Wednesday, January 22, 2014

Tensions and Paradoxes Between Top-Academic Doctors and Top-Down Government

Uncover and work with paradox and tension.  Do not shy away from them as if they were unnatural.

Edgeware: Insights from Complexity Science

America's top doctors tend to be concentated  in academic institutions  or graduated from those institutions.    

Government,  in one way or another, either in terms of grants or subsidies for training,  is a major source of funding for medical schools.   For these and other reasons, such as idealism and compassion for the poor, which often make up a disproportional segment of their patient population,   faculty members tend to have a pro-ObamaCare  mindset.

ObamaCare,  however,  by cutting federal monies for teaching hospitals and specialists and training programs,  has created tensions and paradoxes among the progressively-minded in the top tiers of medical academia and government.   The recent  exclusion of top academic centers by health plans as they narrow their networks to save money has accelerated  these tensions and paradoxes.  

Academic training centers have double roles in our society:  as places where the affluent go to find the top doctors and as safety-net hospitals for the poor.   

I am acutely aware of these tensions and paradoxes because I have served more than 10 years on the medical advisory board of Castle Connolly Ltd, a New York City company that each year that publishes books liting  America’s top doctors.  Top doctor selection is  based on a rigorous vetting process which includes surveying practicing doctors asking them to name what they consider the top doctors.   Most  specialists designated as top doctors practice in academia and in many cases served  the mentors of doctors being asked for their opinion  which  physicians  are the very best.

I spoke yesterday of John Connolly,  CEO of Castle Connolly.   He noted that there is a world-wide movement towards cost-cutting of governments financing  teaching programs.   These cuts weigh heavily upon teaching hospitals.   As the same time,  people in these countries are seeking wider access and more information on top doctors – where to find them, what  their credentials are, and how  to pay for their services.  
Consequently,  Castle Connolly is expanding into Europe,  Asia,  and soon into South America.
There is always a natural human appetite for access to top-tier care.  As Winston Churchill observed, “I am easily satisfied by the very best.” When it comes to our health , most of us share this view.  And, in many cases, those seeking the very best are affluent and can pay for the very best.  

This yearning for the best has caused many institutions to create elite units of care staffed by top specialists  who now derive much of their income from treating those who can afford their expertise.

Reduction of government-financed care and the waiting lines and bureaucracy that accompany government care creates  paradoxes and tensions – both philosophically and practically.   
Academic faculty members in America  tend to liberal and pro-government  and backers of ObamaCare or single payer.  If you doubt me, I invite you to read the “Perspective” section of the New England Journal of Medicine,  which, more often than not,  supports ObamaCare.    When they or their family need care, they gravitate to liberal colleagues, whom they regard as the top doctors in their field. 

At the same time,  affluent patients,  many of whom are conservative,  and who often became  affluent because of their success and accomplishment in the marketplace,  also seek out those same  top doctors.    

The result is many doctors may have philosophical and ideological  conflicts.  They are torn between time spent treating their affluent patients and devotion to teaching.   They enjoy teaching and they enjoy the income. There are advantages to being a top specialist in an academic environment.   You have residents to cover for you while you are at home or away.   You have prestige.   You have research facilities to draw upon.  

The medical professional in general is conservative (A 2008 survey self-identified as follows:  20% liberal, 39% moderate, and 41% conservative), but in teaching institutions dependent on government funding,  political affiliation tends to be  skewed toward liberalism.   But no matter, as one academic observed, “When it comes to personal income and the health of my patients, politics is no obstacle”  ObamaCare  and declining government reimbursement must make for spirited faculty lounge discussions.

Tweet:   ObamaCare creates  tensions and paradoxes among top doctors in academia because of  systematic cuts in federal funding of teaching hospitals

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