The portals of medical care were once open to everyone. Medical care was provided by physicians, there were no intermediaries, those who could afford it saw the physician of “their choice”, the rest, those who couldn’t afford it were seen in the county clinic or county hospital. The elimination of the county hospitals was done smoothly and always the explanations offered were portrayed favorably. It took a while before it became apparent that the indigent no longer were provided for.
Medical insurance provided employment opportunities that had never been seen before. Hospitals once the province of physicians were taken over by administrators. The medical staffs began to realize that their opinions really took second place to “Sound Financial Judgment”. The increased number of physicians employed by hospitals further eroded the influence of medical staffs.
Physicians entering a community were usually required to undergo evaluation by their local medical society. This function was painted as being too self serving and the evaluation of new physicians was not assumed by any organization but hospital administrators could hire physicians of their choice.
Physicians have always been altruistic and assumed that someone else would have the public interest at heart. Unfortunately without input from the medical community the patient now has to see the physician of the insurance carrier’s preference or approval. The indigent without insurance has been able to get some kind of state insurance coverage that makes it financially difficult for physicians to take care of them.
Physicians no longer are judged by ability or capability but are now considered “Generic”. Every surgeon is as good as any other surgeon and all orthopedists are the same. Physicians still, aware of the capability of the specialist to whom they send the patient to will try to circumvent the insurance company’s list. Unfortunately the physician who does this too often is not kept on the list of approved physicians.
Control of medical care at every level has been taken away from the physician. Even the State has gotten into the act and now the physician must see the patient within a specified period of time.
The clock can’t be turned back. Unless the medical profession becomes more assertive they can join the assembly line workers in so far as any say about the services they provide. Administrators may understand economic problems but when their solutions have an impact on the quality of care it behooves the physician to be heard. The overall quality of care should be determined by the physicians who provide the care.
Physicians still play a major role in the provision of medical services and whenever possible should realize that they must work hard on preserving a major role in the way medicine is practiced.