Doctors Aren’t an Afterthought

Marcy ZwellingGeneral, Health ReformLeave a Comment

Published in the Orange County Register: May 22, 2014

It may not be long before a hospital will be the least likely place to find a doctor. Pressures are mounting to replace physicians with computers, guidelines, nurse practitioners and even pharmacists. The assault on the patient/doctor relationship continues to mount.

Centers for Medicare & Medicaid Services recently made a final ruling that finds the regulation requiring a doctor sit on the governing board of a hospital to be “unnecessary, obsolete, and unduly burdensome on health care providers and suppliers.” Hospitals must now only “consult” with a physician “periodically throughout the fiscal or calendar year on matters related to the quality of care.”

Doctors have become the “problem child” of hospital administrators, government officials, insurance companies and the media. That is until their loved one becomes ill. But does CMS really believe that doctors are just an afterthought when it comes to patient management?

Hospitals would have you believe that that they are service centers. When was the last time you got “good” service”? In fact, hospitals are financial institutions that “sell” health care. They are large corporate entities designed to make a profit in an ever-increasing regulatory environment.

Doctors advocate working on behalf of patients. Does anyone really believe that hospitals should be making end-of-life decisions about patients without a doctor? Is it always about the money? Where will the line be drawn?

Amanda Goodall has led research into the question of “whether physicians can be efficient hospital managers.” Her hospital management study cites research suggesting leaders of sports teams are often better when they have “walked the walk” as a player and that the best universities are often led by scholars.

So why wouldn’t doctors be the best hospital managers? Her research concludes using the Index of Hospital Quality and establishes that in the fields of cancer, digestive disorders, heart and heart surgery doctors disproportionally lead the U.S. News and World Report’s list of Best Hospitals.

This is not conclusive evidence that a doctor should lead every hospital. But surely it is convincing evidence that CMS was not interested in patients when it made the ruling about governing boards.

It is about time Marilyn Tavenner, the head of CMS, takes a stroll into the workplace she represents.

Ms. Zwelling-Aamot is a member of the American College of Private Physicians.

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