Saving the soul of medicine
Its so easy to get caught up in our own "universes" and lose sight of the horizon. But every once in a while, we hear or see something that snaps us back, allowing us to refocus and re-examine our course.
I recently read an essay in the New York Times (see http://www.nytimes.com/2009/07/07/health/07essa.html) that has kept me thinking ever since, and may be just the kind of compass that allows the pharma industry to regain its fix on the horizon as it strives to serve its physician customers. Sandeep Jauhar, a cardiologist in Long Island, NY, writes of the struggles todays physician faces in managing the financial aspects of his or her practice and of, surprisingly to me, making money.
Most of us, I would venture to guess, automatically assume that being a physician is, in most instances at least, a lucrative career with few financial concerns. But apparently, were wrong.
Jauhar tells us that he moonlights at a private medical practice in Queens on weekends to meet the expenses of his growing family. He is forced, he says, again and again, to think about how much money my practice is generating.
It is not easy to ignore reimbursement when prescribing tests, he explains, especially in a practice where nearly half of the revenue goes to paying overhead." Most doctors he knows, Jauhar says, say they are not paid enough and that their practices are precariously balanced financially to simply maintain stasis.
Most doctors today, whether in academic or private practice, constantly have to think about money, he writes.
It is an admission that I must say shocked me. Surely as connected to the healthcare world as I am in my day to day work, this should not be news to me, right? Surely pharma should know this, but did we?
Jauhar says rising commercialism, driven by increasing expenses and decreasing reimbursement, among other things, has obvious impacts on the public, but not so obviously perhaps also inflicts harmful effects on doctors themselves.
We are trained to think like caregivers, not businesspeople, he writes. The constant intrusion of the marketplace is creating serious and deepening anxiety in the profession.
It is a stress pharma knows well. Although we like to say were in the business of better health and serving patients and physicians, we know ultimately we must focus on the business of staying in business sometimes to the neglect of our truer and more heartfelt mission. The wishes of Wall Street too often trump the best interest of better healthcare and the focus of investors becomes the focus of our companies out of sheer necessity.
Jauhar speaks of wanting to be freed from the relentless consideration of money from worrying about the bottom line. Something fundamental is lost, he says, when doctors start thinking of medicine as a business.
Sadly, it is the same for pharma.
We speak often of providing value added services to our customers of going beyond providing pills - yet we struggle with how exactly to deliver this value. After a view in Jauhars world, it seems the best service we could provide to physicians would be advice on how to balance financial realities against the mission of caregiving. Not to say, by any means, that we have it all figured out, or can ignore the bottom line while fulfilling our higher mission of bettering and extending the lives of patients.
But as Jauhar points out: it is a battle for the soul of medicine. And perhaps the greatest service pharma could provide to physicians is to help find ways to win it for us all.
As always, we'd love to hear your thoughts on how pharma and its physician customers might better balance financial considerations against our intended mission.