‘Paging Dr. Doctivity’: Medicine Evolves Into a Business Model

By Walter Brasch

      Beneath a three-column headline in my local newspaper was a barely-edited press release.

      That’s not unusual. With the downsizing of newsrooms, there’s more room for wire service soft features and press releases. But this one caught my attention.

      SystemCare Health in New Jersey promoted a graduate of a college in my town to the lofty position of Senior Director of Doctivity.

      I checked the dictionary—“Doctivity” didn’t exist. I checked WebMD, the website for amateurs to learn the meaning of unpronounceable medical terms—and how to recognize their symptoms and treatments. Nothing there.

      That left SystemCare Health’s website, which spewed a barrage of buzzwords and useless gibberish, the kind that people in marketing and business think will impress those who speak fluent English.

      The company says it works with major health systems and medical colleges, giving them insight and “strategic brand platforms, service line business building programs, and breakthrough creative ideas so our clients experience real market-moving results [to] increase physician productivity, streamline operations and strategically acquire new patients.” I assume there is little difference between strategically acquiring new patients and an Army sniper strategically acquiring his target in combat.

      After wading through the mission of the company, I plunged into the swamp of Doctivity, which the company claims is “woven into a health system’s culture to create a repeatable process that provides visibility and accountability for the time it takes a new physician to break even [and] eliminates functional silos.” Since “functional silos” are probably what exist in field of cow manure, I was able to reaffirm my initial impressions about the company, and moved forward.

      Forward led me to learn that the company “delivers a personalized business plan for every new physician so they can reach their financial goals faster,” and that “Physician productivity is at the forefront of most profitability discussions.” Unfortunately, somewhere in those left-over functional silos, “It can take 18-24 months or more for a new physician to reach a break-even point (where they are covering their salaries).” But, with layers of Doctivity, which SystemCare Health says is an “innovative business approach that improves physician productivity,” physicians “are hitting their financial goals faster.”

      The psycho-marketing babble splashes website visitors with explanations— “Internal processes sometimes are burdened with lack of resources as well as market and operational constraints to successfully improve new physician productivity and strengthen retention,” and because of Doctivity, “Physicians reach their financial goals much sooner and better understand their new organization, their business and how the organization intends to market them to build a successful practice. Happy doctor = happy patients.” That last sentence, surgically cut out of a fortune cookie, could mean that SystemCare Health brings clowns and comics into physicians’ offices and operating suites. Physicians who are laughing at uterine cancer, multiple sclerosis, and aortic aneurysms will lead to patients who are so happy about their conditions they are willing to pay their physicians even more so everyone is happy. It could also mean that SystemCare  Health might apply “synergy” with pharmaceutical companies to assure they bring plenty of happy food to meetings with physicians. It could also mean productivity increases with the better use of computers and software, which requires physicians to look at screens more than they look at patients. Possibly, happiness is that SystemCare Health has someone on its staff whose job is to make sure that physicians, who can get depressed at workloads and corporate demands, are able to get the proper mood elevators to improve their happiness quotient.

      Under the Doctrine of Doctivity, health care has evolved from care and compassion to the surgical sterility of a business model, where liquidity, maximizing profits, and return on investment become the fabric and glue of health care practices.

      It’s a model where doctors in corporate health care systems are just like factory workers who help provide their corporate bosses better returns on investment that are contiguous with raising the bottom line. Like some workers who are paid by how many widgets they create every hour, or how many bushels of fruit they pick, these health care workers increase their own productivity by seeing more patients every shift. To increase their own productivity, physicians become more “efficient,” seeing patients every 10 minutes; maybe 30 to 40 a day. It’s not unusual for physicians to have a 5,000 patient case load. Spend too much time with a patient, and you lose that productivity. Take time to research a patient’s symptoms and consult with other physicians and you lose income. But, if you refer your patient to a specialist or order more tests, both you and the system will be happy with additional income. Get those patients into your exam room; move ’em in; move ’em out.

      Physicians in some systems who take too much time with patients get reminders about being focused. They don’t get reminders that spending more time with patients, sometimes just chatting about hobbies, the latest films, or the family, can help a physician better understand a patient’s issues and problems. Trapped by those 10- and 15-minute blocks of time, physicians rely upon templates and superficial questions to determine their diagnoses. They may know, but don't have the time to follow through on the most basic part of research--if you ask enough questions, and if you ask the right question, you'll get the right answer. And since it’s been decades since physicians made house calls—too inefficient—they don’t see or understand how a patient’s home or lifestyle might affect that patient’s illness.

      Most physicians, even those who take lessons from a Doctivity specialist, care about people. Most didn’t go into medicine to be part of the country club set. But when corporations set up Doctivity-induced programs, even the best physicians reluctantly sacrifice the art and science of medicine, possibly forsaking the principles of the Hippocratic Oath, to the business of medicine.

     [Walter Brasch is an award-winning journalist whose undergraduate degree was social work with a minor in health sciences. His current book is Fracking Pennsylvania, which has major sections about business decisions made by the oil and gas industry that may be more important to some companies than the health and environmental effects.]

Questionable Calls in the Sports Department

by Walter Brasch

      With the opening of the high school football season, local newspapers and TV stations have again been running lists of what they believe are the top teams.

      Most lists rank teams in the “top 10.” One Pennsylvania TV station, whose on-air number is 16, runs the “Top 16.”

      There are several problems with these lists. First, we don’t know how they got those rankings. We don’t know who makes up those lists or what criteria were used. It could be a sports editor and her grandfather. It could be a bunch of station personnel sitting at a bar, throwing back vodka slammers and team names.

      Even if we know how the lists are compiled, a second major question arises. Why? Yes, why? Why does it matter? Aren’t won-loss records good enough? Shouldn’t the only rankings that matter be who enters and wins in the playoffs?

      Some newspapers have a half-dozen staffers and a couple of subscribers make predictions of the upcoming high school, college, and pro football games. Winners get prestige and, sometimes, gift cards from local advertisers.

      Some newspapers run the odds on upcoming games, apparently so their subscribers have basic, although seldom accurate, information to assist them with bets. While betting on college and pro games is fairly common, and mostly illegal, should anyone be betting on high school games?

      Several sites rank teams from throughout the country. USAToday runs a pre-season ranking of the Top 25 football teams. With one million boys playing football on 14,000 teams, does anyone think anyone, even those with access to a super-Cray computer, can accurately define the “top 25.” USAToday during mid-summer also does a composite score of four national sites which determine the “Top High School Prospects.” These are, supposedly, the “top 100” high school players, and top recruits for a college football scholarship.

      The rankings don’t stop with football. USAToday also ranks the “top 25” teams in almost every sport, including girls lacrosse and boys soccer.

      Do these rankings and predictions give the sports departments something to fill time and space? Do they make the sports editor appear to be powerful or intelligent? Are the lists something to allow fans to believe their team is good enough to be ranked? Or to complain that their team was cheated and should be ranked No. 3, instead of No. 17?

      Related to rankings are the persistent countdowns of the “Best Play of the Week” and “Athlete of the Week.” These TV clips are loaded in favor of quarterbacks throwing balls to receivers or running backs sidestepping two tackles to score from 20 yards out. Usually overlooked is a great block that springs the running back loose. Or, maybe a quarterback sack that stops the other team’s momentum. But, every week there’s some play that someone—we don’t know who—and we certainly don’t know the criteria—decides for the rest of us.

      On Saturdays, we shouldn’t care who was ranked or what the best play was from the night before. We should care that the teenage boys did their best, played hard, and enjoyed their time on the field.

      After all, it’s only a game.

     [Dr. Brasch began his journalism career as a sports writer and then as a sports editor before turning to public affairs/investigative reporting and in-depth feature writing. He is the author of 20 books. His latest is the critically-acclaimed Fracking Pennsylvania: Flirting With Disaster.]

The Boss Who Fought 

for the Working Class

by Walter Brasch

         He was born into poverty in New Hampshire in 1811.

      His father was a struggling farmer. His mother did most of the other chores.

      He was a brilliant student, but the family often moved, looking for a better life—a couple of times so the father could avoid being put into debtor’s prison.

      At the age of 15, he dropped out of school and became a printer’s apprentice, sending much of his wages to help his family.

      For several years, he worked as an apprentice and then as a printer, his hands covered by ink, his body ingesting the chemicals of that ink.

      He worked hard, saved money, helped others achieve their political dreams, became the editor of newspapers, and soon became an owner.

      In the two decades leading to the Civil War, Horace Greeley had become one of the most powerful and influential men in America. His newspaper, the New York Tribune, was the nation’s largest circulation newspaper.

      But instead of becoming even richer, he used his newspaper as a call for social action. For social justice.

      In 1848, as a congressman fulfilling the last three months of the term of an incumbent who was removed from office, Greeley introduced legislation to end flogging in the Navy, argued for a transcontinental railroad, and introduced legislation to allow citizens to purchase at a reduced price land in unsettled territories as long as they weren’t speculators and promised to develop the land. The Homestead Act, which Congress finally passed 13 years later, helped the indigent, unemployed, and others to help settle the American west and Midwest. But in his three months in office he also became universally hated by almost everyone elected to Congress. The social reformer in his soul had pointed out numerous ethical and criminal abuses by members of Congress; his party didn’t ask him to run for a full term.

      He called for all American citizens—Blacks and women included—to be given the rights of the vote.

      In 1854, Greeley became one of the founders of the Republican party. For more than two decades, he had been a strong abolitionist and now the new political party would make the end of slavery one of its founding principles. He was one of the main reasons why his friend, Abraham Lincoln, whom he helped become president, finally relented and two years after the civil war began, finally issued the Emancipation Proclamation.

      More than 225,000 Americans (of a nation of about 35 million) bought his relatively objective and powerful history of the civil war, making the book one of the best-sellers in the nation’s nine decade history. In today’s sales, that would be about two million copies.

      Unlike some editors who pandered to the readers and advertisers, he maintained a separation of editorial and advertising departments, and demanded the best writers and reporters, no matter what their personal opinions were. Among those he hired were Mark Twain, Henry David Thoreau, Ralph Waldo Emerson, and Karl Marx. And at a time when newsrooms were restricted to men, he hired Margaret Fuller to be his literary editor.

      He believed in a utopian socialism, where all people helped each other, and where even the most unskilled were given the opportunity to earn a living wage.

      He demanded that all workers be treated fairly and with respect. In 1851, he founded a union for printers.

      When his employees said they didn’t need a union because their boss paid them well and treated them fairly, he told them that only in a union could the workers continue to be treated decently, that they had no assurances that some day he might not be as decent and generous as he was that day. The union was for their benefit, the benefit of their families, and their profession, he told them.

      In 1872, Horace Greeley ran for the presidency, nominated on both the Democrat and Liberal Republican tickets. But, his opposition was U.S. Grant, the war hero running for re-election on an establishment Republican ticket.

      Weeks before the electoral college met, Horace Greeley, who lost the popular vote, died, not long after his wife.

      The printers, the working class, erected monuments in his honor.

      And everyone knew that the man with a slight limp, who usually dressed not as a rich man but as a farmer coming into town to buy goods, who greeted everyone as a friend, who could have interesting conversations with everyone from the illiterate to the elite, was a man worthy of respect, even if they disagreed with his views. For most, Horace Greeley was just a bit too eccentric, his ideas just too many decades ahead of their time.

      On this Labor Day weekend, when not one Republican candidate for president believes in unions, when CEOs often make more than 100 times what their workers earn, when millionaires and billionaires running for office pretend they are populists, when even many in the working class seem more comfortable supporting the policies and political beliefs of the elite, the nation needs to reflect upon the man who knew that without the workers, there would be no capitalism.

      [Dr. Brasch has been a member of several crafts, arts, and trade labor unions. He proudly sees himself not as among the elite but as a part of the working class.]