Thursday, February 20, 2014

The Spirit of Physician Enterprise

It is entrepreneurs who know the rules of the world and the laws of God. They overthrow establishments rather than establish equilibrium.  They are the heroes of economic life.

George Gilder, The Spirit of Enterprise, Simon and Schuster, 1984

Successful entrepreneurs aim high.   They are not content simply to improve on what already exists to modify it.  They try to create new and different values and new and different satisfactions.

Peter F. Drucker,  Innovation and Entrepreneurship: Practice and Principles,  Harper & Row, 1986 

Innovation and entrepreneurship fascinate me, so much so that I wrote a book about it  Innovation-Driven Health Care: 24 Key Concepts for Transformation ( Jones and Bartlett, 2007).  

 I believe physician entrepreneurs can change the world for the better by taking risks and pursuing ideas,  often in their own best interest but in the interest of the patient as well,  at the physician's  own personal risk.

Entrepreneurs are like elevators.   They are always coming up with something,  like transformational  ideas, or going down with something,   like short circuiting  from  government transformers.

Health policy makers are critical of physician entrepreneurs.    Policy makers prefer to freeze physicians in place,  to restrict their entrepreneurial activities through rules and regulations,  to decrease their incomes from government programs,  to reorganize them into government cost-saving entities like accountable care organizations,  or to pay them on the basis of “value,” "performance," or outcomes, as defined by government.

To illustrate,  I bring your attention to an article in the February 2014 issue of Health Affairs, “Financial Pressures Spur Physician Entrepreneuralism.”   

The article is by Hoangmai Pham,  a senior health researcher at the Center for Studying Health System Change (HSC) in Washington, D.C. Kelly Devers, an associate professor in the Department of Health Administration, Virginia Commonwealth University,  Jessica May  a health research assistant at HSC.  And Robert Berenson,  a senior fellow at the Urban Institute in Washington.

The authors  describe (1) how financial pressures have intensified physicians’ entrepreneurial activity; (2) range and prevalence of physicians’ activities to increase the volume and prices of services; (3) how strategies varied across geographic areas and types of physicians; (4) how they contrasted with the relative lack of efforts to improve practice efficiency or quality; (5) physicians’ strategies to limit the provision of less lucrative services; and (6) plans’ and hospitals’ responses.

Among the entrepreneurial activities listed are consulting and participating in pharmaceutical studies, investing in endoscopy, cardiac rehab, chemotherapy infusion,  physical therapy,  lithotripsy, and imaging centers; and promoting services that fall outside the realm of  3rd parties, such as cosmetic surgery,  botox therapy,  alternative medicine,  and concierge medicine.

Concierge medicine and its variants, are an entrepreneurial physician  response to overweening government control of what physician  can and cannot do, and to  systematic reduction in incomes and types of services provided.     

Concierge care, direct care provided by a physician,  appeals to a wide swath of Americans. They prefer direct personal care from physicians as opposed to government provided and endorsed care.   Direct care may herald the coming of two tier medicine – one tier for government subsidized patients and a second tier for Americans who prefer private care.    
The last line in the article captures the authors’ attitude  toward physician entrepreneurialism: 

“In an era of physician free agency, professionalism may no longer check-self interest. Policymakers might need to take more active compensatory role.”

In other words, physicians are doing things contrary what policymakers think are in the best interests of society, and physician entrepreneurs  need to be reined in.

Tweet:  Physician entrepreneurs are engaged in a variety of activities that promote physician and patient self-interest and that run contrary to federal policymakers’ wishes..

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