Since when is medicine about productivity?


Category : Medical Rants

45 years ago I entered medical school to join the medical profession.  My father, a psychologist, always expressed great admiration for the medical profession.  He strived to convince psychologists that they should hold their profession to the same standards as medicine.

If he were still alive, I can only imagine his commentary about the following common topics – productivity, RVUs, performance scorecards and our inane documentation rules.  Productivity has several definitions.  Economists define it:

the rate at which goods and services having exchangevalue are brought forth or produced :

When did our profession adopt this definition?  If I spend 1 hour talking with a patient, examining that patient, reading old records, going to the literature to answer some questions, going to radiology to review the films, calling a consultant and then explaining everything to the patient, I represent lousy productivity.  But I have demonstrated great professionalism.  We entered medicine to help people.  The patient’s welfare is the main goal.
Where is the patient in the productivity definition?  How much time should we spend with each patient?  I would argue that we should spend the proper amount of time with the patient to address the patient’s problems.  Some visits are rather simple, but some visits are very complex.  We have short visits and long visits.  Sometimes we need to do significant work away from the patient.
The adoption of the term productivity has, in my opinion, a destructive influence on our professionalism.  Similarly RVUs give the same undesirable message.
Our payment schemes are driving these terms.  When I hear them, I hear fingernails scratching on the blackboard.  How do these terms impact physicians?  Obviously, I would argue that they redefine our profession in negative way.
We all need to reconsider how to define our professionalism.  We need focus on how to best deliver excellent patient caring.  We need to focus on how we can best serve our patients.  Sometimes that takes longer than the formula dictates we should spend.
So please do not describe productivity equations, or bonuses based on RVUs.  Please do not explain coding, upcoding and downcoding.  Please tell me stories about how you help the patient achieve their health needs.
As Voltaire first said, “The people’s representatives will reach their destination, invested with the highest confidence and unlimited power. They will show great character. They must consider that great responsibility follows inseparably from great power. To their energy, to their courage, and above all to their prudence, they shall owe their success and their glory.
We have great power, and thus we have great responsibility.  We must continue to explain that responsibility to all those who threaten our professionalism. Our patients deserve our commitment.

Comments (4)

The profession of medicine has become the business of medicine where clinicians have jobs rather than a calling, and instead of providing care, we sell interventions.

I wish I could imagine a way to reverse the trend, other than talking about it often with medical students, residents and patients.

Bravo again, db! I hope that doctors will make the effort at some time to take back their profession! A good place to start would be to stop selling their practices to hospitals, hedge funds or any other entity only interested in extracting as much money as possible from the patient (or the patient’s insurance company).

Physicians have so completely lost their sense of professionalism that they no longer bat an eye at financial arrangements that anyone else would consider grossly unethical.

A lawyer knows very well that he can’t represent both sides in the same case, but we meekly bend our heads and mutter a soft yes when we’re told that we’re required to balance the conflicting interests of patient, insurer, and society. Would anyone hire a lawyer who worked for an “Accountable Organization” where she was financially rewarded for keeping the services she provided to a minimum? Would anyone use an accountant who said he would file your taxes according to what was best for the population, not you as an individual?

The ABA has a far deeper understanding of professional ethics than our medical societies do, and they have done a far better job of representing the interests of their members.

I understand there are always going to be money and time pressures, we don’t live in some utopia where we don’t have to think about such things.

The balance between the two is the key. When doctors say they are overwhelmed, need more time, need to back off on volume, and care is being compromised, that has to be listened to by administrators and things need to be adjusted. Too often these pleas for rational care are ignored.

The imbalance of power in the productivity debate is the problem.

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