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August 1992, Vol 49, No. 8 >
Article | August 1992

Cost-Containment and the Practice of Neurology: Title and subTitle BreakThe Conflict of Canons

Matthew Menken, MD
[+] Author Affiliations

Acccepted for publication March 12, 1992.

Reprint requests to 1527 Highway No. 27, Somerset, NJ 08873 (Dr Menken).


Arch Neurol. 1992;49(8):877-880. doi:10.1001/archneur.1992.00530320109021
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References
Comments

During the past 25 years, dramatic changes in the practice of neurology have been nourished by major advances in basic and clinical neuroscience research, and the development of new technology. At the same time, it is difficult not to be concerned that the practice of neurology (and medicine generally) appears to be changing from a professional activity into a business.1 This is surprising, because medical practice has always reflected a blend of financial self-interest on the one hand, and the eleemosynary and solicitous characteristics of a profession on the other. However, professional obligations have traditionally outweighed business interests, collegial rather than competitive relationships with peers predominated, the ability to earn an adequate income in virtually any field of practice was assumed by medical students and residents (and so was rarely given much attention), and the intraprofessional status and prestige of the several specialties and subspecialties tended to be independent

REFERENCES

1 +
Lundberg GD.  Countdown to millennium: balancing the professionalism and business of medicine . JAMA . 1990;;263:86.
2 +
Relman AS.  Shattuck lecture: the health care industry: where is it taking us? N Engl J Med . 1991;;325:854-859.
3 +
Silver GA.  The privatization of medical care: caveat medicus . Postgrad Med J . 1985;;61:1093-1095.
4 +
Rosenberg CE.  Looking backward, thinking forward: the roots of hospital crisis . Trans Studies Coll Physicians Pa . 1990;;12:127-150.
5 +
Hsiao WC, Braun P, Becker ER, Thomas SR.  The resource-based relative value scale . JAMA . 1987;;258:799-802.
6 +
Physician Payment Review Commission. Annual Report to Congress 1991 . Washington, DC; 1991;;1:2-10.
7 +
Todd JS.  Whom can we trust? JAMA . 1991;;266:1566.
8 +
Iglehart JK.  The struggle over physicianpayment reform . N Engl J Med . 1991;;325:823-828.
9 +
Reinhardt UE.  The compensation of physicians: approaches used in foreign countries . Q Rev Bull . 1985;;11:366-377.
10 +
Pellegrino ED, Thomasma DC. A Philosophic Basis of Medical Practice . New York, NY: Oxford University Press; 1981;:266-280.
11 +
Hemenway D, Killen A, Cashman SB, Parks CL, Bicknell WJ.  Physicians' responses to financial incentives: evidence from a for-profit ambulatory care center . N Engl J Med . 1990;;322:1059-1063.
12 +
Fuchs VR.  Has cost containment gone too far? Milbank Q . 1986;;64:479-488.
13 +
Hiatt HH.  Protecting the medical commons: who is responsible? N Engl J Med . 1975;;293:235-241.
14 +
Hillman BJ, Joseph CA, Mabry MR, Sunshine JH, Kennedy SD, Noether M.  Frequency and costs of diagnostic imaging in office practice: a comparison of self-referring and radiologist-referring physicians . N Engl J Med . 1990;;323:1604-1608.
15 +
American Academy of Neurology. American Academy of Neurology Position on Conflict of Interest . Minneapolis, Minn: American Academy of Neurology; 1989;.
16 +
Dyckman Z. Joint Ventures Among Health Care Providers in Florida: Impact on MRI Services and Costs . Columbia, Md: Center for Health Policy Studies; 1991;:13-14.
17 +
Iglehart JK.  Congress moves to regulate self-referral and physicians' ownership of clinical laboratories . N Engl J Med . 1990;;322:1682-1687.
18 +
Day P, Klein R.  Britain's health care experiment . Health Affairs . 1991;;10:40-59.
19 +
Relman AS.  The new medical-industrial complex . N Engl J Med . 1980;;303:963-970.
20 +
Menken M.  Rationalizing the use of diagnostic neurotechnology: binational perspective . Neurology . 1990;;40:1023-1027.
21 +
Relman AS.  The future of medical practice . Health Affairs . 1983;;2:5-19.

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1 +
Lundberg GD.  Countdown to millennium: balancing the professionalism and business of medicine . JAMA . 1990;;263:86.
2 +
Relman AS.  Shattuck lecture: the health care industry: where is it taking us? N Engl J Med . 1991;;325:854-859.
3 +
Silver GA.  The privatization of medical care: caveat medicus . Postgrad Med J . 1985;;61:1093-1095.
4 +
Rosenberg CE.  Looking backward, thinking forward: the roots of hospital crisis . Trans Studies Coll Physicians Pa . 1990;;12:127-150.
5 +
Hsiao WC, Braun P, Becker ER, Thomas SR.  The resource-based relative value scale . JAMA . 1987;;258:799-802.
6 +
Physician Payment Review Commission. Annual Report to Congress 1991 . Washington, DC; 1991;;1:2-10.
7 +
Todd JS.  Whom can we trust? JAMA . 1991;;266:1566.
8 +
Iglehart JK.  The struggle over physicianpayment reform . N Engl J Med . 1991;;325:823-828.
9 +
Reinhardt UE.  The compensation of physicians: approaches used in foreign countries . Q Rev Bull . 1985;;11:366-377.
10 +
Pellegrino ED, Thomasma DC. A Philosophic Basis of Medical Practice . New York, NY: Oxford University Press; 1981;:266-280.
11 +
Hemenway D, Killen A, Cashman SB, Parks CL, Bicknell WJ.  Physicians' responses to financial incentives: evidence from a for-profit ambulatory care center . N Engl J Med . 1990;;322:1059-1063.
12 +
Fuchs VR.  Has cost containment gone too far? Milbank Q . 1986;;64:479-488.
13 +
Hiatt HH.  Protecting the medical commons: who is responsible? N Engl J Med . 1975;;293:235-241.
14 +
Hillman BJ, Joseph CA, Mabry MR, Sunshine JH, Kennedy SD, Noether M.  Frequency and costs of diagnostic imaging in office practice: a comparison of self-referring and radiologist-referring physicians . N Engl J Med . 1990;;323:1604-1608.
15 +
American Academy of Neurology. American Academy of Neurology Position on Conflict of Interest . Minneapolis, Minn: American Academy of Neurology; 1989;.
16 +
Dyckman Z. Joint Ventures Among Health Care Providers in Florida: Impact on MRI Services and Costs . Columbia, Md: Center for Health Policy Studies; 1991;:13-14.
17 +
Iglehart JK.  Congress moves to regulate self-referral and physicians' ownership of clinical laboratories . N Engl J Med . 1990;;322:1682-1687.
18 +
Day P, Klein R.  Britain's health care experiment . Health Affairs . 1991;;10:40-59.
19 +
Relman AS.  The new medical-industrial complex . N Engl J Med . 1980;;303:963-970.
20 +
Menken M.  Rationalizing the use of diagnostic neurotechnology: binational perspective . Neurology . 1990;;40:1023-1027.
21 +
Relman AS.  The future of medical practice . Health Affairs . 1983;;2:5-19.

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