Early in the spring of my sophomore year of college, I came across something about a surgery center in Oklahoma that was competing with large hospitals by posting their prices online. I remember bringing it up to one of my friends, and he asked why posting prices helped control prices. I said, “I actually don’t know, but I need to figure that out.” That event set in motion a positive feedback mechanism of curiosity about the nature of free markets, especially in terms of their benefits to healthcare delivery. A year and a half later, I found myself touring that very surgery center and marveling at the beauty of its existence through the lens of knowledge I had gained since that conversation.
The Doctor as an Entrepreneur
Part of the reason that the Surgery Center of Oklahoma has had so much success is that its prosperity is dependent upon understanding and meeting the needs of each patient in a satisfactory manner. The value of the surgery center is demonstrated when a patient makes the decision to receive treatment there. The doctor must offer his treatments at a price that accommodates the patient, yet still offers a profit that allows the center to continue operating into the future. A positive effect of the Surgery Center of Oklahoma being based on cash payments is that the doctor and patient do not have to include third party payments in treatment planning. The saved time and headache translates into time and energy that the doctor can apply to patient-focused pursuits.
Price transparency not only helps the consumer, it also gives the healthcare provider more autonomy and self-determination. As soon as I entered the surgery center, it was blatantly obvious that Dr. Keith Smith, co-founder, anesthesiologist and our tour guide, loves the Surgery Center of Oklahoma. But it’s not the physical structure that he loves. He doesn’t really even own that. There is another company that owns the actual building so that there is no possibility of doctors leaving for the purpose of cashing out. Giving the ownership away, he says proudly, is the best thing he ever did. He gave that up to preserve something less tangible: its spirit. That seems to be a strong quality that differentiates it from a hospital.
It was nice to see Dr. Smith look at us with a smile on his face and say that he works often from 6AM-10PM. Many doctors, after finally getting through the many years of training, think what they want is stability and certainty regarding life and compensation. But really, it seems that humans crave something deeper. People want to feel a sense of purpose. It’s incredibly empowering to have the sort of control and self-determination that Dr. Smith has afforded himself and his coworkers. This control allows for unlimited avenues to pursue for unrestricted potential to improve the lives of all involved parties. Every modicum of improved understanding of any facet of the business has ripple effects that benefit both the doctor and patient. This dichotomy is similar to the movie Groundhog Day when Phil realizes “nothing I do matters” as he drives his car off a cliff. In contrast, only when his perception changes, is he able to improve his life and then the lives of others to the best of his ability. In The Myth of Sisyphus, Albert Camus explores a character, Sisyphus, who is condemned to a meaningless task for the rest of time and says that escape “requires revolt” in a way where you can imagine him happy. This seems to be what the people associated with the Surgery Center of Oklahoma have done. Patients have realized there is a means for finding better quality, and the doctors have taken it upon themselves to provide it in a manner that empowers both themselves and their patients.