Health Care Anew

I have long been fascinated by the subject of how culture changes.  Along the way I have observed one process of change.  When doing a particular thing violates a cultural norm, people will sometimes just quietly start doing it with cultural acceptance coming later.

A current example is the salaried practice of medicine. 

When I began my career in the 1950’s, medical culture considered salaried practice to border on the unethical.  Group practices got away with it so long as they were controlled by physicians.  A few teaching hospitals employed faculty members and used their academic role for cover.  But for the rest of the profession, salaried practice was strongly frowned upon. 

One expression of that disapproval was the prohibition against so-called “corporate practice,” which says basically that a corporation may not hire a physician, charge for his or her services, and keep the money.  Several states have laws on the books that make that practice illegal. 

A feature called “datadig” in the March 2012 issue of Hospitals and Health Networks, the journal of the American Hospital Association, reported that twenty per cent of all practicing physicians in the US are now employed by hospitals.  And by all indications, that number continues to rise. 

While the prevalence of salaried practice is well along, the cultural opposition to it remains largely untouched.  I hear no talk of repealing the anti-corporate practice laws. The obvious form for the Accountable Care Organizations now being encouraged is the community hospital with a salaried medical staff, but it is hard to find anyone who will say that.   Organized medicine no longer talks about it.

At first thought, it would seem that this kind of change would go faster if we were able to talk about it.  But maybe talking about it would actually slow it down.