The last and greatest lesson I’ve learned in my 5 years in the real world—the one I was least prepared to learn and that I spend more time dealing with than I care to admit—is that medicine is a business. Adam Smith, the Scottish economist, once said, “It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.”
I’ve learned many times over that hospitals, industry reps, and insurance companies hire very smart, well-trained people who wake up every day with one goal in mind: screwing me and my business.
Do you really need an example? I’ll give you two. About a year ago, our practice noticed that one of our insurance companies was reimbursing less than we expected. After much digging, it turns out the insurer had sent a letter stating it was going to significantly decrease reimbursement unless we objected. The letter got lost, we didn’t object, and there you have it. Or how about a hospital leveraging its dominant market position to create a narrow network that excludes independent providers of ancillary services, even if that independent provider can provide higher quality care at a cheaper rate?
Nothing illegal about either move, and Adam Smith is probably smiling at the cleverness of the individuals running those two businesses. But have you ever wondered what would happen if we spent as much time trying to optimize the delivery of medicine as we spend staying in business?
Am I arguing that all of us small-town doctors who run our own practices should throw in the towel? Absolutely not. In a world of limited health care resources, a doctor who understands the business of medicine can deliver better, higher quality, more affordable medicine than some cog in the wheel of big business.
After 5 years of practice and 50 blogs, do I regret my decision to go into medicine? No. I would simply advise any young doctor getting ready to leave residency to know and follow your guidelines, pray you don’t have complications, and learn the business of medicine.
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