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
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