The other day I received a letter from the office where my primary care physician has worked for many years. It says “This is to inform you that … (my PCP) has accepted a position with another practice, and will soon leave Palos Medical Group. We wish him the very best in his new venture.” This is bizarre, I thought. I’ve known him for decades. I’ve had a hundred conversations with him – not only about medical matters. He has treated my children too. I consider him a friend. What’s going on?
I did an extensive Google search to find him, in “his new venture”. No luck. His name does appear in hundreds of web entries, though. I learned lots about his education, reputation, role in the community, family history, awards, membership in professional organizations, not to mention the various popular evaluations on generic ‘rate your doctor’ sites. Of course, there were also the usual agencies claiming “We Found … “, that one sees when doing a web search for someone (e.g., publicrecords.com; intelius.com; spokeo.com; and lifescript.com). For a fee, these businesses will reveal their information (which is just a compilation of public white and yellow page entries, legal actions of various sorts, etc.). There were also numberless references relating my lost PCP to the Palos Medical group which he recently left, but not a single word to locate him right now, or indicate which new medical group he had joined, if any.
Somehow, after hours of search, as though by divine intervention, I noticed a suggestion (which I haven’t been able to find again) to try searching the University of Chicago Hospitals. I did so, and found my PCP’s name among their affiliated doctors, with a phone number attached. The operator who answered said that, yes, he is on their doctor list. He has no office yet, but I could leave a message. I left one, but got no response. A few days later, I called again, and now know where his new office will be, and that it will open next month.
Subsequent sleuthing and conversations with friends have revealed that, without question, my PCP must have signed a “non-compete agreement”, also called a “restrictive covenant”, which says he may not set up practice within a specified distance from Palos Medical Group, for a specified time. (Ten miles and two years might be typical in this locale.) Furthermore, he can’t take his patients’ records with him, or solicit their participation in his new practice. Under penalty of law, he is sworn to keep this matter private.
Laws regarding such non-compete agreements are determined by states. Some states enforce them rigidly, while others make it easy to ignore them, since such restrictions are often seen as unjust limitations on employees and their ability to earn a livelihood. Some pros and cons of these covenants are summarized here.
There may be good reasons for such agreements, but generally I don’t think they benefit the public, or ultimately the parties to them, particularly in medicine. Increasingly, especially since the ‘seventies, medicine in this country is about making money, and only secondarily about providing needed services. (I remember when the first ads for doctors appeared, in the early 70’s.) Poor urban neighborhoods, and rural areas are often ill served, which is one of the reasons most developed countries have decided medical care is an obligation that every society should provide for all its citizens – especially the most needy. But not here. American exceptionalism proudly claims ‘We are ‘different’ . In this case, I don’t believe the differences are a reason for pride.
As has become very evident in the recent political ‘regime change’, the governmental approach to medical care is now in total disarray. I doubt the outcome will be good. The Affordable Care Act (so-called Obama Care) was instituted with great difficulty, and with built-in fatal flaws. Unfortunately, the administration which put it through Congress allowed insurance company lobbyists to write the terms of it, which guaranteed the ultimate failure of its alleged good purpose. We’ve seen the gradual downward glide of the system, as more and more insurance companies refuse to participate, because they are losing money. That’s partly because young, healthy people are not buying insurance, thinking they are probably not going to need it, which leaves only those members who are more costly to treat.
The United States presently has a medical care industry that costs roughly two and a half times what the average of other developed countries spend. As seen in this graph, the U.S. spends $9024 per capita, compared to the $3620 per capita average of OECD (Organization for Economic Cooperation and Development) countries.
Even so, the overall health of American citizens is worse than that of other OECD countries, and even of some underdeveloped countries, as measured by many factors. This is shown in international comparisons, by the World Health Organization, and by private foundations, such as the Commonwealth Fund, whose October, 2015 report is linked here.
One factor in these poor ratings of American health overall may be that doctors have too much work, and too little sense of satisfaction. This is a trend at least since the early 80’s (shortly after the financialization of medicine began in earnest. A recent article in the Health Affairs blog (Mar 28, 2017) pointed out the evidence of increasing “burnout” among physicians. One reason for that may be that the major employers of physicians are pushing them too hard to be ‘efficient’. All the contributors to the suggestion that physicians needed to have more support, despite their sympathetic one, were in fact corporate CEO’s, which makes their findings a bit suspect.
My search brought up another interesting discovery. ‘Non-compete agreements’ have been around for a long, long time, in various forms , one of which is the protection of ‘trade secrets’. Perhaps the earliest instance of the latter was in 13th century Venice, which had been a center of glass-blowing since Roman times. Venice traded with Syria, where glass-blowing was invented in the 1st century BCE. Syrian workers were encouraged to develop their skills further by migrating to Venice, where a glass-makers guild was established in the early 13th century. In 1291, allegedly due to the risk of fire, this whole industry was moved by the Doge (‘Duke’) of Venice to Murano – a nearby island – and the glass-blowers were forbidden to leave the island, on pain of death! The reasons for this are transparent. For a colorful history of Murano glass, check this piece by Peruvian art historian Carolina Arevalo. Obviously English isn’t her primary language, but let that go.