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Changing the doctor-patient relationship

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By Nat Hentoff
Friday, Jan. 18, 2013, 9:14 p.m.

Recently, I was anticipating an appointment with one of my favorite doctors. Unlike some of my past physicians, he doesn't rush through a session.

But this time, he seemed somewhat depressed. He explained, “I am no longer independent.” He has long practiced independently while also having an office at a major New York City hospital.

“I can no longer be here at the hospital,” he told me, “unless I become an employee of this hospital and accept its rules of procedure.”

And when his patients need hospital care at this noted teaching and research institute, they may have to go elsewhere if he ultimately decides to leave. Or, if he chooses to stay, his patients' care may significantly decrease.

The growing pressure on the president and Congress to make the cost of our health care less of a rising cause of our national deficit is affecting many of our doctors, including mine. And the result of this historic change in our country's doctor-patient relationship has been largely ignored by the media and, thus, is not yet fully recognized by many of us.

But The New York Times' Robert Pear, a leading reporter on health issues, has been a clear exception. This recent piece of his was submerged in the paper's back pages last month: “Doctors Warned on ‘Divided Loyalty.'”

What “divided loyalty”? It stems from “hospitals buying up medical practices around the country and seeking to make the most of their investment” Pear explains.

In other words, less income and authority for doctors, more for their bosses at the hospitals.

As Pear reports: “Dr. Jerry D. Kennett, a leader of the American College of Cardiology, said he was aware of cases in which a hospital had told doctors not to place defibrillators in Medicaid (low-income) patients because ‘it's a money-losing proposition' for the hospital.

Pear presents another possible reason why my doctor is not compliant with losing his independence: “Hospitals often set a goal for doctors (in their employ) that can result in a bonus, but if the doctors fall short, their salary may be reduced the next year.”

Fall short in doing what the hospital orders them to do? And the patients have nothing to say about it?

Even the American Medical Association balks at this imposition on doctors whose crime is yearning to be independent. As Pear writes: “The medical association discouraged doctors from entering into such agreements, and it said that ‘patients should be given the choice to continue to be seen by the physician in his or her new practice setting.'”

Meanwhile, how will a hospital rule over doctors on its payroll when, as Jane E. Brody of The Times reports: “The number of Americans 65 and older is expected to double to 80 million in the next three decades. People 85 and older are the fastest-growing age group; by 2020, there will be 6.6 million people in that age bracket, when rates of debilitating ailments soar.”

How many of these Americans will be welcome in some of our hospitals under their rules of cost-efficiency? There is a move to care for them at home, but will there be enough support under ObamaCare for their independent doctors?

Nat Hentoff is an authority on the First Amendment and the Bill of Rights. He is a member of the Reporters Committee for Freedom of the Press and the Cato Institute, where he is a senior fellow.

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