My father wanted me to get an MBA from the Harvard Business School, but I wanted to be a doctor, so I am more attuned to the MBA’s excellence in many areas but differences in ethical principles from medicine. Nowhere does maximizing returns for stockholders or returns for nonprofits also include the principles of beneficence and nonmaleficence for our patients. But this principle is foundational in medicine and has been for 2,500 years. This is why physicians and medical practitioners consider patients to be in a distinctly separate category from customers.
However, MBA-trained health care administrators and their clones do see patients as customers, and we ignore this practice at the peril of losing our highly regarded status as physicians and our self-respect as medical professionals.
By its very adversarial nature, when our patients’ accounts are turned over to collections, they become customers with delinquent accounts and cease to be our patients under the protective umbrella of our ethical obligations. This practice is normal and acceptable in business transactions, but not in medicine. The amount of money involved in collections is small when compared to the huge amounts of revenue involved; the resistance to submitting those accounts to medical review prior to consideration of submission to collections is probably based on the principle that all billings need to be pursued aggressively.
An MBA-based point of principle is in direct conflict with medical ethics. Much as our corporate leaders may wish we did not attend to the consequences of sending the bills of our patients to collections, physicians tolerate or turn a blind eye to this practice at the risk of sweeping our professional reputations into the realms of used car salesmen.
The reason why we physicians have been held in higher esteem than the other professions—akin to clergy—is that our profession maintains an ethical obligation to look out for the best interests of our patients. We ignore this obligation at the cost of decreased public respect. Just as importantly, we are more likely to experience burnout within a demanding profession that thrives and receives meaning by looking out for our patients.
The inconvenient truth is that with $4.3 trillion in the churn of our bloated health care system, there is no way we physicians will impact the corporate domination of medicine. But perhaps we can stop the MBA types who handle our billing from ultimately ruining people we sincerely intended to help. As of this writing, 15 percent of my home state of West Virginia is in medical debt; 25 percent of that is in collections. As painful as it may be, we doctors or our delegates must review any accounts that our administration proposes to send to collections, and approve or disapprove each case. I believe this is where the rubber meets the road. If we are to protect our profession and avoid becoming nothing more than highly paid technicians, we need to honor that 2,500-year tradition of Hippocrates, of which we are a part, by not allowing the billings from our healing work to be used to harm our patients.
G. David Leveaux is an emergency physician.
