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Are Physicians Are The Cause Of The Dysfunctional Healthcare System?


Stanley Feld M.D.,FACP, MACE

I wish all my readers a Happy and Healthy New Year!

I would like to thank everyone for continuing to read my blog.

Hopefully, healthcare will become more affordable, easier to access, and not be rationed in the years to come.

I do not think these goals will be reached with President Obama’s healthcare reform act. I think his healthcare reform act will make good medical care more unaffordable and less available.



I should like to react to Dr. Lucas Restrepo’s article on Kevin MD’s website. Kevin Pho M.D. does a wonderful job presenting all sides of the healthcare reform issue.

Dr.Restrepo’s article entitled “Progressive Commercialization of American Medicine” misses the causes responsible for the dysfunction of the healthcare system.

I am a retired clinical endocrinologist without a billfold interest in the practice of medicine. I am the founder of a Clinical Endocrinology practice started in 1970. I was the first practicing Clinical Endocrinologist in a free standing private practice in Dallas, Texas. At that time few people knew what a Clinical Endocrinologist was or did.

I started my Clinical Endocrinology practice without knowing anything about business. I was not taught anything about the business of clinical practice in my training at academic institutions.

I had to learn about the business of clinical practice in order to survive and feed my family. I had to teach myself the value of my intellectual property.

Dr. Restrepo is a neurologist at the UCLA Medical Center (Los Angeles, California) and the Barrow Neurological Institute (Phoenix, Arizona). It sound like he is a full time salaried physician. He does not have a need to understand the business of clinical practice. He also does not have to understand the potential value of his intellectual property. If he does not perform satisfactorily for UCLA’s administration he will be terminated.

Dr. Restrepo starts his article by quoting Sir William Osler:

Medicine, wrote William Osler, is “a calling, not a business.” Patients are not clients, nor physicians businessmen. People do not spend over a decade studying medicine ―living years in poverty or overburdened with debt― merely hoping to get rich. While it is perfectly legitimate to expect a salary that enables a dignified living and financial stability, any medical student who dreams a life of luxury is misguided.”

What is the definition of a dignified living and financial stability versus a life of luxury? Dr. Restrepo leaves the definitions undefined.

I think the definition of a dignified living and financial stability would include the freedom to make medical practice decisions, the freedom to define one’s working conditions and determine one’s time off. It should not include being forced by regulation to accept administrators’ working conditions. Physicians should not be indentured servants.

The fundamental principles sould advocate the primacy of patient welfare, that altruism is the catalyst of the physician–patient relationship, and that “market forces, societal pressures, and administrative exigencies must not compromise this principle.”

Dr. Restrepo implies that physicians’ decrease in their Oslerian moral fabric is the cause of the dysfunctional health care system.

Physicians’ reimbursement accounts for only ten percent of our excessive healthcare costs.

What are the costs generated by the parasites of the healthcare system such as hospital administrators, healthcare insurance executives, pharmaceutical companies and their executives, lawyers, government bureaucrats and lobbyists?

What about the million dollar plus salaries of hospital administrators?

What about the multi-millions to billion dollar salaries of healthcare insurance company executives?

What about the multiple billion dollars a year spent by lobbyist to influence congressional healthcare policy decisions?

What about the $100 to $750 billion dollars spent yearly for defensive medicine and malpractice claims?

These people consume most of the healthcare dollars.

“If health care is deemed a right of every citizen (or more aptly, of every human being), it naturally follows that a legitimate government should protect fully the rights of its citizens and guests (invited and uninvited). “Medicare for all” is the logical and just solution to the argument, but this has not become law. Instead, we have the PPACA, which is a reasonable step forward.

It is easy to blame physicians’ greed for the ills in the healthcare care system. Physicians are an easy target. Remember, when one is sick one needs a good physician to deliver high quality care. One does not need a hospital administrator, a healthcare insurance company executive or a lawyer.

It is easy to say Medicare for all. However the government cannot afford the present Medicare costs because of its outsourcing of the administration services of Medicare and Medicaid to the healthcare insurance industry. The cost of Medicare is not cheap.

Physicians are a small cost to the dysfunctional healthcare system. Most patients and physicians do not understand this reality.

Government takeover of the healthcare system will make access to medical care and affordability of medical care worse. Government should be concentrating on the real problems causing the dysfunction of the healthcare system.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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