By William J. Lewis, M.D., J.D., M.B.A.

President of The Main Line Multispecialty Group

• Introduction
• Physician Unions
• Physician Organizations
• Physician-Owned Insurers
• National Health Insurance

• React to this article in the Discussion Forum.

I understand the frustration that physicians feel dealing with those insurers and hospital systems that place profit over care and with a Philadelphia healthcare marketplace that is in transition without defined direction. There is no doubt that physicians should be in charge of healthcare. A healthcare system needs to be fashioned where resources are appropriately utilized for patient care and not misdirected into corporate profit or consumed by executive bureaucratic superstructure.

As a physician, I am concerned about Drs. Sklaroff’s and Lodise’s call for unionization and protection for physicians under the National Labor Relations Act. I am concerned not with relating ones self-image to labor, but with the potential loss of professionalism and the central tenant of our profession—the doctor/patient relationship. Can professionalism survive unionization? Can we, should we, use the "tool" of unions—a strike—to "protect ourselves" while in doing so we may put patients at risk? The doctor/patient relationship is a sacred one of mutual trust and my concern is that professionalism may not survive unionism, and that ethical and moral ideals may not survive "work actions." I agree with Dr. Tsou, that unionization may be akin to "fighting dragons with toothpicks" and in doing so, we may abandon our role as the patients only advocate in an evolving managed care universe.

Dr. Tsou’s frustration with unionization and corporatizaton leads him to champion a properly financed governmental universal health insurance program as the panacea of our profession. In theory, national health insurance could solve many of our patient problems by eliminating the greed that has occurred with the "hostile takeover" of medicine by Wall Street. In practice, however, I wonder if government intervention, rather than the marketplace, can really control costs. Government control usually breeds runaway bureaucracy; and political realities and compromise always seem to effect a desired goal adversely.

I can understand the frustration of Drs. Sklaroff, Lodise, and Tsou, but I remain a believer in our market system. Quality, cost, and compassion are driving the pendulum away from the HMOs and the "not-for-profit" hospital systems towards physician enterprise where healthcare resources are directed toward care and not diverted to directors and dividends. HMO’s slick marketing tactics have yet to convince many wary patients; and hospital consolidation and practice acquisition is generating increasing financial losses for the Philadelphia megasystems. Physicians must be prepared as the pendulum swings to accept the responsibility of designing a system of healthcare where resources are directed toward the compassionate care of the patient.

I agree with Drs. Brown and Coletta. Dr. Brown advocates a physician-owned health insurance company. The more insurance options the better. A physician-owned company where revenues are not intended to generate a profit, but to insure care is the best option of all. I commend Gary Brown for his enthusiasm and efforts in this initiative. This initiative has come a long way since the first meeting I attended in the living room of his home. Congratulations Gary on making a dream a reality!

I also agree with Dr. Coletta. The "corporatization" of medicine that Dr. Coletta describes should not be viewed as a threat, but rather an opportunity for physicians to come together from different practice styles, and with the aid of information systems, determine the best way to manage patient care, while monitoring costs and outcomes. It is a time to be colleagues and not competitors. I can not agree more with Dr. Coletta that infrastructure and capital are crucial. The heart of the infrastructure is a medical management system that drives the entire process. One must be wary, however, in acquiring capital and infrastructure, that the independence of the group and the care of the patient is not compromised. This seems to be difficult, but it can be done.

Our group, The Main Line Multispecialty Group, has attained the critical "core elements" of capital and infrastructure while keeping our group independent and preserving individual practice and independence. Our business structure allows us to joint venture in many areas of business to provide quality care to our patients. Our offices link to a central database, streamlining registration and billing, and permit us to begin the process of risk contracting. Our information system also provides us with a platform where we plan to implement electronic medical records in the near future. Corporate staff provides "back office" support decreasing costs for our offices, while our members enjoy group discounts in health and malpractice insurance as well as discounts on purchasing supplies and medications. I completely agree with Dr. Coletta—our group has "lived" the vision and we are now in position to take the exciting next step in the changing world of physician reimbursement and the opportunity to enhance care of the patient.

I echo the words of Dr. Gary Brown: physicians must do this together. I am hopeful that all emerging groups in the Delaware Valley will work together in a meaningful way as colleagues and not competitors, to accept the challenge and the opportunity as the pendulum swings to where it always belonged: to physician sponsored enterprise. As Dr. Brown stated, "it must be done, for our patients, for our profession."