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Medicine’s Sellouts (Scrubs Gone Wrong)

For this fifth installment of our series on our sick healthcare system and how to heal it, I air dirty laundry about my own profession.

One critic of our Guest Opinion on Feb. 18, “American health care’s staggering administrative overhead” correctly pointed out that there is more than one driver of the relentlessly escalating costs in our system.

For this fifth installment of our series on our sick healthcare system and how to heal it, I air dirty laundry about my own profession — our ranks are riddled with sellouts, some of whom have abandoned their scrubs to become corporate leaders of our system’s dysfunction and accessories to its escalating costs.

Most physicians entered the field and remain in their scrubs to care for patients.

Some, still in their scrubs, have lost their way and exploit weaknesses in our third-party payer system for their own gain. “Sellouts” is not too harsh a term for them. Their behavior has bred distrust, making the work of more-honorable scrubs harder.

In his latest book, “The Price We Pay,” Dr. Marty Makary of Johns Hopkins discusses physicians who over-test and over-treat to make a buck. When thousands of physicians were surveyed for the book, they estimated that 11% of all procedures were medically unjustifiable.

Some physicians have become enthusiastic shills for the pharmaceutical and medical device industries. According to data assembled by ProPublica, the average remuneration from these industries for all physicians is $3,400. Most fall far below that mark; but the average is pulled upward by 700 who take in more than $1 million each year, and by approximately 1,000 others who are each paid more than $100,000 annually to tout products.

During the COVID-19 crisis, the behavior of two ex-scrubs, executives in the Mount Sinai Health System in New York, exemplified the sellout’s mentality. In 2017, they had received eye-popping compensation packages; but as the pandemic of 2020 exhausted and demoralized the scrubs inside their hospitals, the infamous two retreated to the safety of Palm Beach, Florida.

Sellouts are found also in powerful, well-heeled advocacy organizations.

Many Americans may think of the AMA as the policy voice for most physicians. That ceased to be the case long ago. The percentage of physicians aligned with the AMA has declined drastically — at best, it is somewhere around 15% of all American physicians. The record will show that the organization’s executives stopped representing the interests of the rank and file some time ago.

The public would likely be far more interested to know that the AMA is also a moneymaker through the royalties it collects for the coding system physicians must use to identify ailments and therapies when communicating with insurance carriers. The AMA’s prosperity is thus directly linked to that of the health insurance industry.

As of late 2019, it was reported that the AMA’s top dog is paid in excess of $2 million annually.

Another organization purporting to speak for physicians is the Federation of State Medical Boards, which bills itself as “representing state medical boards in the legislative, policy development and spokesperson arenas.” The FSMB “urges state legislatures to provide… adequate resources to properly discharge their responsibilities and duties.” In other words, the FSMB leans on statehouses (by extension, the taxpayer) for more money. The FSMB’s head, Dr. Humayun Chaudhry made over $816,000 in 2017. His customary workload for the FSMB is three hours per week.

Yes, medicine’s sellouts, the “scrubs gone wrong,” are another of those drivers of the high cost of American healthcare. But in putting a spotlight on them, we must not forget that they are merely part, and not even an especially large part, of a complex web of relationships that have developed over the decades to feed a system that is only coincidentally concerned with the care of the sick.

The sellouts’ colleagues should call out the bad behavior. It has poisoned the public’s trust while contributing to the dysfunction of a deeply troubled system.

Originally appeared in The Bucks Country Courier Times and featured here with author permission.

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Marion Mass, M.D.
Marion Mass, M.D.https://practicingphysician.org/
In 2016, I was privileged to be a co-founder of Practicing Physicians of America (PPA), a true grassroots organization. We have a diverse board, including Brian J. Dixon, M.D., pediatric psychiatrist; Niran S. Al-Agba, M.D., pediatrician; Westby G. Fisher, M.D., cardiologist; and Judith L. Thompson, M.D., general and breast surgeon. With the publication of the position paper, Reducing Cost and Waste in American Medicine: A Physician-Led Roadmap to Patient-Centered Medical Care, for the first Free2Care Physician Symposium in April 2019, groups similar to PPA networked to form the FREE2CARE Coalition, which has since become an umbrella for 30 groups, 8 million citizens, and 70,000 physicians. Many in the coalition now speak, write, and advocate at the state and national levels to advance the agenda articulated in the original position paper. I have no conflicts of interest, have never taken a speaking fee, and serve as a volunteer on my county newspaper’s editorial board and with my county’s health society. Friends and family know my foibles and faux pas best. Sometimes, I’ve been so focused on the task at hand that I’ve run errands in public in my bathrobe—my attire of choice when writing at home.

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