Society relies on clinicians and the organizations that employ them to provide high-quality services, even when it is difficult to measure or reward good performance. More physicians now work for organizations owned or controlled by corporations or large entities, where short-term profit often takes priority over physicians’ intrinsic motivation. Dr. Lawrence P. Casalino, professor of population health sciences, explores the changing relationships between physician professionalism, corporatization, and quality of care in a perspective piece for The New England Journal of Medicine.
Dr. Casalino identifies the four qualities that determine whether an organization supports physician professionalism: leadership, ownership, size, and culture. He explains that clinical experience provides physician leaders with a perspective complementary to that of nonphysician executives. However, the hospital systems, private equity firms, and health insurers that own medical groups, for which stakeholder interest and revenue are priorities, may be less likely to rely on input from physician leaders. Furthermore, health care organizations can earn higher profits by investing in mergers and acquisitions to gain size and negotiating power than they can by investing in high-quality care. As a result, this drives a culture of “widgetization,” where physicians and staff are treated interchangeably.
Research thus far indicates that corporatization leads to higher prices, higher health care spending, and unchanged or poorer quality of service. Additionally, a previous study led by Dr. Casalino found that the average physician is more altruistic than members of the general population, and much more altruistic than the average highly educated, high-income person. Per Dr. Casalino’s assessment, policymakers should rely on the available evidence and common sense to limit the negative effects of corporatization. For example, states could revisit their corporate practice of medicine regulations, which often feature many exceptions or are weakly enforced. Similarly, governments could require transparency in ownership, so that patients choosing a physician could easily determine whether their physician is employed by an independent medical group, a hospital, a health insurer, or a private equity firm. These, among other evidence-based policy changes, could lead to organizational forms that benefit patients and the health care system as a whole.
- Highlights