Friday, July 23, 2010

When Doctors Become Employees

I saw this chart posted in the nurses' break room.  Apparently some people needed a little help determining when to go back to work from their allotted 45 minutes lunch break.  For every minute around the clock the chronologically challenged are told when they have to report back to work.  As an employee there is little incentive to return to work as soon as possible for patient care.  This chart was necessary as people were taking far longer breaks than they were allowed.

Is this where physician autonomy is headed?  There has been lots of talk about doctors becoming employees of large health care corporations as a cost cutting maneuver.  Supposedly as employees there is less incentive to order expensive tests and procedures that could line their or their colleagues' pockets.  The Cleveland Clinic has frequently been held up as an example of lowering the cost of health care by hiring physicians as shift employees. 

All the complicated new regulations and reimbursement cuts have also been driving doctors to sell their practices to hospitals and become employees.  As employees they won't have to pay for all the back office work like chart keeping, billing, and liability insurance.  The employee physician won't have to invest in an expensive electronic medical record system that is duplicated by the doctor in the next door office.  They can all use one EMR paid for by the hospital and maintained by a dedicated IT staff.

What is lost is the incentive to work above and beyond the call of duty.  Sure people say doctors should be saints and not even concern themselves with working for nothing.  But doctors are people too.  We have families we want to support with a decent income and spend time with.  As an employee why should I stay until 7:00 PM when my paid shift ends at 5:00?  As an employee I would want to have the same morning breaks and lunch breaks as other employees.  You want me to work weekends and holidays?  I better get time and a half for that.  If I have my own practice, I will work without a lunch break if that is what it takes to see all the patients waiting out in the waiting room.  I will work late if that is what it takes to finish all the paperwork at the end of the day and take care of my inpatients in the hospital.  But if I'm just an employee the shift mentality will inevitable sink in.  That is not cynicism.  That's just a fact of life.  And I'm afraid that's where medicine is headed in the very near future.

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