• Doctors as businesspeople

    I saw an article flagged for me this morning in the AMA news. The title? “5 mistakes doctors make when borrowing money“. The high points:

    1. Failing to shop for a banker
    2. Using the wrong borrowing tool
    3. Borrowing to cover operating costs
    4. Not doing the math
    5. Failing on financing paperwork

    I am sure that all of these things are critical parts to growing and keeping a small business going. I’m sure that all of them are essential to making money and accumulating returns on investment. I’m really sure, though, that none of them have anything at all to do with improving health care and containing costs.

    There are so many things that I wish physicians could do better, and so many areas where I think their training and education are deficient in light of the modern practice of medicine. It pains me to think that the subjects contained in this article, and not those deficiencies, are where we think doctors should focus their attention. There are plenty of ways for physicians to practice, in a non-government-run system, without having to worry about these things.


    • Uh, do you mean that doctors should become government employees?
      Otherwise, I don’t see how doctors can avoid knowing about the business side of practice.

    • And here’s another example:

      7 tips for marketing a physician practice to patients

      I agree with you about the illogicality of requiring doctors to do these things that have nothing to do with actual patient care. But what system do you see that gets away from it? I assume you mean an end to solo and small group practices, and probably an end to physician ownership of medical practices generally. What else am I missing?

    • I graduated from medical school in 1971. Around 1980 I started hearing more and more that doctors ought to act as businessmen. Before then the ideal, which like many ideals was often honored in the breach rather than in the practice, was that medicine was a profession. A profession is defined by professing something. What was professed albeit imperfectly was that the interests of the patient came before the interests of the doctor. A business model changes that. A business will look at its activities and try to eliminate cost centers and increase profit centers. As a result, it is hard to find a dermatologist in my town who looks at rashes; they are all busy injecting botox and using lasers to smooth out wrinkles. Gastroenterologists who manage chronic liver disease are rare, ones who do lots of endoscopies are common. I am not picking on the GI and skin people, similiar situations abound in all medical fields. In the previous decade, there were substantial numbers of patients discharged from hospitals after coronary artery surgery without scripts for aspirin, beta-blockers, statins, etc.
      I am now working part-time gliding into retirement. I am enjoying working for the first time in a long time. This is because the burden of being a businessman is gone. I enjoyed my training when I did not have to be a businessman but rather was learning in the wonderful exciting field of medicine.
      A lot of physicians are unhappy with their work. I think that being a physician and being a businessman may be contradictory roles that lead to undesired outcomes for patients and providers.

    • This short post goes to the heart of the dilemma and problems in medicine.

      If you want to be a physician, be a physician. If you want to be a busnessperson, be a businessperson.

      If you want to be both be prepared for failure, it cannot be done.

      Once we get to the concept that physicians should be employees they won’t have to waste time reading the AMA about how to borrow money.

    • The list of demands for doctors education is ridiculous:

      1. Microbiologists think that doctors should know every type of bacteria, fungus, virus, and parasite that could possibly infect humans

      2. Geneticists think that docs need to know everything about genetics

      3. Pharmacists think that doctors need to know more about drugs and side effects

      4. Healthcare economists think that doctors should know more about the system economics of heatlhcare

      5. Womens studies people think that doctors dont get enough training on gender issues

      6. Gay/lesbian advocates want doctors to get more training on gay/lesbian/transgendered patients

      7. Minority advocates complain that doctors dont know enough about how to interact with minority patients

      8. Epidemiologists want doctors to learn more about how to read/interpret journal articles.

      9. In general, everybody thinks that doctors should be less like scientists and more like social workers so they can treat the “whole patient.”

      Every month there’s a new article complaining about how doctors dont know enough about _______________. Yet in the same breath these people say that NPs and PAs, who have less than half the training of MDs, can effectively replace physicians because they are cheaper. Its the most schizophrenic attitude I’ve ever seen. Which do you want?

      • Ain’t it the truth? Ain’t it the truth? (As a famous lion in Oz once said)

        And those same people won’t be satisfied until doctors are paid like waitresses, another group known to be in the service industry.