Wednesday, July 31, 2013

Doctors are treated like condoms

Medicine is becoming increasingly corporatized, and some doctors are very excited when they get offered a job at these hospitals.

They are promised a fat salary , and the job seems to be all they could ask for ! The hospital takes care of all the administrative hassles, so that the doctor can focus on taking care of his patients – and the hospital promises them that they'll have a long line of patients clamouring to see them. Doctors are not good managers, and are very happy if someone else does all the work of attracting patients; billing them; and providing the secretarial support they need, so they can do what they enjoy – helping their patients get better. Since this is all done under one roof, using high quality new equipment, the doctor does not need to run around from clinic to clinic to get more patients – and does not need to offer kickbacks to GPs to refer patients to him either ! This seems to be a win-win situation, and it often is for the honeymoon phase, which lasts a few years. At this time, the hospital is new, and they need senior brand name doctors to attract patients. This is why they offer great signing packages when they launch their hospital with a bang, and everyone is delighted in the beginning.

However, in a few years, once the hospital starts becoming profitable, they start showing their true colours. These are for-profit hospitals, which have a clear focus – how do we maximize our revenues ? They understand only one thing – numbers, and soon the management starts singing a new tune. They talk about targets which the doctors need to meet – bed occupancy; number of patients admitted; revenue earned; number of CT scans ordered ; and number of operations done. The focus has now shifted from providing high quality care to patients to earning more money.

Doctors who are high performers and who run the hospital's profit centers are treated as blue eyed boys. However , the rest are told to shape up or to get out. Most doctors buckle under this pressure, and will fall into line quickly, in order to save their jobs. They start doing unnecessary surgery and ordering too many tests, to get their numbers upto speed, so the management can give them a pat on their back and a bonus as well.

However, some doctors refuse to practice bad medicine . They still believe in putting their patients first, and refuse to overtest or overtreat. The management then starts employing sneaky measures to ease these doctors out of the hospital. They get colleagues in a department to compete with each other – and the " top performer's " numbers are used to set the benchmark which the others have to aim for. Salaries are set according to how well the doctor has met his target – and while those who do well are paid a bonus, the doctors who don't comply are pulled up. They are invited to the CEO's office, and
" requested " to improve their performance. If they don't improve, their contract is not renewed. Many are insulted , until they are forced to leave ( for example, the consulting time slots allotted to them are curtailed to one slot per week, so they have very few patients) . It's easy for the management to make a doctor's life miserable ! As a friend of mine who is a senior surgeon said - " I feel I have been treated as a condom – used and then thrown !"

Hospitals treat all doctors as being interchangeable – they are viewed as being cogs in a wheel. If a senior doctor becomes too expensive for them, they get a junior to replace him, because the "cost to company" is much less - and they really don't care about clinical acumen, surgical dexterity or bedside manner, because these are not numbers they can measure !

The fact that hospitals are focused on maximizing their profit does not mean that they are villains. This is to be expected – after all, they are answerable to their share-holders and cannot afford to fritter away money on expensive doctors ! The real problem is that doctors are so simple-minded. They seem to know only one thing – how to take care of patients. While they do a very good job at this, most of them have very few real-world skills, so it's very easy for the management to take them for a ride ! They have no unity and it's very easy to play one against the other.

So what happens when the hospital cracks the whip and the doctor tries to push back ? He soon realises
that he is between a rock and a hard place ! By the time he is 50 , he cannot afford to retire and neither can he afford to start afresh. He is forced to swallow his pride and accept all the rubbish which is doled out to him. He is furious about the fact that he spent the best years of his life working for the hospital and helping them to become successful, and is now being treated like dirt. He retaliates, by taking out his frustrating and angst on his staff – and his patients ! This is the major reason why morale in corporate hospitals is so poor. It's only their fa├žade which is beautiful , but because doctors feel devalued and unappreciated, they do not put their heart and soul in taking care of their patients.

1 comment:

  1. I can't agree more that some woman in India are opting surrogacy just to avoid the pregnancy pain.


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