Saturday, July 11, 2015

The selective outrage of the conscience of medicine now focuses on Medscape

When Bob Doherty, representing the American College of Physicians as the conscience of medicine, was called out for his silence on the serious ethical concerns surrounding the American Board of Internal Medicine, he said: is not within my area of expertise or responsibilities for at ACP. I am responsible for the ACP's governmental affairs efforts (federal and state legislation, regulations by CMS and other regulatory agencies, payment policies by third party payers, the Affordable Care Act, etc), and while I am generally aware of the controversies relating to ABIM, I as a matter of sound practice and policy do not express my opinion, or purport to speak for ACP, on other issues that fall outside my direct governmental affairs responsibilities.

But just a couple of weeks later Doherty seems to have departed form said practice and policy in  this scathing criticism of Medscape's article on the best and worst places to practice in the United States:

I would think that when physicians decide where to set up practice, there are things that they would want to think about other than how much money they’ll make. Yet if one reads Medscape’s current list of the best and worst places to practice, it would appear that money trumps everything else (although Medscape said it also considered factors like “cultural attractions”). What Medscape apparently did not consider at all are factors like the percent of the population that is uninsured, mortality and morbidity rates, rates of chronic disease, per capita healthcare spending, that is, anything having to do with patients.

He goes on to talk around this issue and gives examples of other ways Medscape might have ranked states, but never makes a cogent argument. How, exactly, might a different approach to the ranking of states have helped patients? Doherty never explains. In fact, as he implies, the Medscape article, if anything, points doctors to states where patients are underserved. How could the article better serve patients than to direct doctors where they're needed most?

The entire post seemed incoherent to me until I realized the premise behind Doherty's argument which finally became apparent in this paragraph from the post:

No, my beef is only with Medscape, and the sources (recruiters, interviews, surveys) they used that looked mostly at the economics of practice, not the environment affecting the care of patients. As a result, there is an inherently conservative bias built into Medscape’s analysis, because by emphasizing higher physician earnings, lower cost of living, fewer malpractice suits and lower taxes over health outcomes and the percentage uninsured, its rates more favorably the states that are hostile to government programs to help cover people and reduce healthcare disparities, and less favorably the states that have more activist governmental programs to reduce the ranks of the uninsured and healthcare disparities, often requiring higher taxes to pay for such programs.

According to that premise things that promote the interests of physicians have to be contrary to the interests of patients and, as a corollary, so do things that deviate from the political views of the ACP which is, after all, the new conscience of medicine.

1 comment:

Walter Bond said...

Thanks for highlighting this exchange. Now, of course, ACP has sent a new e-mail to its membership, much more neutral towards ABIM (although see Dr. Wes' post from last week for his not exactly optimistic opinion). We will see how this continues to unfold. Any wagers on the survey of ACP members regarding ABIM?