Apparently, physicians are not going gently into that good night.
Doctors are being increasingly treated like assembly-line workers—forced to see more patients, in order to boost nonprofit hospitals’ profits, or replaced by contractor doctors or outsourced as “hospitalists,” who are employed by multistate management companies.
As recently as the mid-1990s, there was no one called a hospitalist. Most doctors would simply scramble from their offices to the hospital when they had to tend to patients there. But the discipline grew rapidly thereafter — to roughly 50,000 hospitalists nationwide in 2015 from about 11,000 in 2003, according to industry estimates. . .
Hospitalists could also increase hospital profits. They were on hand to discharge people throughout the day, emptying beds that could generate revenue again. And while paying the doctors was a new cost, hospitals at first found the efficiencies so advantageous that hospitalists were afforded the rare privilege of spending more time with patients. The doctors spent the time diagnosing and treating what were often highly complicated conditions — chronic health problems stacked on top of one another, or multiple organ failures.
This reprieve from the economic forces bearing down on the medical profession didn’t last long, however. “A consequence of how much the health care market has changed is that everybody has to be more efficient,” said Adam Higman, who specializes in hospital operations at Soyring Consulting in St. Petersburg, Fla. He noted that the increasing focus on metrics like readmission rates and hospital-acquired infections had created more work for hospitalists, who are responsible for a lot of documentation. “In some sense that comes to the detriment of the patient, there’s not as much quality time,” he said. “In some sense, that’s to their benefit — there’s a system to manage them.”
But now, some of the doctors are fighting back, by forming unions and then affiliating with larger union confederations, which in some cases already represent the nurses at those hospitals.
That’s a start—but probably not enough.
We’ve spent a lot of time in recent years debating health insurance. Clearly, it’s time to take up the debate about how healthcare itself is provided, and how nurses, doctors, and other healthcare providers participate in making the decisions about how their patients are cared for.
And we need to do this while we can still see with blinding sight.