“A weird culture of coercion”: The impact of health care corporatization on clinicians

Abstract

This paper describes the nature of today's corporatized health care system in the United States, offering examples of the psychological toll it takes on clinicians at all levels. It details corporate practices that disenfranchise practitioners from exercising their clinical judgment and from offering input to system administrators about problematic patient care experiences. It discusses the sense of frustration, resignation and moral injury that can permeate their work lives and disrupt their sense of effectiveness and well‐being in this context. Following this background is a psychoanalytic analysis of narratives from two physicians about their corporate health care experiences. Two case studies follow, in which a nurse and a physician entered psychoanalytic psychotherapy to process the destructive psychological impact of their work environments. A third case illustrates the negative impact of automatized insurance practices on one psychologist and her patient.

The ownership elephant is becoming a mammoth: a policy focus on ownership is needed to transform Aotearoa New Zealand’s health system

“…However, there are downsides to corporatisation, especially related to market failure, unresolved tensions between professional ethics and profit imperatives and the corporate models' impact on continuity of care for vulnerable people who live with complex health needs. e.g., 32 Further, clinicians report curtailed clinical freedom to practice in corporate environments, and unless there is government regulatory policy intervention, the focus can be on high-volume episodic throughput rather than health outcomes, 8,9,15 at the expense of high-needs populations. 33 Recent discussions about outsourcing radiology procedures highlight the clash of doctors' ethical and professional duties to patients with commercial responsibilities to shareholders.…”

“…14 Flexibility for professional discretion, time per consultation and service responsiveness are informed significantly by profit imperatives and commercial responsibilities to shareholders. 15 While ownership arrangements do not wholly determine the model of care, they influence how services are run and how professional and business conflicts are managed, as evidenced in recent vigorous discussions over the provision of radiology services. e.g., 16 Notwithstanding the strong influence that ownership arrangements exert on health system performance, 17,18 for example through service accessibility, 4,19,20 current New Zealand health policies pay insufficient attention to this important health system design parameter.…”

Our system of “not‐care”: Psychoanalytic perspectives on the impact of health care corporatization on patients

“…Nor are they constrained by the nurse's or physician's ethical codes: to first do no harm . This situation is described at length in the preceding paper of this special issue (Rudden, 2022, “A weird culture of coercion: the impact of corporatization on hospital staff”).…”