By Nancy Burton
From the Field is a series of guest blogs that offer perspectives from those working in the health care field.
Those of us working in a health care profession are very lucky and blessed in many ways. It is easy to see the value in our work, and we get reminders every day that what we do matters. We are invited into peoples’ lives at very critical and intimate times, and people rely on us to do our jobs well and to treat them with care and dignity.
However, there is one change in health care in recent years that concerns me greatly –the increasing business ethic that is taking control of the industry.
I am afraid that the business of health care is interfering with the “care” in health care. Increasingly, decisions about how care is to be provided are being made by administrators and business executives who have never provided care to people.
More and more decisions are being driven by profit. Cost effectiveness has always been a consideration, as well it should be. There is a limit to what part of our gross national product should be spent on health care, and there has always been an awareness that this has to be considered in how we practice.
But the balance is shifting in a very concerning way. Systems are growing bigger and bigger with increasing layers of bureaucracy. Providers are being pushed to see a greater amount of patients. Doctors and other providers are now being told by office managers, working for a large corporation, to work faster. There are times when I feel it has reached a point where safety is in question.
The mantra “do more with less” is something that is being said to providers in many settings. There is a limit to how far that type of thinking can go, but again, the people making those decisions are most often not the people who have to carry them out. Patients are being unnecessarily inconvenienced because of the business model of care.
I know of sites where providers are told that if a patient comes in with more than one complaint, they are to deal with only one concern per visit. The patient must return to deal with the others at a later appointment because then the site can bill for each visit.
There has always been the reality that there might not be time to deal with everything presented at a visit and sometimes patients will need to return, but that decision was based on the reality of the situation. Now it is a conscious, money making policy in some places. I am grateful I never worked in such a place, but I have talked with others who have.
Insurance companies have set up policies that inconvenience patients and are costly to them. I will give you one personal example.
I had shoulder surgery last year. I also have arthritis in my knees that will eventually require surgery. I see two different partners in the same practice for these problems. I wanted to make an appointment to see them both on the same day, but I couldn’t because my insurance would not pay for both visits on the same day.
For someone taking time off from work or paying for a babysitter, this could be a very costly inconvenience. Minor procedures that could occur during a medical visit often have to be booked separately for the same reason.
I am now on faculty at an educational program. This is another place where I see the business ethic taking hold. Teaching students has generally been felt to be a responsibility for those of us in health care professions. But now, so many of us work for large corporations who demand that schools pay them for the privilege of sending students to them. It seems to have become another way for corporations to make money, an expense that will be felt by students in the tuition they have to pay. These are the health care providers of the future, and society has a stake in seeing enough of them are adequately educated.
These changes and pressures have whittled away at the morale of health care providers. I have heard many doctors and other health care professionals say they would not encourage their children to follow in their footsteps.
People are working harder and harder with less satisfaction in the work they do. Patients are feeling shortchanged because they are feeling more rushed out of their providers’ offices.
In the meantime, we are spending much more of our gross national product on health care than any other country and not doing too well in the international rankings for outcomes. I think those of us in health care have an obligation to do what we can to stop the overtaking of health care by a business ethic and to place the “care” in health care front and foremost.
Society as a whole needs to take responsibility for looking at the direction we are going and start to see quality health care as a right for everyone. We need to push for payment models that place quality, accessible health care as their most important goal.
Nancy Burton has been a nurse-midwife for 40 years. She worked as a nurse for four years before that. In addition to clinical practice, Burton has done clinical teaching of nurse-midwife, nurse-practitioner, nursing and medical students.
She is currently a lecturer at Yale University School of Nursing and is a member of the Board of Directors of Universal Health Care Foundation.
She has published articles and a chapter in a textbook. She has done multiple public speaking engagements on different topics including universal access to health care and has testified before state government entities.