Preparing for the Future of Healthcare in New Jersey: Can Physicians Emerge as Leaders?

The Doctor, by Sir Luke Fildes (1891)
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Preparing for the Future of Healthcare in New Jersey: Can Physicians Emerge as Leaders?

Patricia A. Costante, in Physician’s News (January 3 online edition) wrote:

“The relationship between physicians and hospitals can currently be characterized by a shared interest in increasing the volume of profitable patient services on a fee-for-service basis, with limited opportunities for collaboration to reduce costs and improve the quality of care provided.” . . ., most physicians are accustomed to the model of the physician practice as a small, independently run business. The prospect of changing the very structure in which medicine is practiced must seem complicated and overwhelming at the very least. And all the while that these changes are occurring and the preparations are being made, physicians must remain focused on providing the very best care for their patients each and every day. However, if physicians are not able to come together, it is clear that their status as independent and autonomous professionals and leaders in healthcare will decline, as will their income. The actions of physicians and hospitals during this time will determine the structure of the future healthcare delivery system, and the implications for physicians will be profound.

Here’s my reply to Ms. Costante:

Ms. Costante, your concern is a valid one. However, you must consider other factors when assessing physicians’ ability to affect health care evolution in this country. First, health care reform is necessary for the sustenance of the middle class, the economic foundation of the U.S. It’s unavoidable. Secondly, factors that influence reform to include coordinated care goals, and accountability manifested some real problems: primary care and provider fraud. If you consider the current administration’s view regarding the two problems it should be clear that physicians, those individuals wanting to control reform transition while remaining private contractors have an enormous, if not impossible task. Fees paid to physicians have decreased, insurance rates for targeted specialties have increased, and regulation, compliance, and oversight (to include provider credentialing) have become increasingly more cumbersome. Add to that, hospitals are now hiring hospitalists to handle coordination of care for patients. This allows more control over a physician’s time and quality of work and reduces risks to the institution. Regarding primary care, medical students are avoiding this area due to the rising cost and low return income potential. In my opinion, primary care, regardless of what side of the political spectrum you choose to fall will be the number one challenge to health care reform and it is not being tackled by any party as a priority. I would suggest to any physician wishing to stay relevant in the accountable care environment; invest in time with your patients and getting to understand their “actual” needs. Encourage health repositories among patients. Invest in continuing education to include HIT and privacy practices. More importantly, return to the art of healing and stop going into every hospital-physician relationship asking, “What’s in it for me?”



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