The financialization of our visits to medical practice groups
While I was still residing in Kansas City, my primary care doctor retired and I was handed off to a young new doctor who was building up her practice and “still accepting new patients”. My past annual schedule was changed, because even though I told myself I am a patient, I am simply a SKU. I’ll explain that later. In the month of May, I was told I could be seen by her February of the next year.
Before my appointment date finally arrived to have my physical, we decided to make our long-intended move to New Mexico in July. Medical services availability is no better in Albuquerque, as it turned out. My efforts to schedule myself with new care sources was just as extended. I was offered a spot on my new primary care physician’s calendar for November of the next year. As the date approached, I was texted a notice that my appointment had been canceled because my new doctor’s practice is full and she is not taking any new patients. This was after I had been on the calendar for over a year. There was no suggestion in the message to call and schedule a new appointment. I was simply cancelled.
Recently, I needed to visit a dermatologist to examine a skin lesion that I thought might be a carcinoma. Again, the soonest option for a visit was months away. I circumvented the system on this matter and called a small community nearby and was able to see a doctor two days later. Remember that because you can probably do it, also.
I will spare you the similar experiences with eyecare and dental appointments. A visit to an ENT clinic was the only quickly available service I found.
Do each of these anecdotes about my efforts to schedule appointments for personal medical needs sound familiar? It has become the routine all of us experience today. And we have bought into the most common excuse for why we no longer have timely access any medical needs, excepting extreme emergencies. The explanation is always lack of adequate staff. There is a shortage of doctors, we often are told. And the team that supports doctors is also several members less than what is necessary.
As an enlightening coincidence, in my role with the Center for Health Information & Policy (CHIP), I have become aware of the financialization of the Medical Industrial Complex (MIC). Medical services in America have become commoditized. They are essentially retailed. In this respect, patients have become a SKU. That is an acronym Stock Keeping Unit. It is an identification of units of merchandise in most categories of retail businesses. Grocery stores, department stores, auto parts stores, and any other brick and mortar business you can think of generally uses a SKU number to keep track of the inventory in the store or on the shelf. In the MIC today, we are inventory on the shelf. What we need and when we need it no longer has status or directs the delivery of the service or product.
I have come to realize that far away delivery date I am offered for my doctor’s appointment is not guided by the actual availability of the service. It is a well-designed system for the purpose of managing cashflow for the practice. Most well managed business enterprises use cash management methodologies to forecast what their income and profitability potentially will be as far into the future as possible. When the business is selling spark plugs or boxes of cereal, this is a good strategy beneficial to that business. The store hopes customers will put those items in their shopping cart. There is nothing inappropriate about that.
However, what if that “product” is a human being, whose wellbeing and even survival is in the balance? What is the “shelf life” of someone who is having health problems? When an individual discovers they have a skin lesion that may be cancerous and they call a dermatologist, is an appointment 6 months in the future an example of adequate care? Does the person who books the appointment ask the right questions to ascertain the potential urgency of the situation? Has that carcinoma been developing for over a year and the patient just noticed it?
The reality of medical organizational structure today is that the person calling for an appointment in the community where they live thinks they are talking with someone in the doctor’s office they intend to visit. However, the appointment scheduler on the other end of the phone may be an employee of a contractor five states away. Their job is to fill in blank dates on a calendar displayed on their computer screen. They are trained to do this task in a way that assures the measured distribution of revenues for the management company as far into the future as possible. Ask just mentioned, the caller asking for the appointment is merely a SKU.
This tactic is most prevalent in cases where the medical practice is part of a private equity fund ownership group, which is a rapidly growing segment of medical services delivery.
If you have noticed I have not descriptively used the term “health care”, I assure you that is not a coincidence. Medical services and health care for the purposes of this commentary are not synonyms.
The financialization of the medical industry has become very advanced and sophisticated and remains below the radar to most Americans. The concept of care has become overtaken by for-profit priorities and systems in ways that are considered appalling to wealthy nations all over the world. They simply do not understand why Americans have been so tolerant of this dire method of delivering medical services.
The next time you call a medical practice of any category and are told the earliest you can be seen is months in the future, please do not leave the scheduler with the impression that you are satisfied with that. Ask to be placed on a list that is called in the event of cancellations. Also, as mentioned previously here, do not hesitate to call another office in a nearby community if that is an option for your need.
Do not worry about being loyal to your doctor. That doctor is not paid to be loyal to you. Before they come into the exam room to see you, they review your medical information on their computer because they do not know you. After your appointment is over, they still will not know you. This sad reality is another example of how we have become just a SKU in the medical industrial complex.