Anecdotal but my gen prac warned me on this 10 years ago, that obgyns were being driven out by high malpractice insurance. He suspected this would ultimately lead to consolidation of doctors under health organizations to limit personal liability.
Sure enough you have conglomerate health services corporations absorbing small practices, cheaper prices for consumers with added bureaucratic noise & volume thresholds for practitioners.
I've seen this with my own doctor. They said another reason besides the insurance was the increased demand for paperwork and electronic backups or something like that. So it's much easier and cheaper to have a single team manage the digital side for 20 doctors instead of just 1 or 2 doctors.
From the consumer end I like this more because their new group has a wide variety of specialties so you don't need to keep filling out the same paperwork and they also can afford to maintain an electronic system so you receive text notifications for appointments and can make appointments online and such.
As a consumer, I'm coming to dislike it. In theory, that consolidation of redundant efforts should improve my care and reduce my costs.
In practice, I've seen the opposite happen. My local health care market has consolidated down into a single large corporate entity that, like any good monopoly, has every reason to reduce quality of service while increasing prices.
I guess I fill out less paperwork, but that isn't saving me enough time to justify all the little routine visits that used to cost me $50 out of pocket suddenly costing $300 out of pocket.
I'm an attorney, not a doctor, but from my perspective, rising malpractice rates are connected to burnout because they indicate a working environment that feels hostile. Doctors generally become doctors because they want to help people, and they do all of their work in good faith, and it creates a lot of anxiety to constantly worry about being sued, and it creates even more when your take home pay is materially impacted by malpractice insurance. For competent doctors, this may be misplaced anxiety, but it exists nonetheless. This anxiety might cause the doctors to seek a work set up that limits their personal liability to relieve their own anxiety, but it creates other anxieties, like those that come with working for a giant company and lead to burnout.
Lawyers, it may surprise some people to hear, also enter the legal profession wanting to help people, and the same mechanisms are at work. I may want to be a solo-practitioner for the flexibility and the ability to charge lower rates to help a broader part of the community, but feel pressured into joining a much larger firm just to protect myself from some crazy, one-off, life-destroying legal event.
Like I said, it may be an irrational fear, but that, combined with a giant amount of student loan debt and an already rather stressful profession is a recipe for burnout.
> protect myself from some crazy, one-off, life-destroying legal event
It's funny, it's this exact type of thing that the recommendation "don't talk to the police" comes from. Most cops are wonderful people that do want to help. Then there's the one bad apple that ruins your life.
I guess "don't talk to the police" isn't exactly solid career advice for a lawyer ;)
Haha yeah exactly. I think this dynamic exists in a lot of places.
I feel like there should be a phrase that communicates something like "I know you're acting in good faith, but I'm just trying to be cautious." Because it's easy to misinterpret that reticence to talk as some sort of hostility or distrust (though the best cops won't interpret it that way).
I have a similar experience when someone is trying to sell me something, I don't bear them any ill will for doing their job, but also it's a waste of both our time for them to continue with the sales pitch. But it's hard to communicate that without implying that I think they're doing something untrustworthy.
And from what I've read, there are a lot of cons that rely on people not wanting to be rude and not questioning something they don't think is right.
> He suspected this would ultimately lead to consolidation of doctors under health organizations to limit personal liability.
That's not necessarily a bad thing. Safety in herds and shared risk pools work to limit individual risk for physicians.
This can take the form of larger private practice groups like Kaiser Permanente's physician group (a distinct entity contracted with the Kaiser Permanente hospital/managed care corporation).
It can also take the form of NHS in the UK which employs the vast majority of physicians there and represents them in malpractice cases.
The risk inherent in medicine is real and has to be borne somewhere. Better by shared risk pools, however they are organized, than by individual patients or doctors.
Sure enough you have conglomerate health services corporations absorbing small practices, cheaper prices for consumers with added bureaucratic noise & volume thresholds for practitioners.