An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

by Elisabeth Rosenthal

By the late 1990s the hospital said it no longer wanted to pay a salary to doctors in the ER and clinics; instead, it would treat them as independent contractors. “That turned us into a business also,” Dr. McCullar said. “We negotiated contracts that stipulated what percent of revenues we deserved.” Providence’s marketers also required the doctors to attend what Dr. McCullar calls “charm school.” The seminars were run by a group of physician consultants who had started the Foundation for Medical Excellence in Portland. “I tried to get the administration to look harder at quality outcomes—like infection rates—but they didn’t, and that’s more expensive.” With canny marketing, Providence grew its business, aggressively advertising cardiac care and a state-of-the-art “stroke center.” A new building was adorned with marble columns and featured a fountain with jumping salmon; after more renovation, granite countertops were added and expensive art was displayed. “It became like the Providence Marriott,” Dr. McCullar said. “I was embarrassed to have poor patients come here.”