MISEDUCATION, APPROPRIATION AND OBLITERATION — THE CORPORATE PRACTICE OF MEDICINE
Business and medicine make strange bedfellows. However, this “relationship” is not one born out of love, but out of exploitation. That of a pimp and a ho’. But one cannot speak of the corporate practice of medicine(CPOM) without also including its not-so-strange bedfellow of scope creep by non-physician practitioners(NPPs), aka the sluts who consciously and unabashedly sleep with the pimp, with the hope that their position will be escalated to that of the favored ho’. The CPOM and scope creep go hand-in-hand, so to speak. A symbiotic connection in which all parasites (https://authenticmedicine.com/2020/05/what-kind-of-fkery-is-this/) seeking to practice medicine without a medical license benefit. They gratify each other…if you know what I mean.
I used to be of the opinion that I was being paranoid because I believed the intent of the corporate practice of medicine was to make U.S. physicians obsolete. Not anymore. It became very apparent to me, particularly as a locum tenens physician, that these corporations had no desire to spend money on professional medical expertise. They simply needed my license for liability purposes, to protect their bottom line and what they perceived as their turf. Indemnifying me was not an option. Then the aggressive legislative pursuit to legalize scope creep by NPPs became a huge red flag to me and helped confirm my suspicions about their alliance, be it intentional or unintentional, with the CPOM. In my beloved specialty of emergency medicine(EM), these same private-equity backed corporate entities began opening their own EM residencies. With minimal to no resistance by the American College of Graduate Medical Education(ACGME) and EM physician organizations, they have been allowed to flourish, unhindered, to create programs that enable and enhance impersonal, metric-driven, patient quantity-focused models of education. Physician education is no longer patient-centered – profit is. It’s enough to make a person sick. Pun intended.
The Miseducation:
Where, in the business of medicine, is the best place to begin when one wishes to convince the masses into believing the unbelievable so that it can begin raining Benjamins? Marketing. This is where the intentional miseducation originates. The conflation of physicians with non-physician practitioners.
The Appropriation:
How does one then perpetuate the miseducation? First, one must convince the public that various health care professions are “basically” the same, carefully ensuring that NPPs will be confused and fused with physicians. Professional appropriation (https://authenticmedicine.com/2019/12/professional-appropriation-a-new-term/). Second, persuade obtuse and acquiescent health care professionals(HCPs) to use a dehumanizing term, “provider”, to describe themselves. Previously, that term was used to prescribe companies who provided car or health insurance, internet, plumbing/electric/gas, air conditioning services, etc. Third, take a well-known, long-used acronym, PCP, which was formerly an abbreviation for “Primary Care Physician”, and replace the latter “P” with the vile term, “Provider”; ultimately merging the two terms, implying they are one and the same. Last but not least, if questioned by the partially-woke why this nonsense is necessary, cajole the gullible into accepting that an umbrella term is imperative to describe all HCPs because, you know, using an individual’s actual honorific is somehow cumbersome. Worked in the past with no problem, but for some reason today, it’s now an issue. And should that bulls**t explanation fail, resort to the ad hominem and reliable trope of “arrogant” to shame actual physicians, who insist on being referred to by their apt title, into compliance. Brilliant gaslighting. Because it worked.
The Obliteration:
The forced exodus of physicians, under the guise of a physician shortage, began decades ago. I clearly remember working in emergency departments which were physician-staffed, including Fast Tracks that were staffed by Internal Medicine or Family Medicine physicians, or Physician Assistants who were closely supervised by a physician assigned to oversee the Fast Track. When corporations began taking over hospital contracts, they fired the IM and FM doctors and brought in more NPPs. I was then forced to supervise NPPs while I could barely keep up with my own patients. It was that or lose my job. I was not given a choice. And I could not help but notice that my colleagues, who had worked next to me one day, were suddenly gone the next. Not being quite business savvy at the time, it took me a minute to recognize what was occurring. These companies always promised improved efficiency and quality; yet no one ever questioned how one can have improved efficiency or quality with less physicians. Another marketing ploy that was a bald-faced lie. When new corporations came in and took over EM contracts, I was almost always “fortunate” to be one of the docs who was not terminated by the new corporation with no notice. At least I had a job. We were purposely not told 30-90 days in advance because most of us would have applied for other jobs and left. It still annoys me that my own ED associates participated in the withholding of that information. And when some of my co-workers were fired on short notice, no one, including myself, ever followed up to see how they were doing since they had no job. Out of sight, out of mind. We never said anything and watched this obliteration happen right before our eyes. It is happening throughout hospitals now. Today. We witness this in NPP-only staffed EDs, ICUs and Hospitalist services. There’s no shortage of physicians; however, there is a severe shortage of ethics and empathy for patients by these corporate pimps, their private equity Cartel daddies and the slutty NPPs who benefit financially from this mess.
The undermining of our authority and revocation of our leadership status in medicine is a necessary evil for the corporate practice of medicine to thrive and the sycophantic scope creep movement to have any success. These predators don’t know how to lead ethically or effectively, they only know low-down, slimy snake tactics. I have stated many times that I do not consider the healthcare model in the U.S. sustainable because it is impossible without physicians at the helm. I stand by that assertion. Until the public has decided that they have had enough of corporate medicine’s filthy hands in their business, this nightmare will continue….for a while. Many believe that we are stuck with this system – that it is too big to fail. I don’t believe that at all. I believe it is just a matter of time.
“It always seems impossible until it’s done.”
— Nelson Mandela
And of course this couldn’t have happened without the complete and utter failure – indeed, refusal – of our medical academies to represent the interests of their members.
Natalie, I ADORE your writings. You cut through all the haze and lay things out exactly as I would, if I were more able. When I have to go for a period of time without a Natalie column, I suffer.
You are SO SO SO on target!!! Like a B-17 over Dresden. I, for one, appreciate the heck out of you. Thank you for laying out this case today. Pretty soon we will have conferences where Big Brother speaks to us, and you will be the one sprinting down the aisle and throwing your sledge hammer at the screen. Thank you, Natalie.
Thank you so much Rick! I sincerely appreciate your complement.