Big League Medicine
Does professional sports offer a model for
improving health care?
Maybe, but the doctors will have to make some adjustments.
Maybe, but the doctors will have to make some adjustments.
More and more, Americans complain about
the state of our country’s health-care system. Critics
search far and wide—Europe and Canada for
example—to find a model for us to emulate. However, they
overlook the most obvious paradigm of organizational genius
ever created—professional sports. Nothing has ever been
as efficiently marketed or so completely gained public approval
as big-time sports teams in America. We finance their stadiums,
happily pay a king’s ransom for the privilege of watching
their games, and deliriously fawn over the players. We
don’t complain about pro sports; we love pro sports! In
fact, if the American medical system were simply run more like
professional sports leagues, we’d be cheering our doctors
and organizing massive parades in their honor.
Of course, this would
require some significant transformations in the world of
medicine. For example, although people sometimes accuse doctors
of having oversized egos, it is in pro sports that
self-importance reaches truly epic proportions. Professional
jocks talk about themselves in the third-person because there
actually needs to be two of them; one guy to play the game and
a separate guy, made up totally of ego, who praises the first
guy. So, at the very least, physicians would have to learn to
speak like athletes giving press conferences:
First of all, Dr.
Jones would like to say—Did you see Dr. Jones out there
today! Making every diagnosis, from the routine to the obscure!
Dr. Jones was in the zone! Which is why Dr. Jones is the most
valuable doctor in this practice, and that’s something
management is going to have to deal with come contract
renegotiation time! If the paying public wants to see Dr. Jones
out here on the diagnosing field, management had better pay Dr.
Jones like the ace of this staff. Although, Dr. Jones would
like to point out that it’s not about the money;
it’s about respect!
And you can imagine
what would take the place of “match-day.” Instead
of thousands of students at medical schools across the country
simultaneously opening envelopes, there would be an enormous
media event in New York City, with the
“commissioner” of the AMA standing at a podium:
“And with the 2nd pick in the OBGYN League, the
Mayo Clinic selects...Leslie Donahue!” The cameras would
pan the audience to find the soon-to-be Dr. Donahue, who would
proudly march up to the stage and have her picture taken with
the commissioner, all the while holding up a brightly colored
lab-coat embossed with her name and the hospital’s logo.
Her beaming face amidst flashing bulbs would undoubtedly make
an indelible impression on her friends and family watching on
TV around the country, who will themselves give endless media
interviews about how they always knew “little
Leslie” would make it some day.
When these doctors
make it to “the show” and sign with major league
practices, they’ll meet the customary fate of all rookies
at training camp-hazing. In the eyes of most veterans, nothing
brings a practice together more than shaving the heads of the
new docs or making them stand on chairs in the cafeteria during
lunch and sing their alma-mater’s fight song.
But even after getting
to the ‘promised land,’ no physician could ever
feel completely secure at his position. Whether because of
concerns about an aging staff, bloated payroll or the demands
of keeping up with the competition, every practice would have
to make tough personnel decisions. One day Dr. Lopez could be
walking back to his office whistling a happy tune when he gets
a tap on the shoulder and: “Hey, the manager wants
to see you in her office right away.” Gulp. Dr. Lopez
would slowly make the long walk to see his skipper, going over
in his head all the plays he made yesterday, wondering what he
could have coded differently, thinking about the friends he had
made:
Close the door behind
you. Look, you know we’ve been lacking depth in certain
areas, and we’re having trouble getting all the doctors
the treatment rooms they need to stay sharp. There’s
really no easy way to say this, so I’ll just come out
with it—You’ve been traded to the allergy practice
across town for two physician assistants and a referral source
to be named later. It’s nothing personal. Take an hour to
clear out.
Office life would be
different in other ways, too. Instead of traditional staff
meetings, the managing partner would gather her troops at
crucial moments, like the close of the fiscal year, and give a
fiery, cliché-ridden pep talk:
OK, everyone take a
knee. It’s go time! We’ve got to dig down deep
inside and give 110 percent! Winners never quit and quitters
never win! Remember, there is no capital “I” in
billing! THIS IS OUR HOUSE-AND NO ONE COMES INTO OUR HOUSE AND
MAKES A MESS!! Well, except the incontinent patients, but
that’s OK. Anyway, it’s time to strap on your
stethoscopes, get out there and KICK SOME CHARTS!!
The docs would smear
grease paint under their eyes and build to an emotional
crescendo with head-butts and chest-bumps. Then, with music
blaring and pyrotechnics blasting, they’d run down the
corridor from the doctor’s lounge, giving high-fives to
the staff.
A permanent fixture in
every office would be those well-loved arbiters of proper
behavior, JCAHO officials, outfitted in black-and-white-striped
shirts and whistles. At the first sign of a HIPAA violation,
the zebras would toss yellow flags in the air and blow a stop
in the visit. For no apparent reason, the JCAHO officials would
then huddle for several minutes in the middle of the lobby to
discuss the offense. From this confidential rendezvous, the
most senior of the officials would emerge, switch on his
microphone and announce the offending person’s name and
the loss of revenue.
And doctors would have
to get used to the same travel that all professional athletes
endure. You can see the ortho group showing up to the office
and boarding a charter bus to the airport for a cross-country
flight and an “away day” of surgery. Envision them
as they walk into the confines of the unfamiliar building, a
sea of fans in identical colored jerseys and face-paint jeering
them, raining down showers of stale beer and insults about
their looks, families, and sexual practices. But the ortho
group would have on their game faces, letting the fans know
that they would not be intimidated into fumbling the opening
case or blowing an early timeout to get the correct clamp
called.
Everyone, even the
star surgeons, would have to get used to being coached. Picture
a difficult procedure that’s not going well. The surgeon
is clearly tiring, sweating bullets, but unwilling to ask for
relief. The grizzled chief of surgery watches carefully from
the top step of the observation room. Dressed in the team
scrubs, the chief has a huge plug of tobacco shoved in his
cheek, spitting a stream of dark brown liquid on the floor,
nervously playing with his surgical cap until he realizes that
it’s up to him to stop the bleeding. Striding
deliberately, the chief comes out of the observation room and
raises his right hand to signal for his closer. With a few
quiet words of encouragement for the embattled cutter, he takes
the scalpel, pats the surgeon on the behind and sends him to
the showers.
But the starting
surgeon’s ordeal wouldn’t end with his ignominious
departure. After the operation, he’d be at his locker,
getting dressed and a gang of hungry reporters would be at him
like jackals, asking inane questions:
“How much of the
blame do you put on the poor imaging reports from your
radiology scouts?”
“It seemed like
your scalpel didn’t have much life in it today, do you
need a day off?”
Obviously, with the
constant media attention and the enormous adoring fan base
watching their every move, there would be the very real danger
that doctors will lose sight of the fundamentals and play to
the crowd. Bad enough that they’d be checking the
box-scores and their stats in JAMA every day, with millions of viewers,
including their colleagues, watching, the temptation to
grandstand and make it onto the TV highlights could be
overwhelming. Why simply use a defibrillator when you can crack
the chest, massage the heart, and get a slice of the media
exposure pie? Because every night, with throbbing music
blaring, two anchors would sit behind a desk on an ultra-modern
TV set:
Hello, everyone and
welcome to DOC CENTER on MSPN! This is Tom Epstein getting you
up to date on all today’s happenings from the world of
medicine! In this half-hour, we’ll find out if you see
eye-to-eye with the U.S. News and
World Report pre-season poll of
the top 25 ophthalmology practices. Then we’ll review the
best interventional cardiology plays of the day! Stay tuned!
In the end, other
problems associated with sports would probably find their way
into the world of big-league medicine. Like steroid abuse. At
first, you’d just hear some background grumbling and
unattributed rumors. But eventually someone would go on the
record, noting how, at age 71, Dr. Blanchard went from a wiry
145 pounds to a buff 220 pounds of solid steel. Or how Dr.
Jenkins suddenly developed a burst of speed that lets her run
from exam room to exam room seeing more patients in a day than
she used to see in a week. Competition can be beautiful, but it
can also bring out the ugly side in people.
The truth is, running
medicine like pro sports won’t work because of the
almighty dollar. It’s hard to imagine an HMO signing a
physician to a five-year, $95 million contract, no matter how
good her agent is. So, it’ll never happen...
...unless they do it in Canada first. g
Jim Silver is a free-lance writer and
sports junkie. He is a former federal prosecutor who is married
to physician Julie Silver, MD and now stays at home with their
three young children.
