Fear sells.  Government, big hospitals and big multispecialty clinics or corporate insurers use it on physicians and have done so for some time now.  This fear instilled in physicians is a necessary component of the breakdown of the traditional doctor-patient relationship. This breakdown is necessary for those who would turn modern medicine into a corporate, top down mill for patients, one that combines poor quality and cheap care with maximum profits.  Patient choice and real competition must first be eliminated in order to achieve these goals and that is what we have been witnessing for many years.  

Fear is actually instilled into us as prospective medical students, when admission to medical school is largely out of control of the applicant.  The overwhelming amount of didactic material presented in medical school in the first two years generates fear and uncertainty, as well.  Following this first two years of school are typically the clinical years where student evaluations are frankly subjective and the product of sleep-deprived, angry and fearful residents.  

All of this pales in comparison to the fear of the first night on call as a house officer in a hospital.  Knowing that the outcome of a “code” is in your hands for the first time is quite unsettling.  In the background and at all times there is the moniker of the “testing.”  Failure of “boards” at the end of this road, represents years wasted, and can be career ending.  It is no mystery, I think, that having finished medical training and completed “boards” lends many physicians susceptible to fear-tactics down the road and those in health care administration and government know this.  

The physician fear generated by the Clinton Health Plan in the ‘90’s served the corporate medical cartel managers well, as HPO’s (hospital physician organizations) made their appearance.  Hospital administrators told us that unless we stuck together and battled this new health care paradigm we would be devoured.  Many physicians fell for this.  More and more physicians began accepting positions as hospital employees for the “security” it brought them.  Medicare cuts in the early nineties were unnerving for many doctors, their specialty choice seeming like a mistake now that they were no longer paid reasonable amounts.  I have blogged before about the last open heart anesthetic I delivered, for which I was paid less than $300.  It was tough for me to walk away from cardiac cases but I really had no choice with reimbursement like this.  Every few months, physicians would receive a newsletter announcing their new Medicare fee schedule, always a reduction.  Every year the “Congress” would have physician fee cuts on the table only to delay them at the last minute (what a great fund raising strategy!).  Fear of loss of payment.  Fear of pay cuts.  Fear of lawsuits.  Doctors are fresh meat for those seeking hostile takeovers on a good day, it seems.

Now we have the specter of Obamacare.  Once again, many physicians are seeking the “safety” of working for a hospital or giant multispecialty clinic.  Unfortunately, many taking this path find themselves trapped, unable to escape this decision that virtually all  would do differently if they had it to do over again.  Here is my message to those of you that are staunchly refusing this path and to those who would have the courage to reconsider,  having taken the doctor-as-employee path:

I have never been more excited about the practice of medicine than right now.  The free market always wins out.  There is no stopping it.  Sure, it can be derailed for a time, but market forces are always at work.  Failure to adhere to them results in all sorts of perversions and unintended consequences.  The current cartel-like health care system is coming unhinged.  The role of government in health care threatens to bankrupt the entire country.  None of this is sustainable.  The dust is beginning to settle and cool heads are finally entertaining true and free market solutions to health care provision and financing.  I don’t believe that this would have been possible until we had hit bottom (which I think we have done).  I believe that the big hospitals’ and big insurers’ nightmare of price transparency, that element of the market that shines the brightest light on all that is false, is here and here to stay.  What we have done at our surgery center is just the beginning.  The cat is out of the bag, as they say.  True value and quality in health care will be the result.  More and more healthy competition will be the result.  Those who embrace the free market will thrive and those who don’t will whither and die, just as in other areas of the economy.  

I hope that for those of you who are desperate now, struggling with your fears, you will take to heart what I have just written and know that I believe we are on the brink of a better and brighter (albeit much different) practice environment, one that is better for patients and the physicians who care for them.

G. Keith Smith, M.D.