Insidious Buzzwords Contributing to the Decimation of Physician-Led Healthcare

Patient care is no longer the focus of behemoth hospital conglomerates and insurance companies.  It is about profitability. Managed Care, Gatekeeper, participating vs. non participating, HMO’s, PPO’s, POS, Capitation, Provider, in network vs. out of network, mid-levels, EMRs, and Minute Clinics are just a few of the deleterious terms wreaking havoc on quality healthcare.

The implementation of Managed Care was the harbinger of attempts to distance the doctor-patient relationship. Ascribing the title of gatekeeper to primary care physicians with financial incentives, represented a conflict. Making physicians in charge of approving specialist referrals sparked an immediate alienation of that vital connection. In addition, in network, out of network, participating, and non participating added confusion and untenable options. It was sad to see physicians having to tell patients to choose a specialist from a participating network list. No longer could physicians refer to a specialist they trusted and respected, unless that specialist was on their preferred provider list. Physicians are not interchangeable. Clearly, managed care companies signed up specialists with whom they negotiated the best rates. It was not based on quality, expertise, or performance. Listing physicians, NPs, PAs, and other advanced practice practitioners under the category of providers marginalizes physicians. Non-physician practice managers assume too much control over practices. They determine the need for a patient to be fit in for an appointment, with no regard for the urgency. 

Capitation was another debacle devaluing physicians.  Primary care premiums were kept by insurance carriers, if the patient didn’t sign up with a primary upon enrollment. Only when a patient showed up for a visit or needed a referral was it ascertained that the office had not received the capitation for that patient. Requiring several calls to the health carrier to resolve the issue took up time and man hours. Each carrier was contracted with a different lab, so offices who drew lab required staff to ensure the correct lab was selected for each carrier. 

Graduating from medical school, completing residencies, and fellowships, being on call day and night to, now, having to perform burdensome administrative duties as well, takes time away from patients, sabotaging the patient-doctor relationship further. Restrictions and regulations distract and convolute the noble practice of medicine. EMRs, providers, team, protocols, formularies, model, urgent care, Minute clinics, hinder the physician's ability to spend as much quality time treating patients. Non physician administrators add another layer of impractical, coercive, threatening, and divisive tactics aimed at controlling and restricting the best quality care.  Again, it is about the bottom line with little regard for the expertise of physicians. Team is a key buzzword used to imply that a team approach is better than the one on one physician approach. Continuity of care is so important. It has become more difficult to see the same physician when calling for an appointment. Receptionists offer other physicians and Nurse Practitioners as options available. It is unacceptable.

However, while certain teams provide valuable and comprehensive care, ALS teams, etc., others dilute care and delay information being properly transmitted to the physician. By the time the mid-levels relay the information, it is misconstrued, delaying and obstructing care.