To the Editor:
Re “Is Exploiting Doctors the Business Plan?,” by Danielle Ofri (Sunday Review, June 9):
The corporatization of health care, in the interests of efficiency and lower costs, is bringing down our outstanding system of care that has long been the envy of the world. Patients are treated like widgets, and doctors and nurses are treated like assembly-line employees.
Many doctors are not given the discretion or the time to treat each patient as an individual, with kindness and respect. They are hardly able to think through complicated, life-altering decisions.
Medical care is very expensive and costs have to be reduced. However, there are so many ways to do that without killing the doctor-patient relationship and exploiting medical professionals. The doctor burnout rate is high, and doctors are retiring at younger ages.
Some ways to reduce costs are requiring hospitals to publish the costs of their tests so they can be compared, negotiating on drug prices and creating a universal insurance form.
We can have a high-quality, efficient, humane system if we use common-sense practices, but we have to stop treating health care like any other for-profit industry. It is different and requires a more nuanced approach.
To the Editor:
As a physician, I agree with Dr. Danielle Ofri’s assertion that most health care professionals have remained true to the highest ideals of their fields in the face of increasing corporatization and challenging working conditions. But I find her assertion of exploitation — at least of doctors — difficult to reconcile.
By and large physicians in the United States earn far more money than their peers in the rest of the world, placing us squarely in the top 2 percent, if not 1 percent, of American income distribution. The proliferation of health care administrators is attributable to an unnecessarily complex reimbursement system based on a private, for-profit insurance industry.
Yet the American Medical Association, the largest professional organization of physicians, actively lobbies against the administrative simplicity of Medicare for All. Moreover, physician groups have long opposed expansions in scope of practice for nurses, nurse practitioners and others who could allow physicians to concentrate on the most complex patients who need our expertise.
Doctors continue to be seen as leaders in health care. Rather than just lament the current state of affairs, we must acknowledge that we have been complicit, and make amends.
Keith J. Loud
To the Editor:
From my perspective as a retired health care economist, I believe that the fundamental problem is that our health care system has evolved without direction from the small practice model to team medicine. If we focus on the system as a whole we may find some solutions.
First, insist that all electronic information systems require only essential information to reduce the time that doctors spend entering data.
Second, download any responsibilities that can be prudently handled by a nurse, a technician, a staff person or a less experienced doctor. We have far fewer doctors per capita than many other advanced countries. We need to open many more seats in medical schools, make it easier for foreign-trained doctors to practice in the United States, and empower nurses and physician assistants.
Third, cut noncritical administrative expenses; a 10:1 ratio of administrators to doctors is ridiculous.
And fourth, have the various medical boards define safe harbor treatment standards (which help protect doctors against liability) and guidelines for excessive treatment.
Rancho Mirage, Calif.
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