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The Change Management Project, Part 3: Managing Doctors’ Concerns

Posted in Surgeon as Entrepreneur | Jun 2013 | Comments (4)

Tags: Editor's Choicemedical device developmenthealthcare costspatient communicationsurgeon entrepreneursgenericreimbursement


The physician represents the most difficult piece of the implant alignment puzzle. The orthopaedic implant industry continues to sell to the physician while the hospital pays the bill. Left out of the equation from a choice and cost perspective is the actual consumer—the patient.

One physician at my hospital responded to the possibility of using a wholesale, stable implant by saying that he would be unable to defend himself in court when asked how to justify his choice of a wholesale implant over the traditional sales model. He believes that he would be a “sitting duck” because the court would claim that he chose a lower-quality implant based upon price. Do the paid orthopaedic consultants have these thoughts when they use implants from device companies that pay them a fat consulting check for their “innovative ideas”?

I would like to address the fallacy of perceived increased quality with new technologies versus tried and true, stable ones. An Australian study published in 2011 determined that there was no benefit to the introduction of new prosthesis into the national market, and actually found a 30% increase in significantly worse outcome with the new technology.1 Two recent studies of generic trauma implants recently demonstrated a 67% to 73% reduction in costs, with no difference in outcome.2,3 

The use of stable technologies is actually smart, defensive medicine. There are no class action legal pursuits of stable technologies. One needs to look no further than the Johnson & Johnson metal-on-metal hip lawsuit (ASR hips) to see the exposure that new technology can cause the physician. Pretrial testimony from Johnson & Johnson Biostatistician Brian Devine placed the expected failure rate at 4.57 years at 37%.4 It is not uncommon for new devices to be introduced, only to be silently removed as their results are deemed inferior to their stable counterparts. Dr. Augusto Sarmiento questioned in 1991 if new devices were marketed for the patients, or for the orthopaedic companies’ bottom lines.5

This is not a blanket statement that all new technology brings no increased value and that we should stagnate development. New technology should be rewarded. The only problem is that 75% of all orthopaedic implants are at or near patent expiration (stable). Physicians need to awaken to this fact. Stable technologies are time-tested. When a new technology does not improve the outcome and is brought to market in an aggressive fashion merely to negate a patent’s expiration on the bottom line, new technologies may place the patient and physician at risk.

Read the first two Change Management Project articles:

Part One: A Surgeon's Attempt to Fix a Hospital Orthopaedic Service

Part Two: Setting the Table

Physicians and the medical device industry complain that control is being taken from the physician and handed to purchasing committees that decide implant choice by their predetermined metrics for savings. The cry from the orthopaedic community is that this decision should be left to the surgeon. Why? Are surgeons cutting the checks?

If the medical community can’t look in the mirror and realize that, “Houston, we have a problem,” then I am all for committees and bureaucracies. Medicine is not a free market economy. It should be. The question is, how? The simplest way is to have the customer pay for their purchase. In a land of liberty, the customers get to make the decision and pay both economically and by living with the outcome of their choices. People say that patients aren’t smart enough to make these decisions. I disagree. Look at dental, plastic surgery and LASIK eye surgery.

Some feel that the insurance industry represents the free market, and that insured patients should control their decisions. The problem is that most health insurance is provided through an employer and, therefore, insulates the end user (the patient) from the cost burden. One only needs to look at persons who have to self-insure and evaluate their buying patterns. They typically take out high deductible health plans and use their health dollars judiciously throughout the year. I myself have a $20,000-per-year deductible exposure for my family. You can bet I think twice about random doctor visits.

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Rhode 06/07/2013 01:37 PM
It depends who is getting the check. If its the hospital, they will mitigate the doctor exposure by hiring them. This is already happening (60% new grads are employees). Employee doctors will have a vastly different outlook on medicine. As we say, doctors used to live to work. Now they work to live. Maybe that is how it should be. But I want my doctor to work his ass off. And get paid to do so.
Steve 06/07/2013 08:44 AM
Raji, it's not the government that's the problem, it's fee-for-service that's been the culprit. The total care reimbursement model will reverse the course of costs quickly. One check to be divided between hospital and doctor - then everyone catches up to the patient with caring about cost.
Guest 06/04/2013 10:52 AM
I think you should run for President.
Raji 06/04/2013 10:50 AM
This is brilliant!! Patient driven healthcare. Let's get back to basics and let the patient and doctor make decisions together. God save us from the government system that is right around the corner.