Greetings all!  I’m hosting Grand Rounds for January 6.  I want to tell you about the theme.

Profit in health-care.

What do I mean?  Well, lots of things are driving my thinking here.  The Obama administration may create long-lasting changes in the reimbursement of health-care, up to and including a single-payer system.  To increase the numbers of primary care physicians, there’s talk of paying for the medical education of those students interested in primary care, so that they won’t have a burden of debt and feel compelled to enter high-paying specialties.  (The tacit assumption reasonably being that their primary-jobs won’t be very lucrative.)  All over the house of medicine, we find invective against the pharmaceutical industry; for manipulating data and (let’s be honest) because they seek to make hefty profits.

And if we, as physicians, want to make plenty of cash, are we hypocritical when we come down on big Pharma?  I mean, is everything we do, and recommend, really evidence-based and in the best interest of our patients?  I don’t know all the answers…I’m just posing the question.
So, as physicians and others in the greater health-care world, what do we really think about profit?  We’re taking care of people in need, many of whom have limited incomes and no insurance.  Humans don’t always choose their illnesses (though they often do).  Many really need medical care; some just desire it.

As health-care providers, we’re often working in dangerous environments, subjecting ourselves to the risks of infection, physical harm, lawsuits, exhaustion, relationship troubles and burn-out.

In light of all that, should we be turning a profit?  Should we feel entitled to lots of money?  Are we any different from other necessary professions?  Should your contractor build houses at minimal profit, since people need shelter? Should auto-makers sell cars without much profit, since people need transportation?  It’s an interesting question.

Will young people endure medical education and practice without the promise of significant profit?  Will the young physicians now in practice continue?  Or, if we decided to pay less, would they simply become clock-in, clock-out factor workers?

Does the promise of financial gain make us better providers or worse?

Does profit compromise our morality, our compassion for those in need, or even our faith (to those so disposed)?

OK, hit me!  Send links and responses to my e-mail at:

As before, you don’t have to follow this theme.  But if you do, I’ll be interested to see what you have to say.  I’ll tell you my thoughts on January 6.

If you don’t blog, and want to add your thoughts, send me an e-mail.  I’ll make a place to post your opinion.  If you don’t want your name attached, just say the word.

Have a great day, and a blessed, Happy New Year!


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