In Part I and Part II of this series, we’ve talked about a new condition, known as moral injury, which is plaquing physicians and nurses who are employed by hospitals and large corporations, because they feel they must compromise their best judgement in treating patients. The pressure from their employers is making them treat their patients in ways that sacrifice their moral values for the sake of corporate profits.
Eyal Press, writing in The New York Times, has called attention to this phenomenon, which was first reported by a psychiatrist, Dr. Wendy Dean, who worked for the U.S. Army. Dean has continued her study of the problem and finds it is increasing as more and more physicians leave private practice and join hospital or large corporate staffs.
Press interviewed one emergency room physician who insisted she remain anonymous for the interview. She had recently taken a leave of absence and was unsure if she would return. “It’s all about the almighty dollar and all about productivity,” she said, “which is obviously not why most of us sign up to do the job.”
Press says that’s not always clear to patients, many of whom naturally assume that their doctors are the ones who decide how much time to spend with them and what to charge them for care. “Doctors are increasingly the scapegoats of systemic problems within the health care system,” Mona Masood, a psychiatrist says, “because the patient is not seeing the insurance company that denied them the procedure, they’re not seeing the electronic medical records that are taking up all of our time. They’re just seeing the doctor who can only spend 10 minutes with them in the room, or the doctor who says, ‘I can’t get you this medication, because it costs $500 a month.’ And what ends up happening is we internalize that feeling.”
Press writes, “Concerns about the corporate takeover of America’s medical system are hardly new. More than half a century ago, the writers Barbara and John Ehrenreich assailed the power of pharmaceutical companies and other large corporations in what they termed the “medical industrial complex” which, as the phrase suggests, was anything but a charitable enterprise. In the decades that followed, the official bodies of the medical profession seemed untroubled by this. To the contrary, the American Medical Association consistently opposed efforts to broaden access to health care after World War II, undertaking aggressive lobbying campaigns against proposals for a single-payer public system, which it saw as a threat to physicians’ autonomy.”
I am no fan of the American Medical Association and dropped my membership over thirty years ago. Today, only about 12% of American physicians are members of the AMA. However, I will defend the AMA’s efforts to oppose a single-payer public system, which is simply the road to socialized medicine. Ironically, the same AMA was quite cooperative in facilitating the passage of the Affordable Care Act (ObamaCare) by the Obama Administration some 50 years later, which was a big step forward in the effort to implement socialized medicine.
A single-payer public healthcare system would quickly put private insurance plans out of business since they couldn’t match the lower pricing when the taxpayer picks up the tab for declining revenues. But what is happening now is a gradual corporate takeover leading to a gradual government takeover. The more healthcare is driven by the corporate world, and not independent physicians, the more the government will ultimately be able to control healthcare. That’s the long-term goal of progressives in Washington.
Press writes, “Throughout the medical system, the insistence on revenue and profits has accelerated. This can be seen in the shuttering of pediatric units at many hospitals and regional medical centers, in part because treating children is less lucrative than treating adults, who order more elective surgeries and are less likely to be on Medicaid. It can be seen in emergency rooms that were understaffed because of budgetary constraints long before the pandemic began. And it can be seen in the push by multibillion-dollar companies like CVS and Walmart to buy or invest in primary-care practices, a rapidly consolidating field attractive to investors because many of the patients who seek such care are enrolled in the Medicare Advantage program, which pays out $400 billion to insurers annually. Over the past decade, meanwhile, private-equity investment in the healthcare industry has surged, a wave of acquisitions that has swept up physician practices, hospitals, outpatient clinics, home health agencies. McNamara estimates that the staffing in 30 percent of all emergency rooms is now overseen by private-equity-owned firms. Once in charge, these companies “start squeezing the doctors to see more patients per hour, cutting staff,” he says.
What impact have these changes had on careers in medicine?
(Note: I’ll address this question and more in the next post – Part IV)
