By: Bharani Padmanabhan – 3-23
The ills that characterize the American medical system over the past 20 years have been personally experienced by us in our own lives. Not enough time with our own physician, no one getting back with the test results or getting insurance approval for that medicine etc. When children age out of pediatric clinics, good luck finding a decent PCP.
Corporate executives decided they knew better how to run hospitals and clinics because they knew how to run soft drink bottlers or motels. The Delaware shareholder model captured medicine. The problem is neither patients nor doctors are the shareholders, and instead both are required to maximize shareholder value – meaning patients are made to compromise on their care, and physicians are made to compromise on their standards.
One early example was Tufts Health Plan’s Secure Horizons HMO, which gave physicians a set sum of money per patient per year, and incentivized denial of services, exactly like food service in prisons. Private equity fund Cerberus’ Steward Healthcare Medicaid Accountable Care Organization (ACO = HMO) similarly incentivizes doctors to deny care as much as possible outside of a narrow set of care metrics which make healthcare look good on paper but are poor indicators of true outcomes. It’s only about maximizing shareholder value. For the Massachusetts government it’s all about playing games that make money for the powerful hospital sector and shifting blame when it inevitably falls apart.
Burnout levels amongst physicians in Massachusetts are at the worst ever. Doctors no longer recommend the medical profession to their kids. The real shareholders love that because replacing doctors with physician assistants and nurse practitioners maximizes shareholder value without having to deal with independent professionals and their pesky Hippocratic oaths.
The impact on the classic Marcus Welby show, the family doctors celebrated by Norman Rockwell, the doc on Main Street who you’ve known your whole life and gone fishing with or done carpentry work for, has been devastating.
Like intact families, family physicians are vital for the health of our communities. They see everyone, they know – everyone. Their care is holistic, they don’t identify you with your insurance plan, or your diagnosis. And they have now been forced to spend just eight minutes per patient, and deal with only one problem per visit, because that maximizes shareholder value. Care is not holistic anymore. Family physicians work on the assembly line now, except the line moves people, not cars.
Little wonder then that independent physicians have been pushed out of business in droves. Nationwide, less than a third of physicians have any practice ownership, the lowest number to date. And the Mass Medical Society has done nothing to stop the slide.
As if the corporate consolidation of medicine is not bad enough, consider what was done to a local physician by his landlord. Dr. Ryan Welter MD PhD practiced family medicine in Raynham and occupied two suites within a medical office building ideally located off local highways.
The same building also contained an orthopedic clinic which was growing and on course to merging with University Orthopedics, a corporate group from Rhode Island. The orthopedic clinic needed more space. Dr. Welter’s clinic just happened to be in the way, as the landlord saw it.
According to the complaint in Norfolk Superior, the landlord, a William Whelan of New Bedford’s Whelan and Associates, decided that it would maximize shareholder value, meaning his investors and himself, if he could contrive a way to throw Dr. Welter’s independent clinic out and offer that space to the corporate behemoth present in sixteen locations across two states. Dr. Welter complains that Whelan engineered a cold plan to evict his long-running clinic and roll the red carpet out to deep corporate pockets.
As a result, a long-established clinic was suddenly forced to scramble for alternate space and retain patients while dealing with concerns about its ongoing viability, because a landlord decided it would be more profitable to pick the corporate tenant over the local one, and do it in a way that avoided having to buy out the lease.
As if individual local doctors did not have enough existential threats to deal with already.
The case is due for a hearing on April 12, 2023.
The author, Bharani Padmanabhan MD PhD, is a neurologist. firstname.lastname@example.org ◊