Patients lose as the practice of medicine tightens

January 7, 2022 1:05 p.m. ET

A doctor at Jamaica Hospital Medical Center in New York City, December 29, 2020.


Seth Wenig / Associated press

Kudos to Devorah Goldman for stating what all doctors know and what most patients suspect: As medicine has industrialized, “the doctor’s office becomes an assembly line” (editorial, December 30).

Recently my wife and I have been patients of the Stanford Health System. Although the staff are friendly and knowledgeable, the operation of the system assumes that the patient has no issues other than the primary complaint, the caregiver has no issues either, and we would have no issues with appointments. you potentially conflicting in different places. There is no patient care coordinator to weave the frayed threads of care. There is no one to be considered your lawyer except luck.

As a practitioner, I know that a problem for all of us is that of disparate databases that communicate poorly with each other, causing costly delays and redundant testing. In the ER, I often couldn’t access test results elsewhere and had to do more than necessary. ObamaCare should have put us on a common electronic health records platform.

The only one who unites my care into a cohesive whole is my 76-year-old primary care physician. He has looked after me for 44 years and knows me well. Thank goodness Dr. Dave still runs the marathon occasionally and has no plans to retire. We are more than a collection of our pieces, and we need a new generation of Dr Daves to see us as a whole people and treat us that way.

W. Richard Hencke, MD

Scotts Valley, California

The three factors most responsible for the decline of independent practice are onerous regulations, outdated antitrust laws, and the economic benefits of consolidation for hospital systems.

Doctors spend around 20 unpaid hours per week entering data into electronic records and complying with other regulations. This distracts and compromises patient care and is a major factor in the high incidence of physician burnout.

Under outdated antitrust laws, independent practitioners are considered competitors and therefore prohibited from negotiating collectively with insurance companies. Large healthcare systems, which are seen as unique entities, have been able to negotiate fees up to 300% higher than those charged by independent firms. The drop in fees has forced many independent firms to close their doors or to regroup.

Higher reimbursement levels allow health systems to pay doctors’ salaries. They also benefit from the downstream revenues generated by the physicians employed, including laboratory tests, physiotherapy, radiology, day surgery and hospitalizations.

Our health care system works best when there is competition and choice in the way physicians practice and patients receive care. Private practice remains a cost effective and high quality component of our health care system. Its survival depends on regulatory and antitrust reform.

Michael T. Goldstein, MD

Greenwich, Connecticut.

Ms. Goldman succinctly describes the accelerated decline in the quality of medical care in our country and discusses the causes, on which volumes can be written. As a victim of the seismic changes she describes, I can vouch for the accuracy of her research and conclusions. Unfortunately, it is the patients today who are the victims of an increasingly cold, indifferent and inefficient medical system. To say “that doesn’t bode well for medical care” is an understatement.

In the 5th century BC, Hippocrates urged physicians: “First, do no harm. By losing control of what we are best educated and most experienced to lead, physicians are barred from applying this most age-old and fundamental principle of the practice of medicine. And for whose benefit?

Marc I. Malberg, MD

Rutgers RWJ School of Medicine

Princeton, New Jersey

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