The B Word

The other day I received a note from a professor at a prestigious U.S. medical school. He asked what he should tell his impressionable students about the business of healthcare. To him, talking about business was tantamount to saying that physicians should put profits above patients. He saw good business and good medicine as incompatible.

There was a time when this was the conventional wisdom among physicians. No longer.

These days it's beside the point, at best, to argue that quality medicine and good business are separate concepts. In America, medicine just plain is a business. There's simply no point in arguing that it shouldn't be; there is no alternative. You can't practice medicine if you don't get paid for it - unless you are independently wealthy and enormously good-hearted. To argue that business shouldn't sully medicine is to ignore reality.

As recently as four years ago, many of you, it seemed, were doing just that. In conversations I had with physicians, in letters you sent us, and in our own internal research, most of you made clear you didn't want to read too much in our pages about - ick - money. Medicine is not like other businesses, we were told. Physicians put patients before profit.

That attitude has all but vanished. Reality has set in. You're now telling us that you need to make more money to stay in business and to continue helping patients. You are ready for us to lay it on the line.

So we will.

Our September issue starts a new Physicians Practice. Our fresh look will reflect a redoubled commitment to real world, insider, forward-looking advice for doctors. We want to empower you to be the best businessperson - and best physician - you can be. With no contradiction and no holds barred.

My interlocutor suggested government-sponsored medicine as an option. Right. First, it ain't gonna happen. This country is about as accepting of socialized medicine as it is of socialized government. Meanwhile, the trends are running in the opposite direction, toward requiring consumers to carry more of their own weight via ever-higher employee contributions, copays, and deductibles.

Second, a nationalized medical model is hardly pure. Most countries with socialized medicine have better access available to those willing to pay more, and they make coverage decisions based at least partly on cost.

In short, medicine is always business - but that doesn't make it bad. On the contrary, being a responsible physician means running your practice like the million-dollar business it is. To do otherwise is to endanger your patients, inconvenience your staff, and shortchange your family. All these people will suffer if your practice closes because of poor management.

I don't buy the argument that seeking profitability is tantamount to practicing bad medicine. True, an extreme profit motive could drive poor medical decisions. But smart businesspeople recognize the relationship between profit and quality. We could save money by printing Physicians Practice on newsprint and paying high-school students to write our copy, but then no one would want to read it - or advertise in it or sponsor it.

It's also reductive to assume that every business has to push profitability to the extreme. Physicians don't need to grow their business by 10 percent each quarter. You can set your own modest goals for growth.

So, philosophy is fine for the ivory tower. But here, we vow to talk about the real world in all its glorious compromises and promise.

This article originally appeared in the July/August 2005 issue of Physicians Practice.