Is Medicine A Business or a Profession?

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Is Medicine A Business or a Profession?

This is a question most doctors grapple with at some point in their lives. Most will want to argue the latter. Seasoned physicians may concede the former. All will wish for balance.

In my lifetime, young students entering medicine often were motivated by a love of science, the ability to do well academically, the desire to develop a specialized skill, an experience in their own lives, and the desire to ‘help’ people. Those who announced early for business careers were motivated by other considerations. Doctors-in-the making were often ‘grinds,’ as my friends called them. They were rarely BMOCs, glad-handers, natural salespeople, or the lives of any party. Business types focused on the Big Picture. Future doctors sweated the Details. Training reinforces this. There is a reason young Donald Trump ended up where he is, and the chief resident at The Massachusetts General Hospital where he or she is.

Of course there were always exceptions, if the training didn’t weed them out. Some young doctors had future entrepreneurial or financial interests that emerged later. I recall at one hospital where I trained a doctor we called ‘The Banker’ behind his back. He was up on the stock market more than his patients. He read the Wall Street Journal when others read their professional journals. It was all about the money for him. I recall another older MD on the phone trying to coax an invitation to a Mediterranean cruise out of a celebrity patient. I didn’t stick around the nursing station to find out if he succeeded. These types were exceptions, not the rule. Patients do not usually seek out swinging surgeons or hedge-fund managers with MD degrees. There is method to all this sorting out.

future doctor?

On the other hand, anyone who labors in a specialty where the total US expenditure exceeds  2.6 trillion dollars has to appreciate he or she is part of a Big Business. Starting salaries or income usually begin at six figures. Patients don’t just float in the front door because your mother told them what a ‘Great Healer’ you are. Reputations build slowly. Medical offices do not run themselves. Attention to business counts.

And pays off. Not every occupation is this fortunate in its prospects. Yes, doctors start later to practice than most, but they soon make up for it, if school loans do not defeat them. Schedules are flexible. Medical problems appear at night and on week-ends 365 days a year. Specialists can command impressive fees, and do.

With our society paying increasing attention to cost containment, it means increasing attention to costs period. Someone always has to pay. There is now a third-party payer in the room these days doing just that. Their demands are voluminous. Their power increases. My grandfather took bartered goods in lieu of payment in the Depression. That would not pass scrutiny today.

More time is spent documenting costs and fees, procedures and ‘acuity.’ More attention is paid to reimbursement schedules. Doctors need to be prepared to defend their business practices. Medicare does audits. So does the IRS. That means every doctor, whether solo or in a group, has to pay more and more attention to business. But, it does not have to make him the next  ‘Banker.’

The Banker

What is a profession? Most dictionaries define at as an occupation where one is asked to perform a set of specialized duties for a fee. This means doctors, lawyers, judges, accountants, college professors, and architects. There are many others. Over time this class of worker has gained financial advantages and social prestige. People are drawn to professions because it guarantees a comfortable life. That may be slipping away in the current recession. Doctors work longer hours to maintain their income.

Professional people were often above questioning 100 years ago because of their expertise. Times have changed. Doctors are not held in the esteem they once were.  Even the President can get called a ‘liar’ publicly when he visits Congress. No one gets a pass anymore.

Critics have argued that medical profession used its power in the Twentieth Century to set fees arbitrarily and demand payment, regardless of outcome. They argue being a professional gives you a license to steal. Certainly a whole battalion of new health professionals have come along to challenge the clout doctors alone once held. But doctors do have clout. Congress has blinked more than once on cutting Medicare reimbursements.

Is medicine a profession or a business? The truth is both. Current realities demand increasing attention to latter, but patients will always expect the former. A good doctor neglects neither.

Tom Godfrey

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