I’ve had many opportunities to address physicians across the spectrum of healthcare settings, from those who run private practices, to those who work in large and small groups, to those who are hospital affiliated and employed. I often ask them the question “who controls the practice of medicine?” The answers I receive vary: government, insurance companies, hospitals, health systems, lawyers, employers and, rarely, patients. But one answer I never get to this question is doctors, themselves. I think it’s high time that we physicians take back control over the practice of medicine.
One way we can “take back” medicine is by organizing effectively, like the many organizations that advocate for specialists, hospitals, health systems, insurance companies, and employers. The failure of private practice doctors to organize in large, financially integrated groups has had many consequences on the industry of health care, nearly all of them detrimental to both the practice of medicine and the well-being of patients.
Here are just a few of those negative consequences: the proliferation of quality measures that have little to no relationship to actual outcomes; the waste of 30 to 50 percent of health care spend on high-priced hospital-based facilities; the creation of overpriced drugs for which more money is often spent on marketing than on developmental research; the rampant overutilization that strains the healthcare system and which is mostly blamed on physicians; a reimbursement system that rewards doing rather than good outcomes; electronic medical records that neither deliver on data, nor the patient story; and the gradual morphing of the clinicians’ profession into that of a high-priced typist.
Because physicians do not run health care, the system does not work in the best interest of patients or physicians.
I can’t overstate how tremendously misguided all of this is. Doctors, at the end of the day, want to help people, and over a career spanning 36 years, this is the most consistent truth I’ve discovered among my colleagues. To a real doctor, every other concern is secondary.
Most of us want to see, examine, assess and treat patients and watch them get better, but we’ve been hampered in our efforts because the doctor-patient relationship is no longer valued. No longer am I given adequate time to meet with a patient, hear their story, examine them and develop a differential diagnosis based on what I have learned. There just simply isn’t time to make this connection because lesser pursuits have been prioritized.
This is why the key to fixing the health care system is to ensure that any and all endeavors in medicine are geared towards allowing primary care physicians do what they do best: solve problems and support patients with proactive programs so that we can change health care from a sick system to a wellness system.
I have had the good fortune to work with private practice physicians and have found when you ask them for help to improve both the outcomes and lower the cost of health care; they are not only willing, but capable. We need to center the healthcare machine around them and, via physician-led groups, engage doctors in quality and safety forums that allow them to solve problems that they encounter firsthand.
The future of medicine hinges on the ability of organizations composed of private practice physicians to be data-driven, evidence-based, with a single population health platform and embedded care management. This type of organization must be physician-led. Physician-led organizations work because they place patients and doctors at the center of the health care system. That is how it should be.
This blog was initially featured on KevinMD.com.