Why Doctors Are Rebelling Against Saving Lives

When I was in medical school, “real” doctors saved lives. Period.

Specialists who focused on a patient’s quality of life, (the plastic surgeons, bariatric surgeons, holistic practitioners, infertility experts, etc.) were considered sellouts. (We won’t even consider the med school status of future psychiatrists.)

We disparaged these doctors because they could be saving lives and chose not to, because they were often paid (God forbid) out-of-pocket by their patients, and because they actively self-promoted themselves to the public (another doctor no-no). These “greedy” docs were scorned as entrepreneurs in a profession too sacred to be tainted by money. (This as traditional docs plundered third party payers. Don’t get me started.)

Fast forward. Many future doctors now choose “quality of life” specialties. Their priorities have changed. For one thing, they’re not ashamed to admit they prefer dealing with self-reliant mostly healthy patients. As an orthopedic surgeon client proudly put it, “I don’t treat sick patients. I treat healthy patients with sick joints.” What’s more while treating chronic disease offers little closure, quality-of-life doctors confront, and correct, discrete problems every day. They’ve gratefully escaped the frustrating long-term holding action of their colleagues.

(This last point, by the way, speaks to a larger problem: A profession dedicated to “healing the sick” now actively avoids the sick. My firm focus-tests young primary care practitioners for insurers. The vast majority avoid both hospitals and older sicker patients. They prefer treating young healthy upbeat families they can relate to. And while society cries for gerontologists, they dismiss the specialty as a “downer.”)

But back to reasons why new docs prefer quality of life specialties. For one they like the fact that in these fields expertise counts. They can provide a service their patients are capable of judging (e.g., a nose job, new joint, or successful pregnancy). That means in their chosen fields the best practitioners are recognized by their patients and rise to the top.  These are the ground rules risk-takers prefer.

For me, the true irony here is that the “life and death” doctors who felt above the corrupting influence of business have now become its victims. Precisely because consumers can’t judge their individual worth (and quality goes unrewarded), these doctors all occupy the same level playing field. They’ve become commoditized, serfs in a system that views them as interchangeable. Just the way hospitals and insurers like it.

For better or worse, almost all our marketing clients are quality of life practices. They’re rare self-selected doctors confident in their excellence and steeled for the uphill fight to maintain their autonomy.

It’s my bitter regret that most life and death doctors have already lost their own fight for survival.

 

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