One score and ten PDRs ago: the transformation of medical practice

Journal of Drugs in Dermatology, Dec, 2003 by Craig G. Burkhart

The practice of medicine continues to be altered by political and legal forces. Before government involvement with Medicare, organized medicine functioned like a club with total professional autonomy. Local society memberships were necessary for patient referrals, professional appointments, and hospital access. The practice of medicine was colleague-dependent. The American legal system reinforced physicians' right to self-regulation by not applying the Sherman Antitrust Act to medicines professional activities (1).

Beginning with the 1970s, new entities entered the health care field including federal and state agencies, private insurers, and managed-care organization. The press questioned the escalating governmental funds allocated for provision of medical care and the ability of organized medicine to police hospitals, In an effort to control costs, the government monitored expenditures, pursued fraudulent practices, and enhanced market competition by improving opportunities for commercial investment in healthcare delivery systems. These reforms lead to a power shift from physicians to government and corporate administrators. The transition for the medical establishment was basically from self-regulation to government regulation, and from decentralized to centralized controls (1).

The medical profession that once was based on collegiality, informality, and confidentiality, today stresses hierarchy, formality, and accountability. Large, for-profit companies placing physicians now as both patient advocate and corporate employee now dominate the health care industry. In short, the system presently has a bureaucratic framework with government and corporate oversight. The structure includes standardized case reviews, legal process, public and corporate accountability, and incorporation of management principles into medical practice and formalization of professional controls.

Although the rules of medicine have changed, the personal satisfactions in offering medical care to the needy remains. The essence and beauty of our profession lives on. Its just harder to find.

References:

(1.) Ameringer CF. State medical boards and the politics of public protection Johns Hopkins University Press, Maryland, 1999.

Craig G. Burkhart MPH MD

Clinical Professor

Medical College of Ohio at Toledo

5600 Monroe Street, Suite 106B

Sylvania, OH 43560