PEPonline
Professionalization of Exercise Physiologyonline

An international electronic
journal for exercise physiologists
ISSN 1099-5862

Vol 11 No 11 November 2008

 


Commentary

Greed in Health Care?
Larry Birnbaum, PhD, MA, FASEP, EPC
Professor and Graduate Program Director
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811

With the current economic crisis, greed is being widely discussed and blame is being assigned to CEOs, politicians and others for the failure of so many of the nation’s financial giants.  With greed in the limelight, perhaps it is a good time for health care providers and educators to do some self-reflection and ask ourselves, “How greedy are we?”

That may seem like a ridiculous question.  After all, we are healing the sick and injured!  Yes, and most of us are well paid for providing those services.  All too often I have heard health care workers complain that they are not paid what they are worth, while arguing that others (e.g., doctors, CEOs, lawyers) are overpaid.  Trying to determine one’s worth or the worth of a particular profession or position is fraught with difficulties.  How do we objectively determine one’s worth?  One answer has been to let the market determine that.  However, the market has been and continues to be manipulated by the health care professions themselves.  For example, the number of students allowed into some health care professions is limited for the purpose of limiting the supply.  By limiting the supply, demand is kept high and correspondingly, so are salaries.  It is an age old strategy.  The professions that apply this strategy will deny it and argue that other factors keep the supply low, such as resource contraints or lack of qualified candidates.  Surely there is enough money in those fields to overcome the resource contraints, and the number of applicants to these programs is staggering. 

Of course, the applicant numbers are high partly because of the high salaries and prestige associated with these professions.  Yes, some applicants have their hearts in the right place and genuinely want to serve the public.  Unfortunately, some are drawn to the money and prestige.  Well, just how much money and prestige is enough?  How much is excessive?  How many health care providers would be willing to take a 10% reduction in salary if it would enable all the basic health care needs of the American public to be met?  How about a 20% cut?  Or how about contributing 10% or even 20% of one’s work week hours to populations that cannot afford health care?  These are rhetorical questions, but they are worth pondering. 

Another rhetorical question is, “To what degree do accreditation and licensure limit access to health care, either by making it unaffordable for many or by restricting the number of practitioners or both?”  A standard argument for accreditation and licensure is that they are necessary to protect the public from incompetent practitioners.  That is a strong argument and an important function of accreditation and licensure.  However, if accreditation and licensure also manipulate the market by keeping the number of practitioners low to keep salaries high, then, they fail to serve the public good.  This is a contentious issue particularly for those health care professions that have achieved prominence in our society and have the power to control the number of practitioners in their respective fields.  Nonetheless, this is one place where greed is a significant factor, and it is one place where practitioners can make a difference.  Instead of pursuing the highest salaries possible, put the public first.  Practitioners can improve access to health care by limiting their own greed.  Imagine the impact on affordability and accessability of health care if the highest paid professions agreed to a 10% reduction in salary.  This may sound too socialistic, but it is not if the reduction is achieved through professional organizations and the membership agrees to it.  What would these professionals prefer, self-imposed reductions or government-mandated reductions? 

It is easy to blame CEOs of HMOs and other third party payors, litigation lawyers, and technology for the high cost of health care.  It is always easier to blame the other guy than share any of the blame.  If we acknowledge that we are contributing to the problem, then we are obligated to do something about it.  That requires change.  Change is a dirty word for people who are comfortable with the status quo.  Yet change is inevitable and happens whether we initiate it or other forces initiate it.  There probably is not much we can do about the salaries of CEOs, or litigation, or technology.  Yet, if serving the public is our first and foremost goal, then litigation should be minimal and technology should be used appropriately (i.e., profit would not be the primary motive).  And we would be more selfless as the public would take priority over our personal financial interests.

Greed is part of human nature.  It needs to be held in check.  As health care providers, we need to periodically assess our own level of greed and make adjustments as necessary.  Given the current climate, it seems that now would be a good time to do so.




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