPA annual meeting, Dr. MacDiarmid said health care costs in the U.S. are out of control, largely due to the “corporatization” of the health care system in which generating ever greater profits is the ultimate goal. At the same time, he said, the quality of care is deteriorating, patients are suffering and increasing numbers of physicians are experiencing burnout, which only exacerbates the problem.

Dr. MacDiarmid called for a grassroots movement of physicians to seek and implement solutions.

He pointed to the steadily rising cost of health insurance with its rates so staggering that costs are higher than mortgage payments for some families and so expensive that many business can no longer afford to provide it for their employees.

In fact, he said, even the government cannot afford health care, with the steadily increasing costs of Medicare and Medicaid contributing to a $20 trillion national debt.

The drive for profit

While Dr. MacDiarmid said he was not “demonizing corporate America” or the drive for profits, he said when it comes to health care, “it has gone too far.”

“Over the years in building a fabulous health care system, we have over-corporatized the American health care system,” he explained. “The ‘Wall Street’ of medicine – the corporations that make drugs and equipment, hospitals, the legal profession, the insurance companies-have got the money. And they are lobbying Washington, DC every day to further influence their environment as to maximize their profits.

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“They are doubling down year after year on huge profit margins driving the costs of health care through the roof. And honestly, it’s not sustainable.”

Victimized in this pursuit of profits, Dr. MacDiarmid said, “is ‘main street’– the doctor, the nurse, and the patient, or what I refer to as functional or day-to-day health care-[which] is getting hammered. And I mean hammered big time.”

Hospitals today, he said, “are about function and profit and not primarily about excellence. I believe that hospitals every day sacrifice excellence for profit.”

This can be seen, he said, in the increased use of nurse practitioners and physician assistants, who while they play a vital role when serving as “our extenders,” are used in increasing numbers in place of physicians because they cost less.

The problem, he said, is that “hospitals are run by businessmen and like businesses. They do not take care and protect and love those that are tasked to care for the patients, and they hire less qualified persons to deliver care to improve profits, and they try to automate something that often needs the art of medicine and not an assembly line person.”

It is the “greed and entitlement virus” that has infected medicine, said Dr. MacDiarmid, with patients caring more about what it cost and the outcome rather than their relationship with a trusted physician.

Next:Physician burnout ensuesPhysician burnout ensues

All of this, combined with the pressures of practicing medicine, potential lawsuits, and the like, contributes to physician burnout, according to Dr. MacDiarmid. And that is threatening to patients and physicians as well as the health care systems that employ them.

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“When we die, you die,” he asserted, “because we are the bridge to hospital profits… to cost-effective care medicine… to curbing insurance payouts… to patient satisfaction scores… to using the newest and best drugs and equipment, and most importantly, we are the bridge to loving and compassionate and excellent health care.

“As more and more of us continue to check out and start behaving like everyone else in health care, the greatest country in the world that spends the most on health care is in a great deal of trouble.”

Many physicians, he said, feel fatigued, burned out, frustrated, disheartened, angry, afraid, and lacking hope. They feel like a commodity, devalued and disrespected. They are no longer having fun. And they want relief. Some, he said, even contemplate suicide.

What can they do?

• Put on your suit of armor, your white lab coat, be proud, and be ready to serve, to use your gifts to help others, and for the challenges ahead.
• Fortify the homeland-your group practice, your surgery center-and make it healthy and a great place to work. Use your administrators; empower your staff. Set patient policies.
• Make peace with the enemies – the insurance companies, the health care systems, the corporate entities. All parties need to work together.
• Call in reinforcements; participate in government affairs activities, seek support from lawmakers and people with influence. Utilize LUGPA resources to do so.

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In addition, he recommended steps to “reduce the grind,” such as finding ways to reduce workload, eliminate weekend calls, use office urologists, and implement job sharing. And provide an exit strategy.

Movement needed

“As a realist, I believe that for us to save our health care system it will require a movement, yes a grassroots effort started from the bottom up and likely led by physicians like you and me-folks who want to make an impact,” he said.

“Be different,” Dr. MacDiarmid said. “Be different because health care matters. And it matters more than me.”