Saturday, February 20, 2016


Opportunity Costs of Free Capacity

I find the business terminology interesting. So before much ado, let me define the two terms to make what follows easier to explain.

Opportunity Costs:  The loss of potential gain from other alternatives when one alternative is chosen
Free Capacity: Portion of resource-time not allocated to any customer's order or job.

Private companies are fairly efficient in utilizing their employee time, unlike the public domain. Private companies have to concern themselves with the loss of opportunity if they choose the wrong path, widget or product in the market place. The loss of time, resource and space in that exercise could easily have been utilized in another far more lucrative endeavor. This then is the essence of opportunity costs; costs that could have been put to better use for better outcomes.

Private companies also use their Free Capacity to enhance their productivity. This can be managed by fostering higher education for their employees, seminars in efficiency, seminars in personal resource management, seminars in six sigma, etc. All these mechanisms are designed to help an employee grow in the company and achieve better results both in productivity and quality of the product the company produces.

In these product or productivity improvements lies the inanimate material molding to form a widget but not the currency of a living body’s mechanisms. Now let me take you into the discipline of medicine where the business industry has taken over the nobility of this profession but in the process has forgotten its own all important tenets.

A physician’s Free Capacity is mostly diverted into thought and then into action. The former precedes the latter in time. Physicians on the whole while taking caring of their patients spend an inordinate amount of time thinking through the process of the pathology within the patient and the nature of the nurture that has transformed that patient’s condition. This thought fills the crucible of a physician’s wisdom. The action that emanates from the rising ethereal wispy clouds of thought is the essence of the care provided to the patient. Every patient is a different dilemma, even though he or she may have the same type of illness; a diagnosis of pneumonia or appendicitis or diabetic vasculopathy or cancer. How to treat is an amalgamation of the resources, a collection of evidence a musing over possibilities and potential of probabilities and the collection of experiential wisdom over time I mentioned earlier. This then is the Free Capacity inherent in the limits of a physician’s time. There are no “reimbursements” for this Free Capacity, no logs to fill, no boxes to check. It is Free Capacity because it is the motion of internal thought unencumbered by wasteful moments. This is the healer at work. This is the maestro directing the orchestra with the many shades of nuance within a symphony. This is the batter in the batter’s box waiting for the pitcher’s delivery.

Now we add to the physician’s lair a multiplicity of useless arguments; filing for preauthorization from the insurance companies to better understand the patient’s pathology, filling forms, clicking on the computer, checking boxes, copying and pasting data, spending time arguing with insurers for getting paid for services already rendered, adjusting for denial claims, wasting time over audits, meeting the challenges of “less is more,” and “Choosing Wisely,” or wasting time for a continuous certification requirements as mandated by the ABIM (American Board of Internal Medicine) with purported potential detriment to the patient and the physician. You might see that there is opportunity costs related to this wasted time. That the opportunity cost here is huge; it is the very immersion of thought in the patient care itself that is being violated. It is what makes us physicians, physicians. It is what defines us as humans. Inordinate and unnecessary burdens leech out strength eventually. 

Something will have to give!

Consider then that these useless actions as mandated by the experts who in large part also happen to be in the business world, are promulgated by the very people who define efficiency.  They are stifling thought in search of nirvana health based on a binary concept of good and bad. They are placing burdens on both patients and physicians and then using arbitrary metrics of “value” and “quality.” The very attempt distills down to dollars and cents, because that is what business people do best for themselves.

Somewhere the train of thought has been derailed. The last champion of the thinking mind is rendered a voiceless dregs of the society. Such continuous fatigue leads to wistful despair. The enterprise of form now controls the engine of function.

“With this regard, their currents run awry, and lose the name of action.” - Shakespeare

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