MarzH05 said:
As a medical school applicant, I would like to learn as much as I can about the field of medicine. A topic I see come up a lot on these forums is the loss of autonomy physicians are experiencing. I have been able to peice together some facts about this topic, but would appreciate someone compiling what they know into one coherent post. Things I would like someone to touch on are.
1. A brief history on how autonomy has been taken away from physicians, including what policies/organizations have contributed to this.
2. JCAHO-what exactly are they?( I really know nothing about this, but I am assuming they are contributing to this problem based on some of your posts)
3. Any other things you think worth mentioning
4. How is this problem getting better/worse?
Thanks to anyone in advance who is willing to take the time to answer my questions.
I too am an applicant this year and will be starting next year, but I think I can answer some of your posts since I'm finishing up my MBA in healthcare management this year and have years experience working in a hospital.
1. The loss of autonomy often complained about today is mostly due to what medicine was like during the "Golden Age" of medicine a few decades ago. Docs had the final say, and insurers basically consisted of indemnity plans (the blues) that were basically (especially given the lower level of technology (and therefore costs) 40-50 years ago) were bottomless pits in terms of money for care. If a doctor said something was needed, the insurers paid for it without question.
Plus, there were docs often involved in setting reimbursement rates with these plans (ie on boards and what not), so it's no surprise the reimbursement was good and overall things for docs was good.
Autonomy started to decrease in 1965 with the passage of Medicare and Medicaid. Medicare more so due to the number of people covered. Medicare could set its own reimbursement rates and since it's a monopoly payer, it could basically do whatever it wants and docs have to deal with the lower reimbursement rates.
Furthermore, as medical costs started to increase, managed care eventually came into the picture. HMO's were very cost driven and run by admininstrators. They started doing things such as utilization review. This is where they can approve (ie pay for) or disapprove (ie not pay for) a service that a doctor ordered. Often times and this is still the case, docs would get approval for a certain procedure or test from the insurance company.
As you can see, this is clearly less autonomy for docs. They are no longer unquestioned in what they do and that doesn't go over well with docs. HMO's also set lower reimbursement rates for docs too.
So that makes two major streams of revenue falling for docs.
2. JCAHO = Joint Commission on Accreditation of Hospital Organizations
JCAHO is extremely important to hospitals. A hospital can still run if it is not accredited by JCAHO (much like a college can still run if it is not accredited). However, this is bad for 2 reasons. The minor of these two is that it looks bad. A hospital is probably not doing so well if it fails to get JCAHO accreditation and therefore the public (if they know enough) should go elsewhere.
The major impact of JCAHO deals with Medicare. Medicare will stop paying any hospital that does not pass JCAHO inspection. This is HUGE for hospitals seeing as how most patients in hospitals now are elderly who are on Medicare due to the shift to outpt care that our healthcare system has seen in the past few decades. So hospitals freak out any time JCAHO comes b/c they will crumble without Medicare payments.
3. Other things - Unhappiness with documentation and paperwork relating to so many rules and regulations with Medicare and HMO's.
Patients are difficult to deal with. I work in a hospital and definitely can attest to this. Majority (from my personal experience) are demanding pain the asses. Patients have an entitlement attitude and they are unappreciative no matter how much you bust you ass for them. Patients also look at doctors as a means to and end. They know what procedure or drug they need and expect docs to just mindlessly order it without question.
However, I'm still going into medicine because the 1-2 patients and their familes that truly appreciates and is thankful for what you are doing makes up for the other 14-15 pain in the asses. They make everything all worth it in the end.
4. Probably getting worse
