One way to help deliver better health care to more people would be to take a hard look at EGO in medicine. What am I talking about here? In a word: prestige—the medical profession’s absolute obsession with prestige, which translates into an ever-increasing number of specialists. Unfortunately, this comes at the expense of primary care doctors, who traditionally serve the poor, families, and people with easily identifiable and easily treatable ailments.
Instead, the medical industry—and it is as much a business as computers, transportation, or construction—puts a gigantic premium on prestige. Hence the surplus of cardiologists, pulmonologists, and gastroenterologists—all of whom come at the expense of primary care physicians, the doctors who work at the front line of medicine and community involvement.
Blame it on emotional marketing. Once people believe something is expensive or coveted or popular, demand naturally increases. In medicine, this attitude translates into a form of defiance—the notion that one doctor’s general opinion, never mind his exemplary skills or education, is simply not enough. Send in the specialists! And specialists, unlike primary care doctors, are far more prone to ordering a lot of costly, possibly unneeded tests. This, in turn, causes the third party payers to turn the screws, and gives us medicine run by the bean counters. Talk about unintended consequences.
According to the Washington Monthly:
“Regardless of which kind of health care system we end up with, failing to remedy the shortage of primary care providers, and fast, will cost us enormous sums and may even serve to lower the quality of care Americans receive.”
I can cite a recent personal example. Suffering from a fairly nasty household burn, I went to the local hospital’s emergency room for some quick care, and then was referred to a very busy plastic surgeon. To be sure, had skin grafting been needed, and thankfully it wasn’t, this type of specialist would have been appropriate. But, wouldn’t it have been more efficient—and less expensive—to put me under general care, to be referred out only if I really required specialized care?
Saying that, it was difficult enough finding a plastic surgeon who even deigned to see burn patients, since a goodly number of them are 100% occupied with elective cosmetic work. So here, the specialist opts out of the very system that encourages his existence!
The obsession with medical prestige is itself a statistical fact. For example (these numbers are from the same Washington Monthly piece): The number of gastroenterologists grew by more than 1,000 percent from 1965 to 1990; cardiologists by 900 percent; neurologists by 325 percent; and plastic surgeons by 300 percent.
In the same period, the number of primary care physicians increased by only 66 percent. Leave aside, momentarily, this constant production of specialists for another equally important revelation: Primary care doctors are less likely to hospitalize patients than specialists treating individuals with similar kinds of illness.
“Primary care protects people from unwanted procedures,” states Fitzhugh Mullan, an assistant U.S. surgeon general.
Medical schools deserve their share of blame for this problem, as well. The bias against primary care is an institutionalized phenomenon among professors and students. After all, the vast majority of federal money goes to specialized programs, and these are highly coveted by most med schools. According to Christopher Georges, an investigative reporter who writes about public policy: “The name of the game has become not just medicine, but survival and prestige.”
The victims of the medical profession’s unyielding love affair with prestige are millions of people who need basic health care. For many Americans, that is only available in an emergency room. No matter how much money we commit to health care, and no matter how we pay for it, we still have to deliver care to the patient, and the fixation on specialization puts us further from this goal.