January 13, 2020
The Problem With Corporate Medicine
By Michael D. Shaw
“Corporate Medicine” comes reasonably close to being what grammarians and wordsmiths refer to as a “contronym,” a term that, depending on context, can have opposite or contradictory meanings. One dramatic example is “fix,” which can mean repair or castration.
The positive meaning of “corporate medicine” is expressed by the American College of Occupational and Environmental Medicine:
“Corporate medicine pertains to the population health management of workers within an employer and potentially family members of employees, and ranges from health promotion/general prevention, occupational medicine, sickness absence/disability/fitness to work issues, ranges from strategy development to service delivery/vendor management, and may involve these issues on an international or global scale.”
However, the better known and derogatory meaning refers to the overall ethos of much of modern American medical practice, whereby the healing professions are increasingly controlled by people not directly involved in patient care, who have lost contact with the realities of day-to-day clinical practice. Part of this is the current trend of formerly independent physician practices being swallowed up by either private equity or major hospital chains.
Some of this is innocent enough. As medicine became more technologically driven, and in light of increased regulation and dominance of third-party payers, the notion of an independent “Marcus Welby, MD” ceased to be economically feasible in most cases. Exceptions include concierge practices and direct primary care.
A special case involves primary care practices that operate on a cash basis, charging only for the office visit. Laboratory services and other diagnostics are referred out, and can be covered by the patient’s insurance, while hospital admissions go through the emergency department. In-patients can be visited “socially” by this type of physician.
But, these exceptions are seldom small practices or sole proprietorships. Even most of the “rebels” need to be of a certain size to survive.
Debra Blaine, MD is a strong voice decrying all that is wrong with today’s corporate medicine—with a mordant tone to her writings. A recent piece published on KevinMD is entitled “Is health care just legal human trafficking?” This is a scathing indictment of how the standard business model ruins the delivery of healthcare…
“Our current system treats medicine as a commodity, not as an essential service. We the people are preyed upon by tycoons who wish to sell their services, and for whom quality control is not a moral directive but a necessary expense. There is no acknowledgment of the sanctity of human life, and caring for humans has become equivalent to manufacturing microchips.”
While this contention is largely true, Blaine is silent on the sad fact that consumers were so enthralled with having someone else pay for their healthcare, that they were only too willing to cede this level of control to the insurance companies back in the 1970s. And, to be honest, the doctors didn’t really push back too hard, either.
The “human trafficking” angle springs from this paradigm of using healthcare as just another vehicle to create revenue…
“It is not that we do not have the financial resources to provide appropriate care; they are just being rerouted into the pockets of large corporate holders. Human life is being forfeited for the sake of the profit margin, and it is being done ‘legally.’ How much is it worth to save a life? How is this not human trafficking?”‘
Blaine uses hyperbole to make her point, and would surely stipulate that this practice is not strictly “human trafficking,” in that the patients are not abducted slaves, but have entered into our healthcare system of their own free will. Still, the patients have few alternatives.
You can get much more of how Dr. Blaine feels from her blog entitled “The Price of Greed.” Corporate greed and its effect on healthcare should certainly be attacked, and she also goes after clueless patients, including those who demand scripts for drugs they don’t need.
Some people wonder what caused the demise of the small owner-operated stationery stores, that all disappeared in the wake of the big box outfits such as Staples and Office Depot. For every small shop that had a knowledgeable and helpful owner, there were far more that had limited inventory, high prices, and a bad attitude. At least the big box stores would have better prices. Feel free to draw the analogy to the doctor-patient relationship.
Alas, the rise of corporate medicine—along with its shortcomings and misdeeds—is directly related to public apathy and the acquiescence of physicians.