The following letter was sent by Nick C. Benton, MD, of Corvallis (Ore.) Clinic Ambulatory Surgery Center.
Dear Mr. Becker,
As a surgeon and director of a physician group-owned surgery center, I enjoy your newsletter. In an article published in November, "Trend of Hospital-Employed Physicians Causing Concerns About Market Leverage," you referred to the Wall Street Journal Article entitled "When the Doctor Has a Boss." This is a particular area of interest of mine, but not for the reasons noted in the article. The problem is that your doctor now has a boss that can fire him at will. As a result, your doctor no longer works for you, he works for the guy that can fire him.
We literally have congressional committees looking at how drug and equipment representatives can have "undue influence" on the practices of physicians, yet no one seems at all concerned that the majority of doctors now are "at will" employees who can be leaned on by some administrator to change their practice so as to maximize revenue. Who is more likely make me do something that might not be in the best interest of my patient — some drug representative with pizza and a logo pen or some suit who can fire me, make me walk away from my practice, pull my kids out of school, sell my house and relocate?
The power to fire a doctor at-will is the power to practice medicine through him. In some states like California, there are laws specifically against the Corporate Practice of Medicine, but I really don't know that they address this issue, which is largely under the radar screen.
I wrote a short blog a couple of years ago about this at www.whoownsyourdoctor.blogspot.com, mostly just to organize my thoughts. You may find it interesting. I never really went anywhere with it, but I go back and read it every now and then, especially when my 80-partner multispecialty group practice, where I have been for the last 19 years, gets into it with the local hospital megasystem that has swallowed up every other practice for 50 miles in any direction. Then I smile to myself knowing that I am doing the right thing by not selling out. I only wish I had a mechanism for letting the public know how important it is that their doctor works for them. Those relationships should be reportable, and easily available to the public by law, but they are not. That fact alone should raise suspicion.
Nick C. Benton, MD
Otolaryngologist, Head and Neck Surgery and Maxillofacial Trauma
Corvallis Clinic P.C.
Corvallis Clinic Ambulatory Surgery Center