Are U.S. Doctors 'Free' to Practice Medicine?

By Deane Waldman, MD MBA - 26/05/20

The title question might seem silly, even ludicrous. It is anything but.

In the United States today, a truck driver is free to choose which gear to use going up a hill and at what speed to go down the hill. Accountants and lawyers are free to accept or refuse specific jobs and how to do their work.

Clinical physicians are not similarly free to do their work as they see fit in the best interests of the patient before them

People who never went to medical school-insurance actuaries, state insurance commissioners, and federal regulators-dictate to physicians what they can do for their patients, and especially, what they cannot. Hospital lawyers require physicians to strictly follow federal guidelines as though Washington's advisories were stone tablets handed down from Mount Sinai. The one person not free to practice best medicine on you is your personal doctor.

The federal government believes it must protect patients from their doctors. Physicians are no longer highly valued and explicitly trusted professionals. Washington, erects barriers between patient and physician to prevent a physician from exercising independent judgment. Computer programs that tell the doctor the acceptable diagnosis. Mandates determine what tests to order, which ones are not allowed, and where the tests must be performed. A pharmacy benefits manager dictates to your physician what specific drugs can be prescribed for you, how to order them, and from whom. Insurance bureaucrats even dictate when a patient must be discharged from or can re-admitted to hospital.

Professionally, a modern physician is like a computerized robot and the federal government is the programmer.

A graduating physician today is not free to choose which branch of medicine or surgery to practice. In 2014, the average U.S. medical graduate left school carrying a debt of more than $180,000 in student loans. This requires newly minted doctors to take the highest paying job they can find if they ever want to get out from under the lender's heavy hand. In part, that is why there are more cardiologists than primary care doctors.

Physicians are taught that patient welfare comes before everything. Graduating MDs swear to, "use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Into whatsoever houses I enter, I will enter to help the sick. I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free And whatsoever I shall see or hear [I shall view] such things to be holy secrets." Hippocrates wrote that doctors work for and in the best interests of their patients.

With today's third party payment structure, U.S. doctors work for insurance companies or thus for Washington just as British doctors work for the government.

Instead of individualizing patient care plans, physicians now must abide by government's rules for population medicine.

If health care is considered a right, physicians' freedom is taken away. They become slaves!

What is a right, functionally? It is a liberty or freedom that everyone has, automatically, simply by being alive. You don't pay for a right or have to qualify for one, such as free speech, religious liberty, or the right to assemble (First Amendment). If you own a car, you have the right to keep it (Fourth Amendment). One person's freedom to act cannot take away another person's freedom.

What is health care, operationally? It is a provider's physical and mental labor. Health care, two words, is the personal service of one individual acting as a fiduciary for another. Person "A" gives his or her legal autonomy or personal power to another person, "B" so that "B" can use that power for the benefit of "A." When a patient "A" agrees to allow a surgeon "B" to operate, patient "A" temporarily yields control of his body so "B" can make "A" healthy, such as by cutting out a tumor. "B" is a fiduciary physician for "A."

Health care is a provider's work product. According to the father of medicine, Hippocrates, a physician's work should be compensated. While lawyers and accountants determine their prices for their services, the federal government dictates to physicians how much they will be paid, when and even if, take it or leave it.

So, if care by a physician were a patient's "basic human right," then that patient could demand a doctor's services, whatever the patient wants, when and where desired, and the doctor would have to comply...for no money. That is an operational definition of slavery.

No matter whether you view your physician as a federal employee, a robot, or a slave, the answer to the title question is no: your doctor is not free to practice medicine in your best interest.