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Hospitals [BDs] “versus” Family Practitioners [FAs]
By Dr. David Edward Marcinko; MBA, CMP™
[Editor-in-Chief]
The Big Mistake
Those who believe that hospitals need medical specialists like radiologists, pathologists and oncologists, more than primary care doctors, are mistaken. And, those doctors who believe that the majority of “financial advisors” work for their clients are also mistaken. Here’s why in analogy format.
Why Hospitals Need PCPs
Hospitals generally need primary care physicians, more than specialists, because insurance contracts can be negotiated from a position of strength. A solid [large] primary care panel is a must-have for most insurance contracts. Just recall more than a decade ago – when PCPs were told of an emerging new renaissance where they would reign in place of the medical specialists? It never happened then, but it may happen now following healthcare reform.
Also, recall that the growth of fiduciary Registered Investment Advisors [RIAs] was slow until the stock market collapse of 2008. The pace is accelerating today with the political dawn of financial reform.
Patient’s Love their PCPs – Not their Hospitals
Moreover, please realize that few patients shop around for specialists, or hospitals, as they do for PCPs. OK, the OB-GYNs are unique in that they can play a dual role – as specialist and primary care doctor – just ask my wife who would rather eat nails than change her [female] female doctor.
Hospitals also need PCPs as referring physicians to generate business through their ERs, admissions department, outpatient centers, and/or by ordering invasive and non-invasive radiology tests, images, scans or laboratory tests, and/or sending patients to specialists who will do expensive procedures or surgery in their ORs, hospital and/or related facilities.
Doesn’t this sound like a stock broker working for his wire-house or broker-dealer?
The PCP Loss Leader
Primary care is a loss-leader to hospitals as they make little money directly off medical practices, but can generate a great deal from the referrals and procedures the grass-roots docs generate; especially if they “play the game” like commissioned stockbrokers. And, consider brilliant medical diagnosticians, like TV’s Gregory House MD, and all those tests and procedures they can do – just to be sure!
No wonder that physician-executives and hospital administrators like Dr. Lisa Cuddy of the Princeton-Plainsboro Teaching Hospital, in New Jersey, love them.
Ditto for wire-house office managers and stock-brokerage OSJs [Office of Supervisory Jurisdiction] who love their “top producers”, brokers and FAs.
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Conflicted Missions
Unfortunately, this shifts the mission of PCPs from keeping patients out of the hospital – as physical and fiscal advocate – to sending them to the hospital as a “heavy admitter-referrer” with resulting perks and swagger.
Thus, “success” of the PCP from a hospital perspective is not to avoid referrals or costly procedures, but to gather them. However, success is a matter of perspective that may be very unfortunate for the patient, state or federal payer, private employer and/or insurance company.
Financial Advisor Analog
Does this PCP conundrum sound like the conflicted situation found with many “independent” financial advisors today? Are PCPs becoming mere patient gatherers, or profit generating shills, for their hospitals, employers or healthcare systems? Where does one’s duty rest? Are we doctor’s or medical product/procedure merchants?
www.CertifiedMedicalPlanner.com
Conclusion
And so, your thoughts and comments on this ME-P are appreciated. Is this analogy correct, or not. Is it too harsh or too gentle – and for whom?
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Filed under: CMP Program, Ethics, Op-Editorials | Tagged: broker-dealer, family practitioners, fiduciary, financial advisors, managed care contracts, OSJ, PCPs, stock broker, wire-house, www.certifiedmedicalplanner.com, www.healthcarefinancials.com |
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Pity the Poor PCPs – Financially Shafted Again
The healthcare reform law may benefit medical specialist physicians more than primary care providers, according to this new report.
http://www.healthcarefinancenews.com/news/health-reform-may-benefit-specialists-more-primary-care-providers
Jack
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Will Doctors Entice, Cajole and/or Persuade You?
Patients often fall victim to certain biases and pitfalls that lead them to act against their own long-term goals, i.e. smoking because they don’t actually know anyone with lung cancer. Doctors could better arm themselves to detect and counter those biases in their patients, according to this paper just published in the Annals of Family Medicine.
http://www.annfammed.org/cgi/content/abstract/8/3/260
But, hopefully the ethical line is not crossed into a possible scam, as noted in the painful story below.
http://www.thehealthcareblog.com/the_health_care_blog/2010/05/a-painful-story.html#comments
On the other hand, is this just an example of a malevolent dictator?
http://blogs.wsj.com/health/2010/05/10/the-doctor-will-persuade-you-now/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+wsj%2Fhealth%2Ffeed+%28WSJ.com%3A+Health+Blog%29&mod=smallbusiness
Any philosophers or ethical thought-leaders out there who care to comment on this excellent post by Dr. Marcinko, with f/u comments? Are doctors more like benevolent, or malevolent, dictators advancing their own self-good?
Blanche
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Dr. Marcinko,
This is a very interesting analogy, and one that I have thought about frequently as a family practitioner and a financial advisor working with a RIA.
Regarding the possible conflicts of interest facing both FPs and FAs, I have viewed my “fiduciary” designation in my advisory role as analogous to the Hippocratic Oath I took in my role as a doctor. In both cases, I pledge to “do no harm”, and to take actions and make recommendations which are only in the best interest of the customer (ie patient or client). Having said that, it is important to realize that professionals are inclined to use the tools which are available to them, and with which they are familiar.
Some examples, in the financial and medical arenas:
If you ask a physician how you should be screened for colon cancer, the answer might depend upon whom you ask. A gastroenterologist will offer a colonoscopy, but a radiologist would be more likely to talk about a virtual colonoscopy.
Do you need to lose weight? An internist might review medications and appropriate dietary changes. A surgeon, on the other hand, might be more inclined to discuss the LAP-BAND vs. gastric bypass.
If you ask an insurance agent how to meet a financial goal or need, what do you think they will recommend? An insurance product, of course!
If an investor asks a broker to give a recommendation on a mutual fund, and that broker is compensated more by recommending certain funds which include loads and commissions, which funds do you think the broker will find “most appropriate” for the investor? The answer is obvious.
The best model in both fields – medicine and finance – is an alignment of the goals of both the provider and the patient/customer.
Brian J. Knabe, MD
Savant Capital Management, Inc®
190 Buckley Drive
Rockford, IL 61107
Tel 815-227-0300
Fax 815-226-2195
bknabe@savantcapital.com
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Dr. Knabe,
Insightful comments. Isn’t there an old saying that goes: “When all you have is a hammer, everything looks like a nail?”
Grace
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