Corl decided that he couldn’t let that happen. Exchanging glances, he and the nurse disconnected the patient from the monitor, pushed her gurney down the hall, and pushed her out of the hospital. The blast of cold air as the door opened made Corl shiver. A nurse called the police to come and pick up the patient. Her (It turned out that she had an outstanding warrant for her arrest and she was arrested). Later, after returning to the ER, Corl couldn’t stop thinking about what he’d done, imagining how the med school version of himself would have judged his behavior. . He “he would have been horrified”.
Concerns about the corporate takeover of the US medical system are not new. More than half a century ago, writers Barbara and John Ehrenreich attacked the power of pharmaceutical companies and other large corporations in what they called the “medical-industrial complex”, which, as the phrase suggests, was anything but a charitable enterprise. In the decades that followed, the official bodies of the medical profession did not seem to care about this. By contrast, the American Medical Association consistently opposed efforts to expand access to health care after World War II, and aggressively lobbied against proposals for a public single-payer system, which it viewed as a threat. for the autonomy of doctors.
But as sociologist Paul Starr noted in “The Social Transformation of American Medicine,” doctors earned the public’s trust and gained much of their authority because they were perceived as “above the market and pure commercialism.” And in fields like emergency medicine, a spirit of service and sacrifice prevailed. In academic training programs, Robert McNamara told me, students were taught that the needs of patients should always come first and that doctors should never let financial interests get in the way of doing their jobs. Many of these programs were based in inner-city hospitals whose emergency rooms were often full of indigent patients. Caring for people, regardless of financial means, was a legal obligation, codified in the Emergency Medical Treatment and Labor Act, a federal law passed in 1986, and, in programs like the one McNamara led at Temple, a reason for pride. But he acknowledged that over time, these values increasingly clashed with the reality residents encountered once they entered the workforce. “We’re training people to put the patient first,” he says, “and they’re running into a chainsaw.”
Throughout the medical system, the insistence on income and profit has accelerated. This can be seen in the closure of pediatric units at many hospitals and regional medical centers, in part because treating children is less lucrative than treating adults, who order more elective surgeries and are less likely to have Medicaid. It can be seen in ERs that were understaffed due to budget constraints long before the pandemic began. And it can be seen in the push by multibillion-dollar companies like CVS and Walmart to buy or invest in primary care practices, an attractive field for investors that is fast entrenching because many of the patients seeking such care are enrolled in the Medicare program. Advantage. , which pays out $400 billion to insurers annually. During the last decade, meanwhile, private capital investment in the health care industry has increased, a wave of acquisitions that has swept through doctors’ offices, hospitals, outpatient clinics, home health agencies. McNamara estimates that staffing in 30 percent of all emergency rooms is now overseen by private equity firms. Once in charge, these companies “start squeezing doctors to see more patients per hour, cutting staff,” he says.
As the focus on revenue and the adoption of business metrics has become more mainstream, young people embarking on careers in medicine are beginning to question whether they are the profiteers of capitalism or just another exploited class. In 2021, the average medical student graduated with more than $200,000 in debt. In the past, a privilege conferred on physicians who made these sacrifices was the freedom to control their working conditions in independent practices. But today, 70 percent of physicians work as salaried employees of large hospital systems or corporate entities, taking orders from managers and executives who don’t always share their values or priorities.
Philip Sossenheimer, a 30-year-old Stanford physician-resident, told me that these changes had begun to precipitate a shift in self-perception among physicians. In the past, doctors “didn’t really see themselves as workers,” he notes. “They saw themselves as business owners or scientists, as a class above working people.” Sossenheimer feels that it is different for his generation, because younger doctors realize that they will have much less control over their working conditions than their elders, that the prestige of their profession will not save them from the degradation experienced by workers of other sectors. of the economy “For our generation, millennials and below, our feeling is that there is a huge power imbalance between employers and workers,” he says.
Last May, Stanford’s resident physicians voted to form a union by a total of 835 to 214, a campaign Sossenheimer enthusiastically supported. “We’ve seen a boom in unionization in many other industries,” he told me, “and we realize that it can level the power dynamic, not just for other workers but within medicine as well.” One thing that drove him home was seeing union-owned Stanford nurses go on strike to advocate for safer staffing and better working conditions. His candor stood in stark contrast to the silence of the residents, who risked being singled out and penalized if they dared to say anything that might draw the attention of management or their superiors. “That’s a big reason unionization is so important,” he says.
