The corporatization of medicine: What would Osler say?
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“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.” – Sir William Osler, MD, FRS, FRCP
I first want to thank all the discussants in this month’s cover story — Stanley B. Cohen, MD, Madelaine A. Feldman, MD, FACR, Harry L. Gewanter, MD, Allan Gibofsky, MD, JD, and Michael C. Schweitz, MD — for a fair and balanced treatment of the realities surrounding the intrusion of private equity into the field of rheumatology.
They have clearly laid out the advantages, which are, at least in my simplistic view of such transactions, a profit for those who put much into building a successful practice and have equity in it to sell. Who can deny their right? However, after the practice is sold the new entity is now no longer run by the struggling physicians, who went into medicine to care for patients in a fashion that fulfilled their aspirations of what medicine would, and should, be and at the same time make a good living. The new boss is a corporate entity whose mission is to derive maximal profits from the new arrangement.
I am well aware that in many of these large corporate entities, many physicians are involved in management and that safeguards are ideally put in place to protect and serve the patients, as well as their new employees. However, in the end, the primary mission of the new entity is profitability — begging the question, in my mind, of what would the great Sir William Osler say?
After all, when we graduated from medical school, we all took an oath. We did not merely make a promise like, “Don’t worry, I’ll bring some takeout home tonight.” An oath is an affirmation, a solemn promise we swear by. Although we no longer speak the neo-modern Hippocratic oath, we have more modern versions such as the one crafted by the medical humanist Louis Lasagna, MD, in 1964. In that version, we pledge our very being to the sick and recognize our “special obligations” to our patients and our society. It also speaks of warmth and sympathy yet does not proscribe profit.
On the whole, I proffer that most private equity firms not be eager to brandish this oath as their corporate “mission statement.”
As Osler said: “The practice of medicine is not a business and can never become one,” and “The human heart by which we live must control our professional relations.” In fairness, Osler was not above criticism for making a lot of money from practice, publications and the like, just as many of us do now. I would be quite surprised, however, if Sir William would have sold out the practice at Johns Hopkins to a private equity firm, to which he then would become their employee.
Well as you can perceive, I am not a fan of such deals, but I am also not in a position to profit if my practice were sold anyway. In fairness, maybe I would think differently if I had a significant equity interest in a practice I built and wanted to buttress my retirement. I cannot answer this for certain, but I hope not. Having said this, I am confident that some will feel my musings on this topic are overly romantic, from one longing for an art and practice that is no longer here.
I hear you, but I will close by saying that for many of us, our days of patient care range from the average — which in my world is pretty good — to the bad — on days that seem so unfair to the caregivers and the patients. However, there are still yet other days, such as when we come together collaboratively in the care of complex cases, or engage in poignant moments of teaching with those that will follow us, or simply when we are privileged to truly share our humanity with another, that still feel like magic to me.
That’s my take. What’s yours? Please share your thoughts with me at calabrl@ccf.org or at rheumatology@healio.com.
- For more information:
- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
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