There is a truism that every physician needs to constantly remind themselves of; there is no healthcare without doctors. So why do so many of us feel so powerless and why are so many of us unwilling to do something about it?
Most of us do what we do professionally because we enjoy helping people. That is our collective strength but also our weakness. What we do is special, but other entities have staked out their “turf” in our professional world; the government, insurance companies, and hospitals. They need doctors to remain an active player in this world, but have learned to exploit us in business matters, counting on the fact that our sense of morality and responsibility would supersede our fiduciary capabilities.
For the most part, this is exactly what has happened and what said entities are counting on in the future. Simply look at the model under which most of us receive payment for services rendered to patients. In almost all cases, someone else pays us, whether it is the government or the insurance companies. To make matters worse, someone else has decided how much your service is worth, not you. There is no other business model in existence quite like this. Does anyone think that lawyers would allow someone else to set their fees and wait for someone other than the client to pay them, often having to fight for their reimbursement and having to continuously resubmit their claims to get paid because the payment form was improperly filled out?
The healthcare industry is a vibrant and booming sector of our economy. Between 2008-9, when every sector of our economy was in recession and losing jobs, the only part of our economy (besides the federal government) that had added jobs was healthcare. It is not the “black hole” that politicians in Washington would have the public believe. Healthcare is an $800 billion annual part of the economy, which accounts for over 25 million jobs. So it should come as no surprise that lots of people want in on it. Doctors’ professional fees account for approximately 12% of the healthcare dollar. That means that 88% goes elsewhere — pharmacy, hospitals, insurance, management, legal, etc. In difficult economic times, when everyone is getting squeezed, and when doctors are already perceived as pushovers in the business world, how do you think that they will fare? Couple this with the fact that all of the other players in healthcare spend billions on lobbyists and are well organized, while doctors have essentially no organized representation. The future looks bleak for doctors if we continue down this same path.
It is interesting that talks about healthcare reform play to packed auditoriums. Doctors are eager to get news “from the front.” They want to know what is going to happen, and after hearing the news of what is in store for them, many will be motivated to act, but most will settle into the ennui that characterizes their professional lives these days as it relates to their business.
There are basically five groups of doctors that I have encountered: those who are angry about what they hear and are stirred to action; those who are angry but are convinced that there is nothing that they can do; those who think that they can game the system and what is coming will not affect them; those who are looking for an exit strategy; and those who welcome the change that is coming (for whatever reason that may be).
The average doctor spends less than $100 annually on advocacy for themselves, whether it is on a PAC, or some other group that is trying to defend their interests. Contrast this with trial lawyers who spend 100 times that amount. Most doctors will become defensive when confronted with this fact, claiming that they already give to their specialty societies and state medical associations. Unfortunately, that has failed to protect us from the sharks that constantly swim around us. The American Medical Association is perceived by the public as the lobby for doctors, but they have become part of the problem, looking out for their own special interests, and have failed doctors in general.
We are a profession at a crossroad. The massive federal expansion over control of our healthcare system, and quite frankly, over doctors, is beginning to show cracks in the wall. Beginning with a shaky foundation, it fails to support the massive superstructure on which it rests. The mandate to purchase health insurance is being challenged in court and the entire law is at risk of being thrown out. The new majority in the House of Representatives is vowing not to fund portions of the law that require new agencies and expanded bureaucracies to function. However, there are parts of the law that will remain in effect. These provisions threaten to place more burdens on doctors and will limit our ability to remain economically solvent. Doing nothing and just hoping that this will go away or be acceptable is simply no longer an option.
Doctors who are already struggling to keep their practices open because of decreasing reimbursement from insurance companies, or the constant threat of Medicare cuts to physicians (a new round of across the board cuts goes into effect in October, separate from the SGR postponement or “doc fix” due to expire in January 2012) are now facing further financial burdens. The mandate requiring health information systems in their offices means that doctors who have not implemented such a system will get lower levels of reimbursement from the government, if they get anything at all. Thus doctors are forced to divert money that could be spent on new staff or on salary increases for existing employees, and instead spend it on technology which is not currently configured to improve medical care, but to comply with government regulations. In fact, in many situations, these systems may negatively impact care. The new law contains provisions which favor special interests such as hospitals, who lobbied to get restrictions placed on physicians who own surgery centers, hospitals, and imaging centers, which limit or restrict physician ownership in these entities.
And how are doctors responding to all of this? Too often, in fear and desperation, they are selling their practices to hospitals and relinquishing financial and professional control to entities whose only concern is the bottom line. These organizations have proven over the years that they desire to work with doctors, but only on their terms. We are now seeing the newest iteration of HMOs, the Accountable Care Organization, which is a group of doctors who get together to manage care and make it better by coordinating care, sharing information and driving the cost curve down. Payment is delivered in a lump sum for an episode of care, left to be divided by the ACO; frequently controlled by a hospital. The reality is that this is an attempt to have doctors manage risk, get paid less, take on liability, and allow insurance companies and hospitals to reap the financial rewards.
As bleak as this may appear, the solution is closer than we may think. Doctors still control healthcare, and they are still the most respected profession in the eyes of the general public; 89% rate their doctors favorably in a Gallup poll in 2010, compared to 11% for politicians. Doctors need to consolidate their power into a single, strong unified voice that can deliver the message that things are not working well under this model. We need to begin to take personal responsibility for our profession because it has been, and continues to be, under attack. Doctors need to open up their pocket books and understand that it will take money to keep our profession safe from all of the intruders who want what we have. If we do not act soon, private practice medicine will be a distant memory and we will all be federal, state or hospital employees. There will be no one to blame but ourselves. Doing nothing is not an option.
Dr. Scherz is the Founder and President/CEO of Docs 4 Patient Care (www.docs4patientcare.org).