“Aiding in increasing healthcare access, delivering quality and compassionate healthcare, and reducing health disparities in underserved communities is the driving force behind my desire in becoming a physician assistant.”
This was the opening sentence of my personal statement for PA school, and this was a viewpoint I was deeply passionate about for years prior. This passion was reflected in my employment history and in community service efforts I participated in. Interestingly, now that I am a provider I see the complexity in accomplishing this in a broken health care system that is profit driven. Increasing access and delivering quality care is meaningless if profit is not generated.
Historically the US healthcare system has focused on treating sick patients instead of preventing sick patients. Hence, why preventive medicine services have lower reimbursement rates compared to reimbursements for surgery interventions. When providers are incentivized to perform surgeries through higher reimbursements, this inherently will lead to unnecessary surgical recommendations.
“As a prospective physician assistant my goal is to aid in bridging the gap amongst health disparities and provide accessible health care in addition to quality and compassion.“
Pushback to Procedural Incentives
Provide less reimbursement
Providing less reimbursement for surgical and procedural intervention is one solution to reduce incentives. This though can motive provides to perform more surgeries to make up for loss profits.
Reestablish the care model
Another solution is to establish a care model that places higher incentives on prevention. However, this strips patients of accountability for their healthcare. As providers we can only do so much in ensuring patients stay healthy. It is frustrating when patients are non compliant because you feel you are waiting your time and energy. This is a good idea to an extent, but patients also need to be responsible in ensuring good health outcomes.
Does the solution lie within utilitarianism?
The US could allocate a pre-determined level of healthcare resources and apply them to achieving “the greatest good for the greatest number or people” However, this is under the accepted premise that resources available to meet the costs of healthcare are finite and continuing to increase dollars allocated for healthcare expenses carries “opportunity costs”. This trade off in opportunity cost being that finite resources, would by default exclude some patients. Also, pre-determined resources do not consider unforeseen changes within the healthcare system, as we witnessed with COVID-19.
Transparency
I do believe transparency of cost of care across healthcare facilities the rate of services is a potential solution to better monitor spending and reduce unnecessary surgeries. Additionally, there needs to be more regulation of private equity firms buying up private practices and their corporatization of medicine because they are pushing the primary agenda of profit.
Overall I’m not too sure what the solution is and I know it’s more intricate then solutions I’ve listed here. I do though now understand how providers become burned out and jaded over time working within this system. I am a new provider, I am already exhausted from this constant push for profit and productivity in corporate medicine.
“Medicine is a business” a friend recently told me as I vented about my distaste for such a system. Those words sat with me. As a prior public health researcher this I surely should have known. I guess reading about it and living it provided two different realities. I didn’t expect to have such mixed emotions and internal ethical conflict, but this is my current reality. At times I think “maybe corporate medicine isn’t for me.” Or maybe I need to get with the program if I expect to professionally thrive. I just want to practice medicine and do what’s best for my patients, but I guess we can’t always get what we want.
Remember you are loved❤️