There is a revolution taking place in medicine and it forebodes poorly for the future of patient healthcare. I’ve written about changes in healthcare in the past and have even published a book, Changing Healthcare, to discuss some of what is happening.
When I began my practice in 1984, most doctors were self-employed or employed by other doctors. The only doctors who weren’t were mostly pathologists and radiologists who worked for hospitals. Today, about 70% of all doctors are employed by hospitals, large healthcare systems, or the government.
What is the impact of this change?
Simply put, doctors are no longer in control of their decisions about treating patients. They are pressured by the employers they work for to save money by limiting costly expenses or make money by performing costly procedures. Money has become the driving influence in healthcare whereas before the patient’s welfare generally came first. Doctors are trained to do what’s best for their patients, but when others have the final say, the patient’s best usually gets forgotten.
To add to this mess, patients are losing trust in their doctors, and in scientists in general. According to Pew Research, the number of U.S. adults who place confidence in medical scientists to act in the best interests of the public declined from 40 percent in 2020 to 29 percent in 2022. You can thank the Covid pandemic for this decline in trust. However, even 40 percent is much lower than the confidence people had in their doctors fifty years ago.
All of this is driving doctors to retire early or leave the profession for greener pastures. I’ve written about the doctor shortage before (Physician Shortage Getting Worse – 2024) so I’ll not belabor that issue here. But there is new information that further explains this decline.
There is a new revolution taking place in medicine that some have called the managerial revolution. Aaron Kheriaty, a physician and fellow at The Ethics and Public Policy Center, writing in The Epoch Times tells us that medicine, like many other contemporary institutions since WWII, has succumbed to managerialism – the unfounded belief that everything can and should be deliberately engineered and managed from the top down. He says, “Managerialism is destroying good medicine.”
The managerialist ideology consists of several core tenets, according to Washington-based writer and analyst N.S. Lyons. The first is technocratic scientism, or the belief that everything, including society and human nature, can and should be fully understood and controlled through materialist scientific and technical means, and that those with superior scientific and technical knowledge are therefore best placed to govern society.
This is a new concept in medicine, but one that has been prevalent in politics for some time. Angelo Codevilla, professor at Boston University, wrote about this in 2010 in a book entitled The Ruling Class. In it he warns us there is an elite group of individuals from both political parties who see themselves as the only ones fit to make decisions for the people “for the good of the country.” This antidemocratic ideology has infiltrated our political system and is a real threat to our democracy.
The same way of thinking threatens our healthcare system as doctors are forced into a one-size-fits-all mentality that may be good for business but not so much for patients. As any physician knows, every patient is an individual and decisions based on the population as a whole rarely are best for that patient.
How does this way of thinking manifest itself in medicine?
(Note: I’ll discuss the answer to this question in the next post.)
