Does the Doctor Need a Boss?

Yes, according to a Cato Institute Briefing Paper:

Treating a complex patient is comparable to building a house. The work of a number of skilled craftsmen needs to be planned and managed. When unexpected problems occur, someone needs to revise and adapt the plan. In constructing a house, that role is played by a general contractor.

[However, in medicine] it is as if the concrete contractor, the drywall contractor, the electrician, and the plumber all refuse to work under a general contractor. Instead, they each try to do their jobs independently, regardless of the impact on the rest of the project. No one craftsman is in a position to take responsibility for delivering the overall finished product, and quality suffers as a result.

Comments (7)

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  1. Joe S. says:

    Why do you assume that the only way to put together an efficient team is with a boss? Surely there are other ways of achieving coordinated care.

  2. Larry C. says:

    Joe, the problem is the Stark Amendment. You can have gain sharing (splitting the profits) if a hospital employs a doctor. But doctors cannot share the rewards of their voluntary contractual arrangements.

    Basically, Rep. Stark requires doctors to have a boss.

  3. Ken says:

    Speaking of buses (see my comment on previous post), I’m surprised to see the Cato Insitute (publisher of Patient Power) so willing to throw the doctors under the bus.

  4. John Goodman says:

    Greg Scandlen has some blistering things to say about this study in his new Consumer Power Report. We’ll try to post a link to it.

  5. Devon Herrick, National Center for Policy Analysis says:

    Greg is correct that the third-party payment system is ultimately to blame for much of our health care system’s woes. Indeed, physician practice patterns, which were codified into law long ago, are largely the result of how we pay physicians. Nonetheless, I think Arnold Kling and Michael Cannon made some interesting observations in their study. A doctor once told me that physician care is basically a cottage industry. Whether or not this is desirable depends upon the circumstances. A solo physician practice might treat the same family throughout their lives and provide personalized care that would be hard to duplicate in an institutional setting. However, I can see how some patients — especially those with multiple problems or complex ailments — might fare better in a setting where care is coordinated among numerous providers working for a large institution. I don’t believe that one type of physician practice is necessarily better in all circumstances. If we relied less on third-party payment, all manner of practice types would be created by entrepreneurial providers creating innovative practices to better serve the diverse needs of their patients. (read my study: Health Care Entrepreneurs: The Changing Nature of Providers)

  6. […] head of Association of American Physicians and Surgeons, responding to the Cato report described here: So just who should be my boss? What credentials? What oversight of the boss? Who gets sued if […]

  7. Dan Smith says:

    I continue to be amused by analogies that compare medical care with some other standardized industrial process. I guess I need to point out that it is a wholly different situation. Let’s pretend we are trying to remodel a house which is in imminent danger of collapsing to due rotting timbers, a furnace that has gone out in the dead of winter and with no external power source while an earthquake is threatening the foundation, all done while protecting the family living inside the dwelling, providing them with adequate food and sanitary services. Any wonder why the outcome is sometimes disaster? Would a general contractor improve the outcome? Doubtful.