A SECOND OPINION
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Revolting Sheep by LARRY GRIFFIN , MD , FACOG
The sheep have revolted !! Not too long ago , it was often said that getting doctors to agree on most anything was like trying to herd cats . You know , those creatures who are maddeningly independent and strong willed , and will do what THEY feel is appropriate . Doctors , too , are educated and trained to gather evidence , assess the situation and make a decision . And doctors are educated and trained to trust those decisions , and , if the decision is made based on rational information , to be open to other opinions , but to ultimately , in the absence of compelling information to the contrary , to believe his or her decision is correct .
The ability of physicians to organize effectively is obviously hampered by this characteristic , since there has to be a compelling reason to subvert one ’ s own professional opinion to those of another , especially when the other person lacks the professional qualifications and credentials to even form a valid opinion .
Hospital systems recognized this characteristic and combined with the high costs of running a practice and the limited , if any , increased reimbursement from payers to offset those costs , a perfect storm developed to push physicians into employment contracts with them . In addition , many of the more successful practices were owned / managed by physicians who were aging and looking toward retirement in the not-too-distant future , and who were concerned about the ability to do so while still ensuring their patients had ongoing care .
As a result , the independent physician ( the cat ) rapidly evolved into another familiar animal … the sheep . And like all sheep , they can expect to be seasonally sheared , and often led to the slaughter eventually . After all , sheep can be replaced pretty easily . Doctors could become near-slaves to their employers , having no or very little say in how long to spend with patients , where to refer them for testing and ancillary services , feeling controlled in so many other ways . If the employed physicians raised even the least amount of difficulty by not eagerly running into the shearing shed with zeal , the hammer came down . Until recently , there was little that could be done , other than resign , but the employment contract with the hospital system forbade them to practice in their own home area , not to speak of the costs of staring a new practice , particularly when the employer basically owned the records of the patients and most often would not even notify them of the doctor ’ s new location , a clear violation of medical ethics … but then hospitals do not take the Hippocratic Oath , and patients come second to profitability and control .
However , recently , a hospital system was tagged for multiple millions of dollars for violating the rights of an employed physician : a unanimous jury verdict in a Kentucky courtroom . The evidence indicated that the physician was accused of behavior unbecoming , possible substance abuse , and was suspended without due process and without the benefit of even the appearance of fairness . I have heard of similar instances from other hospital systems in the state . The FTC is challenging the onerous restrictive covenants that hold physicians hostage as well . I hope this is the start of the metamorphosis from sheep to cat again for the physician community , and that it indicates that hospital systems are not above the rule of fair play . I hope it indicates that physicians can once again claim their rightful place as leaders in health care instead of zombie followers .
Who knows if that will happen … I believe only that each of us can determine the direction medicine takes . Will complacency continue to rule , or will we rise up and start to refuse to participate in a system which treats physicians as just any other employee and not as the leaders of the health care team they are educated , trained and sworn to be ?
Dr . Griffin is a retired obstetrician-gynecologist .
26 LOUISVILLE MEDICINE OPINION