Why don’t physicians have more power in healthcare?

By Laura Dyrda for Becker’s Hospital Review 

Physicians are essential to the healthcare system. They treat patients, perform surgery, write prescriptions and conduct research advancing the field.

But their opinions carry less weight on Capitol Hill than in the operating room.

Health policy is shaped by legislators and influenced by lobbyists representing drug companies, medtech, insurers, hospitals and more. In the first half of 2021, healthcare organizations spent $331 million on lobbying, led by Pharmaceutical Research and Manufacturing of America. The top five spenders were:

• Pharmaceutical Research and Manufacturers of America: $15.2 million
• American Hospital Association: $12.1 million
• Blue Cross Blue Shield Association: $12 million
• American Medical Association: $10.9 million
• Pfizer: $6.6 million

The American Medical Association promotes the “art and science of medicine” to advocate on behalf of medical societies and all physicians, but their spending is overshadowed by the numerous other non-provider industry interests.

It’s why physicians have their Medicare pay on the chopping block during every budget negotiation. Physicians were also largely left out of Affordable Care Act discussions, which put a moratorium on physician-owned hospitals and added regulations that sparked consolidation in many specialties, which also raised prices.

“Physicians have been ‘relinquishing’ their power in healthcare system for a long time,” said Vladimir Sinkov, MD, founder and CEO of Sinkov Spine Center in Las Vegas. “The three major areas where physicians lost their influence over the healthcare system are hospital control, financial relationship with the patients, and the need to practice ‘defensive medicine’ in an effort to avoid a frivolous lawsuit.”

Few hospitals are owned or operated by physicians, and insurance companies removed the direct financial relationship between patients and physicians, who often don’t know how much patients are charged.

“Insurance companies control which doctors their patients can see,” said Dr. Sinkov. “Since the insurance companies control the flow of patients and money, they control how the physicians practice and earn income. Furthermore, once the government got into the health insurance business, through Medicare and Medicaid programs, the government officials, who for the most part have no medical knowledge or training, get to pass laws and regulations further controlling the physicians and how they practice.”

More recently, CMS surprised physicians by removing procedures from the ASC payable list and placing barriers to pay for new procedures.

“The decision-makers in government are often unaware of both the issues we face as providers and the specific sufferings of our patients, and, of course, these problems are interconnected,” said C. Ann Conn, MD, of Advanced Pain Institute in Hammond, La. “Therefore, it is important that we speak out to improve the situation.”

Over the last two years, physicians were front and center in treating COVID-19 patients, but it was deja-vu on Capitol Hill when it came to who was informing public health policy.

“Facing the pandemic, the medical profession took a back seat to the government task forces, which have made flagrant missteps,” wrote Ronald Frank, MD, in a Wall Street Journal opinion. “While physicians treated patients, the directions of care were outlined largely by government. How can we possibly think government agencies would be more adept than the clinicians, the ‘foot soldiers’ in the field? Physicians have been disrespected — taken out of the equation and largely ignored or silenced in policy-making.”

The pandemic ushered in a new era of healthcare with an emphasis on connectivity, accessibility, equity and science. But will physicians finally wrestle a seat at the table as policymakers reshape healthcare for the next generation? As healthcare spending grows, it becomes less likely, Dr. Sinkov thinks. Healthcare is big business and most physicians don’t have a business background.

“They have been convinced by all those other entities that they can no longer manage or control the healthcare system,” he said. “Most physicians do not understand the current financial complexities of the system and would rather compete with each other for hospital privileges or exclusive insurance contracts than unite, take control of the system, and be able to provide better and cheaper care for their patients.”