As managed care was conscripting the medical profession in the 1980s and 1990s, and doctors became impotent to the forces of control of our professional expertise, very few took the risk of not signing the managed care contracts being circulated among us.
When I go to the Medical Grand Rounds at the UC Davis Medical Center on Thursday noon, the young interns and medical students are quite unaware of the stresses of the 1970s and the 1980s. And they wonder what was the problem in thinking we were losing our professional standing?
On November 23, 1994, I received that following article which, I think captured the predicament in which we found ourselves. It was submitted for publication in Sacramento Medicine by the late Dr Clark while I was the editor. I hope this repeat from our archives epitomizes the forces that were placed on our profession.
A Piece of the Pie
by Charles Clark, MD, Surgery of the upper extremities
When I entered practice twenty-seven years ago, I found that my membership in the Country Medical Society included being listed on a panel of doctors for an insurance company that reduced our fees. (We were getting $4.00 for an office visit at the time.) I asked one of the older doctors in the community why we should voluntarily accept a reduction in our fees. He told me it was to keep the lid on inflation.
When I dropped out of the plan, I found that no one referred those patients any longer. It soon became clear that being a member was a sure way of receiving an increased volume of patients. The greater volume of patients meant a larger income. Everyone who was a member was secure in the knowledge that he was getting a piece of the pie.
Eventually there were other insurance plans making payment of less that customary fees. They never had any trouble attracting doctors. The catalogue of member-doctors for some of these plans often goes on for page after page after page. The more of them the individuals joins, the more patients he can see. This has been accompanied by a reduction in fees that often has been horrendous. Still there is a certain security in belonging to these organizations because it guarantees a piece of the pie.
As these plans proliferate, some of them remain competitive by gradually reducing the amount that goes to the doctors. Still the doctors hang in there. It is not necessarily because they aren’t busy enough. Some of their appointment schedules are filled up for two or three months in advance. But they are assured of getting a piece of the pie.
Without doctors to join these plans, the closed panel organizations wouldn’t exist. By joining them, we are giving away our freedom by bits and pieces. And yet we continue to support these organizations while we are gradually allowing control of our destiny to slip away. As I see these things happening, I can’t help wondering if we are committing collective professional suicide in terms of trying to maintain any semblance of our independence as doctors.
What are we going to tell those bright-eyed little boys and girls who are going to be the doctors of tomorrow? When there isn’t anything left for them, are we going to tell them we didn’t fight because the changes were inevitable anyway? What are we going to say when they ask us why we laid down and died when things got a little tough? Are we going to feel good about ourselves when we tell them it’s all right because we got a piece of the pie?
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