Hospitals came into existence in the American colonies in 1751 courtesy of Dr. Thomas Bond and Ben Franklin – yes, that Ben Franklin – as a substitute for those who couldn’t receive care at home because they were poor and didn’t have homes.
Over the next 150 years, physicians advocated for the creation of community hospitals, and they grew their own medical practices into clinics that morphed into hospitals.
By the early years of the 20th Century, hospitals became large healthcare factories due to the size and expense of what was then cutting edge technology and due to the fact that it was efficient to have fewer nurses monitor large groups of patients housed in a concentrated location.
But throughout that time and into most of the 20th Century, hospitals remained a place where physicians independently practiced their profession. Often with privileges at multiple facilities, office-practice physicians decided where best to admit their patients and to whom in their network, that is their personal network, to refer them.
But then, for a variety of reasons, including those that were financial and those that were regulatory, hospitals flipped the script. They began employing physicians, especially primary care doctors, to capture their referrals for their aligned specialists, dumping all of those patients into the business enterprise that the hospitals controlled.
And many physicians bought the line of alignment, or as I called it at the time, the lie of alignment, which went mostly like this: “You didn’t go to medical school to be in business but to practice medicine. Let us run the business; you practice medicine.”
Physicians were very slow to realize that what wasn’t said was that that sort of alignment, financial alignment, comes with control. Despite all the legal protections about the distinction between the hospital business, even the so-called nonprofit hospital business, and the practice of medicine, hospitals directly and through their employed physician taskmasters increasingly controlled how their captive physicians practiced medicine.
Which takes us to today, with many hospital-employed physicians sick of hospital employment. Their compensation is falling behind expectations and the cost-of-living while, at the same time, production requirements are increasing. In their analysis, hospitals are not devoting sufficient resources to patient care, but to bloated administration and, in many instances, outrageous administrative salaries. And then, as mentioned, there’s the loss of practice autonomy as a result of hospital-exerted control.
But ask yourself this–who really needs whom?
Are physicians dependent upon hospitals or are hospitals more dependent upon physicians?
Just as the technology explosion of the 1950s fueled the growth of large hospitals and, ultimately, to hospital control of physicians, today’s technology explosion fuels the opposite. Any procedure and any test that can be done outside of the hospital will be done outside of the hospital. In many cases it will be done better and for less—less for the payor and less for the patient. As to procedures in ASCs, it’s also less in terms of infection, and more in terms of physicians being able to become facility owners. Who needs the hospital for that?
Of course, the renaissance of financially unaligned medical practice is also being fueled by the failure of many hospitals and, at the same time, of many so-called physician management companies.
The bottom line is that there are alternatives to remaining employed by a hospital or jumping from one hospital employment situation to another or to a Big Medicine equivalent.
Of course that takes resources, but the reality is that the financial resources are easier to obtain than the emotional resources. It also takes some degree of forethought, as was discussed in more detail in my blog post Leaving Big Medicine? Look Before You Leap.
I think it’s fair to say that many physicians think they are dependent upon hospitals.
But the reality is analogous to the adult elephant that still thinks it’s still a baby chained to a stump.
Interested in freedom?
