January 15, 1998

An ad hoc committee of nurses, physicians, and others have signed a "Call to Action," pleading for an end to the pursuit of profit in health care. The missive was published in a recent issue of the Journal of the American Medical Association. "Mounting shadows darken our calling and threaten to transform healing from a covenant into a business contract… The pursuit of corporate profit and personal fortune has no place in caregiving," they say.

But is profit the problem? Everyone needs health care, it’s true. But everybody also needs food, shelter, and clothing. Somehow, profit doesn’t bug us when we’re going to the grocery store, renting an apartment, or buying a new pair of jeans.

For the first time in human history, we are asking more of the healthcare system than we want to pay. The healthcare system is squeezing providers because the economic equation itself has been tightened. We’ve gone from an era of blank-check medicine to a time in which employers, employees, and the government have demanded less cost.

There’s another problem with the diatribe against profit. Many of those who signed the "Call to Action" are physicians who have personally profited greatly from the old fee-for-service system. I don’t begrudge them their $165,000 or more a year, but the pursuit of personal fortune—as they call it—has long been a virtual expectation of those entering medicine. I don’t remember hearing physicians decrying profit before managed care hit.

Nurses, on the other hand, have typically better understood what it means to enter a profession for the love of the work itself, and not for projected earnings. Are the physicians suddenly interested in selling the second home and the Mercedes for a simpler life? Or, are they feeling, for the first time in decades, some of the complex financial and ethical pressures most families live with every day?

The potential for profit can create terrific incentives for investment in needed research. Pharmaceutical and medical device research is almost completely funded by the stock market and its interest in finding needed products that work. That’s why countries without a strong profit incentive tend to create fewer new drugs and medical devices. Do you really want to live in a nation where there isn’t a financial reward for inventing the AIDS vaccine or a bio-engineered kidney?

When a nurse feels overwhelmed on a unit because there isn’t enough staff, when the ICU is completely full and there’s another patient who needs a bed, when a very sick senior is stuck at home with no support, the problem’s not necessarily the profit motive in health care. It might be a system—or a society—squeezed too tight. It might be some bad decisions made within an organization. It might be the very nature of health care.

The best of us feel a calling to our profession, and we are not primarily driven by the desire to earn great sums of money. But earning money for quality work is not the problem. Perhaps there is too little profit in health care—at least for those who produce the most good for the patient. Perhaps too much money is going to the middlemen, to systems that line up health care but don’t directly deliver it.

Barbara Bronson Gray, MN, RN
Editor in Chief

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