In his farewell address to the nation, President Dwight D. Eisenhower warned Americans to beware of the “military-industrial complex” as it can overwhelm us. He noted a “formidable union” between politicians, the armed forces, and defense contractors implying that soldiers were not central players in an “iron triangle” between Congress, special interests, and bureaucracy.
It is no surprise to practicing physicians that an American medical industrial complex has evolved.1 Physicians are less central and increasingly commoditized and corporatized, ill equipped due to our training and/or nature to battle the forces of change brought about by the “iron triangle” of politics, economics, and the growing bureaucracy of healthcare.
In 2012, healthcare spending accounted for more than 17% of our gross domestic product (GDP). In 2013, national healthcare spending increased 3.6% to $2.89 trillion (compared with a 3.4% increase of the overall GDP). This marks the fifth consecutive year that medical spending increases were less than 4%.
While economists debate how much is attributable to the Affordable Care Act, the most likely explanation is that bending of the curve is largely a product of a sluggish economy and a trend toward medical consumer cost sharing. Not surprisingly, spending on prescription drugs showed the greatest increase while spending on physician services showed the greatest decrease—down nearly 30% from 2012 to 2013.2
American medicine is undergoing vast changes, placing the status of physicians in the medical industrial complex at risk. Most physicians feel overwhelmed by increasing bureaucratic mandates from insurers, hospitals, and government. At the same time, physicians are the front line employees of healthcare and assume the majority of the risk for patient care. This has left many in the profession with increasing disillusionment.3
So while there is no simple solution for the mounting frustration within the profession, the long hours, and years of post-graduate training, remember that all ecosystems swing into and out of balance. Medicine is no different. Physician empowerment in the medical complex comes from the realization that we are indispensable, especially when we are engaged.
- Stevens CW, Glatstein E. Beware the Medical-Industrial Complex. Oncologist 1996;1:IV-V.
- Armour S. Health Spending Grew 3.6% in 2013, Projections Show. The Wall Street Journal Sept 3, 2014
- Jauhar S. Why Doctors are Sick of Their Profession. The Wall Street Journal Aug 29, 2014.