The future of corporatized medicine

Corporations are now recognized as legal entities with rights and privileges similar to people. They are born, documented with incorporation papers, grow, shrink, and die just like humans. Corporations have a collective consciousness and declare war on other corporations who do not wish to be engulfed through hostile takeovers.  Corporations wish to grow and get bigger until finances intervene and then sometimes split or spin off children in the form of smaller corporations. Now corporations have overtaken medicine. What does this mean for the physician?

The new federal regulations regarding the practice of medicine have basically corporatized medicine and corporatized physicians. Physicians can no longer “hang out their own shingle” in many communities. They must sign up to work for the multispecialty group who is linked to the hospital who are both owned by corporate America.  Their salaries are determined by satisfaction responses from patient questionnaires and how much money they save the system. Physicians are bound to hospital based protocols that determine treatment for a given condition without deviation. Gone is the autonomy and self-driven excellence derived from autonomy. What does this mean for the physician?

It is a shame to take our most innovative and motivated youth who desire to be physicians and corporatize them.  Corporatization leads to a mind set of following rules, not improving the rules or questioning why the rules exist or removing unnecessary rules. Ruler followers are much different than creative spirits. Rule followers quit thinking, accept the status quo, and discard entrepreneurial ideas. They find corporate rewards in conforming rather than improving or changing the system. Medicine is not an area that thrives on consistency. Every disease manifests differently in different individuals at different times. Medicine teaches physicians to recognize patterns, but think creatively to diagnose when not all of the symptoms or laboratory data fit the pattern perfectly. Medicine is the art of constantly evaluating and changing current paradigms to make them more useful. What does this mean for the physician?

Prior to becoming a physician, I trained and worked as a mechanical engineer. I was tasked with designing concrete lined ponds to retain the tailings from a gold mine in Brazil. I wanted to create a pond that was more attractive and less environmentally intrusive by modifying the design. Absolutely not! My supervisor told me that tailings ponds had been designed a certain way for years and this is the way they were to be designed and this is the way they would always be designed and who was I to suggest a design change and I should follow directions and stop causing trouble and wasting time. I designed a tailings pond the way they had always been designed, received a raise for doing a good job, and applied to medical school. I wanted to pursue a career where I could think outside the box and perhaps improve the human condition through creativity. This career might no longer be in medicine that is corporatized. What does this mean for the physician?

I think medicine as a whole and specifically dermatology are at a crossroads. Corporations do not work unless conformity is the rule. One dermatologist can easily try something new and innovate, but a corporation of 100 physicians cannot survive unless all are unified. The corporation usurps the identity of the physician and the goals of the physician must be the goal of the corporation. What this means is that the physician is the corporation. This will be challenging for dermatology. Dermatologists have always been outside the body, outside the hospital, and outside the corporation. We try new drugs with enthusiasm, we invent new procedures, we love new devices, we are creative in our off label prescribing, and we share our new ideas with our peers. Dermatology is one of the most innovative areas of medicine attracting keen minds that see the skin, hair, and nails differently and we all benefit from their vision. I am concerned that dermatology will loose its inherent creativity as physicians are relegated to conformity. Will dermatology become corporatized? This will depend on those of us who are currently in practice and how we manage our specialty for those who will follow.