Wednesday, September 19, 2012

The Commodification of Medicine

Spent some time with a pleasant fellow who had a long career in pharmaceutical sales, calling on doctors to sell products of the drug companies.  He retired a few years ago--and very recently has undergone a few procedures himself.

His commentary was interesting.

First off, he mentioned that the practice of medicine has changed.  Docs rely much more on charts and computerized diagnosis protocols than the older 'touch and talk' method of diagnosis.  And to a noticeable extent, they are being replaced by nurse practitioners and physician's assistants for minor treatment/prescription and data-gathering (respectively).

More germane to his old profession, the mega-hospital/doctor "groups" have banned or severely restricted the pharmaceutical reps from calling on the doctors.  The doctors have become revenue-centers, and spending time with pharma-reps is NOT revenue-producing time.  The pharma-reps instead are forced to call on the mega-group purchasing officials.

IOW, your doc is a scarce commodity; the time spent with patients and pharma-reps is restricted because that time could be spent with other patients (read:  revenue sources).  Computer-aided diagnosis, combined with the gradual mission-creep of the NP's and PA's, this will have another effect:  the commodification of the practice of medicine.

In every other sector, 'commodification' has led to reduced earnings and/or off-shoring; and in a noticeable number of cases, it has also led to quality problems--some quite severe.  Since 'quality' of medicine can have serious effects (like, for example, death or disability), this is an interesting development, no?


1 comment:

GOR said...

I have been convinced for some time that doctors in “groups” have become like lawyers in large firms: expected to generate revenue for the firm (do they have quotas?). And they do this through repetitive tests, whether through multiple blood tests, X-rays, CAT scans, MRIs etc. - in addition to the outrageous charges for repeat 15-minute consultations and referrals to ‘specialists’.

Of course they will advance medical reasons why all this is ‘necessary’. But the bottom line is – it is about the bottom line for the group.

I treat doctors as I do plumbers and electricians: call upon them only when necessary. No ‘routine’ annual visits, just as I don’t have a plumber check the pipes or an electrician the wiring on an annual basis.

“Those who are well need not the physician”