Wednesday, April 25, 2012

Exclusion of Trust

Exclusion of Trust
                 Competition and consumer sovereignty are the two main pillars of clinical medical practices. While the non-clinical practices have long been subject to exclusive contracts, recent trend of such monopolies in clinical fields like Cardio-thoracic surgery is quite disturbing. While such contracts may be unfair to excluded physicians, the ultimate brunt is borne by our trusting patients.
                 The major concern in any dispute over monopolies is the elimination of competition, which has with it inherent harms. Exclusionary contracts quite clearly do eliminate competition from other medical practices, and disturbingly, the motivation seems to be purely financial in nature, rather than grounded in concern for the patients. The physicians who are party to the exclusive contract subsequently receive control over all procedures under their jurisdiction at the hospital. Of course, for the hospital to offer such a guaranteed revenue stream to the physicians, the contract must pose some perceived benefit to the hospital as well.
                Proponents of exclusive contracts argue that there are other fail safes in place in medicine that do not exist in other fields which control quality. Hospitals monitor quality through yearly reviews, for example. While this oversight certainly is the case, even assuming that the review board acts in the best interest of the patients and not the hospital—a shaky assumption, since the review board would be established by the hospital and therefore be susceptible to its desire to increase patient volume—the review board only acts negatively to control quality. In other words, the review board theoretically only acts when the physician is failing to meet a certain quality standard: for example, for failing to below a certain mortality rate. Instead, competition acts in a positive way as well; one physician learning a new procedure or techniques for an old procedure that reduces complications forces competing physicians to positively increase their quality as well. Without positive quality control, there is no incentive for a physician to improve upon his or her skills. In an incredibly dynamic field like heart surgery, a lack of positive quality control could quickly lead to archaic and therefore dangerous medical practices.
             Of all human powers operating on the affair of mankind, none is greater than that of competition.

Pankaj Kulshrestha, M.D.Dayton Cardiac Surgery
East Medical Plaza
627 Edwin C. Moses Boulevard, Suite 5J
Dayton, OH 45417
Tel: (937) 938-9194 | Fax: (937) 938-9242

Monday, April 23, 2012



The exclusive contracts defile the sanctity of the doctor-patient relationship. It is necessary to evaluate the effect these contracts have upon the medical field. I isolate the number one consideration in the medical field to be quality of patient care, based upon the Hippocratic Oath. The effects of exclusionary contracts upon patient care are akin to any monopoly on the quality of a service. Competition is a natural check upon quality; all producers must provide high quality services in a competitive market or lose business. By eliminating competition, the exclusive contract removes the risk of losing business, the major motivation for providing high quality care. In the medical field, however, the implication of losing high quality services is obviously much more sinister; it equates to the suffering and/or loss of life of the patient. Instead of vying for exclusive contracts, physicians must be willing to demonstrate their worth in a competitive market. We have a moral responsibility to provide our patient with a freedom to choose the best. Bill Clinton shopped for a surgeon when he needed heart surgery; and so did the CEO of the hospital.  In clinical specialties, exclusive contracts deny a common man the freedom to select a physician. It is high time that we collectively make exclusive contracts illegal.