- Machiavelli's Laboratory is a free ebook that I published on April 13, 2010. It is a satiric discourse on scientific ethics, from the perspective of an unethical scientist. Please don't take any of the advice and opinions in the book (or the excerpts featured in this blog) seriously.
This blog entry continue's yesterday's blog, "Right-sizing the physician workforce".
Just as restaurants can be divided into two broad categories: fast and slow; so can medical care.
The fast care specialties involve treating large numbers of patients with short, billable procedures. These procedure-oriented specialties include dermatology, gastroenterology, anesthesiology, radiology, and emergency medicine.
The slow care specialties require listening to the patient describe his many complaints, detailed history-taking, drawn-out and repeated instructions, and follow-up encounters. Many of the most time-consuming efforts in "slow-care" specialties are non-reimbursable. These slow-care, procedure-poor specialties include family practice, geriatric medicine, and psychiatry.
Though surgeons pride themselves as being hands-on proceduralists, their work often requires them to talk to patients before and after surgery, and to attend to a host of post-operative medical sequelae. Like it or not, surgery is a slow care specialty.
Physicians are reimbursed for procedures, with their income depending directly on the number of billable procedures they perform. It comes as no surprise that there is growing competition among recent medical school graduates for placement in the fast care specialties.
The slow care specialties, including family practice and surgery, can no longer fill their training slots with U.S. medical school graduates (1). Hence, there is a strong incentive for the slow care specialties to become "faster" (i.e. less time per patient, and more dependence on ancillary caregivers such as nurse practitioners and physician assistants).
Suppose you're a physician working in a slow care specialty, like psychiatry. How can you make your practice "faster" and increase your income? This will be the subject of tomorrow's blog, "Psychiatry: slow care getting faster".
REFERENCE
1. Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by U.S. medical students. JAMA 290:1173-1178, 2003.
- © 2010 Jules Berman
key words: medical-industrial complex, American healthcare, physician reimbursement
