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P&S Journal

P&S Journal: Fall 1997, Vol.17, No.3
Medicine: Business or Art

Garfein'65 & Relman'46 Oscar B. Garfein'65, left, and Arnold "Bud" Relman'46
Cardiologist Oscar B. Garfein'65, who diversified his intellectual portfolio this past spring with the addition of a Columbia M.B.A., moderated a lively alumni panel discussion on the "business" of medicine. Participants included Arnold Relman'46, professor emeritus of medicine and social medicine at Harvard Medical School, former editor-in-chief of the New England Journal of Medicine, and trustee emeritus of Columbia University; Robert Blabey'67, associate director of surgery at Stamford Hospital; Stephen E. Hefler'68, president and medical director of Princeton Individual Practice Association and president of Physicians Healthcare Associates; and Laura L. Forese'87, executive officer for departmental affairs and assistant professor of orthopedic surgery at P&S.

Dr. Garfein set the stage, contending that "some of the problems that we are facing in medicine due to the onslaught of managed care are in part due to the inability of all the multiple parties involved to understand the needs and the visions of others."

Dr. Relman gave a dire prognosis of the current state of affairs. "It is my considered opinion," he said, "that the American health care system now is in the worst shape that it has been in my professional lifetime." While today's medical science and technology "is enormously more sophisticated and powerful and effective than it has ever been, and physicians are better trained, more knowledgeable, more capable than ever before," he argued that "given the amount of money we're now spending on health care, which is roughly 14 percent of our entire economy--$1 trillion--you have to say it's been an enormous failure." Future prospects, he said, "depend, not on what the politicians do...but on what health care providers do."

Dr. Blabey agreed that "we doctors have to get involved in what is a political process." He supports the concept of "a basic medical care system with an income-based deductible on an all-payers basis."

Dr. Hefler argued that "entrepreneurs and businessmen have reaped windfall profits off the physicians' hard work. Physicians have been moving through three stages in terms of their relationship to managed care." The first: Managed care is an evil empire trying to take away my autonomy. Second: OK, now how can I get a piece of these medical resources? And third: Where we are now, and that's fiscal responsibility.

Dr. Forese, who pursued a senior undergraduate thesis at Princeton in operations research, urged that "it's not evil to think of medical systems and to think of medicine as a business. It's a service business, a unique business, but it's still a business." She argued that it was precisely in looking at medicine as a business that "we take control as physicians, as the ultimate decision makers."

Dr. Relman bristled at the latter suggestion, that medicine might be viewed as a business, while Dr. Forese held her ground, insisting on the need for businesslike thinking in medical management. A lively exchange ensued and spilled over into the audience question-and-answer period and on into lunch at the P&S Faculty Club.

copyright ©, Columbia-Presbyterian Medical Center

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