Spirit of Physician Enterprise
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.
Gilder, The Spirit of Enterprise, Simon
and Schuster, 1984
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.
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
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.
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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