Productivity Is Killing Medicine – and You!
Commentary by Rima E. Laibow, MD
As a licensed physician, I receive many specialized newsletters. Sometimes these publications inform me, mostly they appall me and not infrequently the enrage me. Recently, my inbox contained a remarkably astute and correct article about the shameful automation of medicine, not because of AI or mechanical robots, but because, years ago, doctors, lured by the flesh pots of somebody buying and managing their practices, allowed themselves to become wage slaves instead of health care professionals. Frankly, what they wanted was a steady income without the hassles of running their own practices.
Now, running your own practice is tough. I know. I have done it for multiple decades and it is a weary, worrisome life which sometimes pays pretty well and sometimes pays everyone else pretty well while you stand at the end of the line, hoping there is enough left in the pot for you.
But that has pretty much changed for the vast majority of doctors. They have allowed themselves, or they follow a generation or so of docs who allowed themselves, to become the equivalent of the women who sit in their dark third world huts sewing collars on the expensive shirts of first world companies – the more collars they sew, the more money they make and the more likely their children are to eat tomorrow or go to school next week.
What do I mean? Read these excerpts from “A Corrosive Force in Medical Care“ by John Mandrola, MD written last month and you will understand:
It comes in a large white envelope each month. It’s marked confidential.
When I hold it up to the light, I can see through the envelope. I can’t see the details, but the colored graphs give it away.
It’s my monthly productivity report based on relative value units (RVUs). Most employed doctors get these graphs.
These “dashboards” of value include your own productivity as well as many other graphs showing how you stack up with other doctors across the country. It tells your employer if you are a hard worker.
Doing an [procedures like – Dr. Laibow] ablation, catheterization, or stent or valve replacement earns a bunch of RVUs.
Listening to patients, examining patients, counseling patients, or hugging patients earns very few RVUs.
Doing important research, teaching colleagues, and reading the medical evidence earns zero RVUs. [Emphasis added – Dr. Laibow]
Too often, in too many medical systems, RVUs have become the primary unit of success.
No, you can’t be a mean and nasty doctor. And no, you can’t be a totally unskilled doctor who has too many complications.
But short of those extremes, if you make few waves, have good templates on your electronic health record so documentation is complete, and do tons of procedures, you are valuable.
If, on the other hand, you like slow, conservative medicine, or narrative notes rather than templates, or worse, if you are thoughtful and frank about silly policies, you become an outlier. If you do these things, your RVU tally usually does not reach the 75% of standard bar. Then trouble can come to you. [Emphasis added – Dr. Laibow]
… I was shocked to learn that a major teaching center (which will remain nameless) compensates its teaching faculty solely on the basis of productivity. [Emphasis added – Dr. Laibow] Imagine that. Educators whose paychecks are determined by the number of RVUs they generate rather than the bedside skills they impart to learners.
Productivity and the RVU have no place in medical care. There needs to be a different system of valuing the care of people with disease. [Emphasis added – Dr. Laibow]
What’s the solution? Are hospital corporations and bureaucrat-driven medicine going to vanish? Well, yes, if we make that happen. You see, there is a group of health care professionals who are still just that, HEALTH CARE PROFESSIONALS. They take time to listen to you. They take time to think. They take time to study better ways to treat you without toxic drugs. Time is, truly, money, and it does not sell drugs, it cures problems. Where does the money come from? The same place that the money you do not see coming out of your pocket that supports these RVU disasters come from: your pocket.
You can pay out of pocket (which some people can do, but many cannot) or you can join, right now, during this Open Enrollment Period, a Health Cost Sharing Plan. The one that I like best is HEP, Health Excellence Plus.
Through it, YOU decide what doctor you want to see following what health care plan. HEP negotiates the best price and then you pay for it out of your Health Savings Account or out if its premium pool. AND the cost for your coverage and your family’s is massively less than conventional “Health” insurance which is about procedures, drugs, doctor productivity, RUVs and the rest.
It’s not what I want and I do not believe it is what any reasonable person wants. I know none of us need it!
Open enrollment closes in just two weeks.