Why Doctors Are Sick of Their Profession - WSJ

It does not surprise me that doctor’s are sick and tired of how they are being treated as professionals. It seems axiomatic.

Doc, you are sitting on a three legged stool which is being kicked out from under you. It started a long time ago.

In fact I predicted this in 1990 when I represented 25 doctors against the hospital system during an employment contract renewal where we wanted the non-compete clauses off the table and out of the contracts. 

Leg #1: After selling their practices no doctor knows what they are worth. When doctors sold their practices to hospital systems they lost their most important asset; it was their books. The day they sold the books they lost the knowledge of what they were worth. When you don’t control the income statement and don’t own the balance sheet you are simply a high paid employee - not an owner.

Leg #2: Doctors no longer have a seat at the table. They gave up their right to negotiate reimbursement rates and fees. This is the second leg of a three legged stool. They gave up the power to negotiate with the major health insurers. When you are an employee your employer negotiates those contracts; not the employee doctors. At the point where this occurred the hospitals began to negotiate using their fees to get higher reimbursement rates in emergency rooms or for x-rays and other ancillary services. In other words the hospital systems screwed the doctors to make more money in places the doctors don't' control or get a piece of the pie. Your fees were and continue to be traded away so the hospitals can get higher reimbursement rates in other areas of the hospital systems. It is why the hospitals can pay unGodly prices for real estate and continue to erect brick and mortar wherever the eye can see. That brick and mortar is your future. 

Leg #3: Everyone is kicking a leg of the stool; even the federal government. In years past the doctors had the right to make a profit from something other than a wage, but that was taken away by the Stark decision. The Stark decision is killing your doctor's income stream. And let's face it the patients don't really belong to the doctor; patients belong to the hospital system.

The Seat of the Chair: Having the right to move across the street and open a practice/business is an important part of being happy as a professional. Non-compete clauses are now widely used by hospital systems to choke off that option. Working under a non-compete limits a doctor's options when he/she becomes dissatisfied. The only option is to move from the community where you have made a home. It requires moving their children, selling the family home and being uprooted from a community where their patient population lives. So living and working with a non-compete clause is like having red pepper repeatedly sprinkled on the seat of this three legged stool. Non-complete clauses remind me of the former Soviet Union and why the Russian people were so unhappy. You couldn’t live except by the Politburo’s rules and if you were unhappy you had to sneak out of town in the middle of the night before sneaking across the border to another country.

Welcome to the world of the medical factory widget maker.

Being a professional means we supposedly control our own destiny. Let us be frank, there are parts of our practices that suck, but we put up with those parts because as professionals our incomes are higher than most people and we can control our financial outcomes better than wage earners. (How many hours a week do you work?)  If we lose that control and accept a lesser earning power we become terribly dissatisfied with our professions. This is exactly what the doctors and pharmacists are experiencing. Without regaining control of their incomes and income streams this disenchantment will only grow deeper, wider and louder.

So here repeat after me: You screwed youselves by not sticking together to eliminate non-compete clauses from your employment contracts; because you refused to believe there were other options. You didn't want to make the hard choices early on; and now you proved how difficult it is to sit on this three legged stool. 

Steve Lombardi
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