Is there a physician executive in the house?
Is there a physician executive in the house?
By Jean Edwards Holt, MD
The American health care delivery system is like a wheel out of balance. It is in a great state of unrest with almost daily consolidations, integrations, and mergers - in an attempt to keep pace with market forces.
Change is being forced by payers, businesses, patients, competitors, governments, technologies, and demographics. Concern for the lofty goals of equal access, high quality, and reasonable cost are being clouded by the creation of conflicting financial incentives, oftentimes unrealistic patient expectations, and a lack of direction for the proper model or policy for health care delivery. The resultant fragmentation in patient care delivery reminds me of the misdirected slogan, "Ready; fire; aim." Hitting the target isn't the easiest thing for a team to do when it hasn't learned what to aim at.
In his book, Revitalizing Health Care in America,1 Shortell presents a perspective on the evolution of the American health care system. He characterizes the present system as existing in the third stage of a four-stage process. The present stage, developed primarily due to emphasis on cost reduction driven by the market pressures of managed care is providing the scaffold upon which physician organization and leadership is re-emerging as an integral and vital segment of the delivery process.
Thus far, the stimulus for the emergence of a new physician leader has come from outside the physician community, re-empowering us to establish our rightful place in directing the delivery of health care to our patients.
Physicians generally criticize the corporate practice of medicine because it challenges our professional paradigm that: a) appropriate medical care should be given on the basis of scientific efficiency not cost; b) patients are unable to make the appropriate health care decisions; and c) physicians as ethical scientists should enjoy the autonomy of clinical decision making. The problem with this philosophy: The payers of health care have deemed our practices unaffordable. Therefore, the re-empowering of physicians with such autonomy will be watched closely. There is concern by the purchasers of health care into the next century of what physicians will do as they regain autonomy and power in the health care arena. If old behavior patterns are repeated, their concerns may be valid.
'The collective good'
We must now, to hold onto our re-emergence of power, consider responsibility for the collective good as an aspect of our autonomy. We have resisted governmental intervention for cost control, thereby fostering the development of corporate medicine, which is now our playing field. Physician autonomy should be championed, not just as part of the old paradigm, but because it leads to more responsible patient care.
The speed with which physician integrated systems have developed has been dependent on the external environment demanding change, and the internal environment has been weak. Practicing physicians oftentimes continue to be comfortable with the status quo and do not recognize the need to change their habits of practice in response to the changing societal and fiscal environment.
The physician leader must initiate an understanding of the proper amount of awareness and create manageable discomfort to get his or her colleagues out of their boxes and trying new approaches, all the while providing reassurance that the collective vision will prosper.
(Dr. Jean Edwards Holt is an ophthalmologist in private practice in San Antonio and serves as medical director for a Texas HMO. She currently serves as a Texas state representative chairman of the coordinating committee on Education for the Southern Medical Association, a physician leadership organization based in Birmingham, AL. Holt is also pursuing a master's degree in health care administration. This article originally appeared in Southern Medical Association's Southern Healthcare Trends newsletter.)
Reference
1. Shortell S. Remaking Health Care in American: Building Organized Delivery Systems. San Francisco: Jossey-Bass; 1996.
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