BUREAUCRATS TAKING OVER!

Academic medicine seemed to offer the best of both worlds: plenty of time for research, some teaching, and limited practice responsibilities.

Today, it all seems somehow lost: the independence, the time, the easily acquired grants, the lifestyle, and the security. Control has been wrested from medicine and is in the hands of bureaucrats, politicians, and CEOs. Patients—or consumers as they are now known—are distrustful and litigious. Lawyers are ever present and increasingly skilled at pitting one doctor against another. Academic health centers are locked in fierce battles for survival, and all physicians worry about the future.

Why has this happened?

The usual response to this questions mentions four major factors that have precipitated a health care "crisis," largely by driving up the costs of medical care: 1) the spectacular (and expensive) advances in medical technology and treatment; 2) changes in society, including epidemics of violence, drug abuse, economic disenfranchisement, and AIDS, which have added considerably to the nation's health care needs; 3) the shifting demographics of American society, particularly the growing numbers of elderly, who consume a disproportionate share of health care; and 4) the economic realities of global competition, in which American products lose a competitive edge because of the escalating health insurance costs of large employers.

To this list may be added two other factors: the unrealistic expectations of consumers, and the unchecked growth of physician specialists.