"Big Med" may be headed down the same path as "Big Law," as national rankings increasingly dictate hospital performance, physicians become mere service providers and healthcare undergoes "professional erosion," according to a report from The Atlantic.
Many of the country's largest and most profitable law firms, or those employing more than 1,000 attorneys, have been forced to reduce their staffs since demand for high-end legal services has not increased since the recession of 2008. In "dozens of cases," firms were economically unable to sustain their operations and forced to merge or file for bankruptcy, according to the report.
But the authors — Richard Gunderman, MD, PhD, vice chair of radiology at Indiana University, and Mark Mutz, lawyer and consultant in Indianapolis — dig deeper to find some of the trends that have backfired in law, one being the industry's regard for national rankings. Law schools are ranked by job placement rates and law firms are ranked by profits.
While this may provide a seemingly objective basis to assess performance, it can also bring out the worst in people and organizations, according to the report. Lawyers begin to place priority on billable hours, and pro bono work or the aspirations that first drew them to law can shrink in hindsight.
The report says hospitals and medical schools are increasingly rankings-focused, and the industry's RVU/FTE, or relative value units per full-time equivalent, isn't much different from law's profits per partner equation. "Physicians who care for the poor, take their time and get to know their patients are likely to suffer in the rankings," according to the article.
But the biggest problem may be the demoralization lawyers, and now physicians, feel when they are treated as mere units of production, according to the report. As a service provider, the lawyer's role is to provide a discrete technical service, often assumed equal to that which any other lawyer would provide, for a fee.
Physicians, increasingly called "service providers," are encountering similar expectations, according to the report. The decreased value placed on a physician's wisdom, rapport with patients and ability to collaborate with other physicians can be demoralizing.
The authors note that the story of "Big Law" shows competition can be good, "but only when it truly brings out the best in us."
"It is possible to reverse the tide and restore a sense of what it really means to be a professional — to be devoted to the service of others and the ideals of a noble profession. Collaboration can supplant competition, and the best interests of clients and patients can regain their rightful primacy."
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