It’s probably not news to people in the U.S. that doctors have to be somewhat entrepreneurial … as do most people in the U.S. But in Canada where we have a ‘public healthcare’ system something comes to mind for me.
I’ve been listening to a show on CBC radio periodically called White Coat Black Art which is a show about the medical industry/culture. This week there was a discussion about doctors being fired by their patients. An interesting word kept recurring in the episode: agenda; i.e. ‘the patient’s agenda’ or ‘the physicians agenda’ and the gap between the two.
The power imbalance, real or perceived, between these to agendas aside, it’s interesting to consider the concept of the doctorpreneur inherent in the medical system. Doctors, like pharmacists, have to be at least somewhat entrepreneurial. Several years ago I did a research study in a hospital and was surprised to learn that few of the physicians I met were actually directly employed by the hospital. Instead they were paid by the government (and in the US by the medical insurance company) for contact hours.
I found this fascinating because I had always thought of doctors as employees of a system which, to an extent, they are. But in reality they bill by the patient and don’t get paid for much of anything that doesn’t directly involve patient contact. This means that doctors have to find ways in which to balance seeing patients with everything else while only getting paid for parts of their job (which, lets face it, is often the case for many other professions, too but not so overtly). It made it difficult to get doctors to attend meetings or participate in my study.
This idea of the invisibility of the conditions of labour was fascinating to me particularly as it speaks to the ‘agenda gap’ that they described in White Coat, Black Art.