After recent stay at the hospital in February, I began asking questions about how health care really works in this country. It seems like valuable information to me. It might save me some money – co-pays on a lot of services are not cheap – and maybe help minimize all those time-eating trips to the doctor’s office or hospital. Like many of you, I see certain doctors more often than I see some of my friends. Make that most of my friends.

When I was growing up in small town, Oklahoma, doctors were royalty. I know this from all the heroic stories people told about my father, an ENT specialist who died suddenly at the age of 36. Doctors were almost a different class, both smarter and richer. As a kid looking for extra spending cash, you always wanted to be the caddy of a doctor out at the country club golf course. They were the best tippers.

Doctors still make a lot of money. According to one source, out of the top 15 best-paying professions in America, 13 involved medicine or dentistry. But from a recent spat of articles in the New York Times, as well as other sources, it’s clear that doctoring now is a long way away from old Doc Martin. The super-expensive, super-complicated American health system is slowly altering both doctors’ traditional independence as well as their social profile. Many still act like they run the show but know, more often than not, that they are posing. Think of it like Queen Elizabeth waving her hand and making people bow in her presence. She looks regal but has no real power.

The power in medicine is now, or will soon be, in the system, not in the individual, whether that is patient or doctor. Again I turned to my friend, Dr. Charles Bethea, cardiologist and Chief Medical Officer at the Integris Heart Hospital in Oklahoma City, to explain what is coming. As he describes the situation, modern medicine has long been a balancing act between quality of care and the financial management of that care. Now, he says, the needle is definitely tipping toward financial management.

The upshot is that the doctor/patient relationship is about to become much more depersonalized. More and more doctors will become salaried employees of medical centers and less the entrepreneurial businessmen and women of the old paradigm. They will have established hours and not be getting calls at two in the morning from a panicked patient with a temperature of 100.1. They will share patients, depending on the medical situation, and may only be there for part of that patient’s treatment. In the words of one New York Times writer, “medicine has gone from being an individual to a team sport.” (Read more here.)

As Dr. Bethea explains, the new system is all about something called RVU’s, or Relative Value Units. This is an abstract calculus now being implemented to determine the value of any set procedure, one that will cross specialty lines to create a universal medical accounting system. I don’t quite understand it either, but Dr. Bethea does. If, he says, you consult with a new patient, whether you are a urologist or brain surgeon, you’ll get, say, 3.5 RVU’s. If you install a pacemaker, a more advanced skill, you might get 10 units. Those units will determine what the hospital charges and insurance, public or private, pays. (The procedure might not work, but you get those units anyway.) Under such a standardized program, doctors will no longer be gods. They will be, in Dr. Bethea’s blunt assessment, “RVU sharecroppers.”

Sounds pretty Orwellian, doesn’t it? No more office time chatting with your “personal” doctor about his golf game. No more need for a doctor with a sensitive bedside manner, unless, of course, it’s the hospital psychologist or social worker. No more putting your life in the hands of the one doctor you’ve known and trusted for years. You’ll most likely be putting your life in the hands of an institution, not a person.

It could be awful, I guess, but then again, it could be much more efficient and allow doctors to doctor and not spend, like Dr. Bethea, a third of their time doing bureaucratic paperwork. I’ll give one quick example in my own life. As I was writing this, I made another trip to the ER at Cedars-Sinai Hospital in LA with another wound-induced infection. The Cedars computer, which knows more about my health than I do, signed me in and a nice lady led me to a examining room. Soon after a very no-nonsense, professional ER doctor spent five minutes looking me over and said I would soon be checked into the hospital for IV antibiotic therapy. I never even got the guy’s name, let alone his golf handicap, but I instinctively knew he knew what he was doing. I don’t know how many RVU’s he got for the job but he earned every one of them.

I of course knew my own internist and my own wound specialist who picked up the ball from there. The question is, I guess, did I really need to know them anymore than I needed to know that crack ER doctor? I’m not sure. Psychologically, it is very reassuring to have doctors who have intimate knowledge of you. But I’ve been in situations at Cedars where an ER doctor I’d never met made a diagnosis and handed me off to a surgeon and anesthesiologist I’d never met and they performed life-saving surgery before passing me along to a tag team of skilled nurses I’d never met.

In that situation, I had to trust the Cedars Sinai system and not any individual doctor with my life, and in that situation, it worked out fine. Who knows how it will work when all of American health care is standardized and team-organized and most doctors out there are RVU sharecroppers?