MONETARY MEDICINE

It can only promote cynicism among our students if we preach humanism and ignore the realities of the contemporary scene: hospital admissions policies designed to unload the "losers" onto municipal hospitals, house officers overwhelmed by more admissions and sicker patients, and "quicker and sicker" discharges for cost control. Medical care is being "monetarized"; physicians are becoming the "proletarians" of health care capitalism. The lexicon of our hospitals is rife with terms borrowed from the corporate world: teaching hospitals "position themselves" to seize their "market share," "demarket" money-losing clinical services, diversify, "unbundle," "spin-off" for-profit subsidiaries, develop "convenience-oriented feeder systems," maneuver to adjust case mix, and triage admissions by their ability to pay and "deselect" physicians with costly styles of practice. The corporatization of medicine proceeds apace. What matters for stockholders is the bottom line; what should matter for all physicians, and still does for many, is the patient'S welfare. It remains to be seen how long that attitude will survive when patients are transformed into customers and physicians into providers.