The era of physicians competing with other physicians is rapidly coming to a close.
Job security can only occur through collaboration with like-minded individuals. While hospitals and insurance companies vie for position, anticipating a possible sea-change from fee-for-service to bundled payments, doctors and patients risk being marginalized and left out of the party.
Now more than ever before, physicians are seeking employment by hospitals, hoping that choosing such employment will result in more security, not less. But there is a flaw in this perspective.
Let us examine why:
Hospitals are run by administrators who, regardless of not-for-profit or for-profit status, are tasked with finding the lowest cost solutions that still allow delivery of the best possible care.
Insurance companies are typically publicly run companies who, as a result, must maximize shareholders returns. Insurers reimburse provider-delivered care. Reimbursements to providers (e.g. doctors, nurses, therapists, etc.) correlate negatively with profit margins and returns on investment.
Doctors care for patients. Such care delivery has value, which translates into income.
Patients expect and deserve the highest quality care at the lowest reasonable cost. In the USA, most health care is subsidized by health insurance, which drastically reduces the actual out-of-pocket costs that individuals have to pay.
But the cost of health care stopped being reasonable long ago.
So where do we stand?
At a crossroads - In one direction, the health care system becomes controlled by administrators, with care delivery doled out according to lowest cost units, measured by availability and accessibility.
In the opposite direction, the health care system and care delivery retains value according to demand and necessity, with access and availability dictated by reasonable supply and demand.
It defies logic for physicians to choose employment, where income is doled out by administrators charged with finding the lowest cost solutions. The losing proposition for caretakers is obvious under such a scenario.
While governments, hospitals, insurance companies and corporations focus on decreasing costs, doctors continue to care for patients and patients continue to need care. Patient care is being devalued. But the facilities and the administrators were never intended to also be the employers. Caregivers are not commodities. Physicians, nurses, etc., are highly trained specialists treating people with widely disparate ailments. Devaluing health care through indiscriminate cost-cutting will leave America’s health care system in shambles, reducing care delivery to an 8-5, weekday-only venture that will result in a rapid decline in access and quality. I’m not inclined towards that future.
What we need is a sea-change in the opposite direction. Diminish the central role of insurers. Place hospitals in the position to function as receptacles for patients and their caregivers. Hospitals have value just as care delivery has value. Neither the facility nor the people should be devalued.
Doctors and patients must establish new payment algorithms. Caregivers must retain their central role in health care. Already, concierge medical practices are successfully eliminating the insurance company in the doctor-patient relationship. Such paradigms will continue to increase the efficiency of care delivery, while valuing medical delivery services appropriately.
Entities such as Doctors for Patient Care aim to redirect the current pathway America is heading down. Such organizations want to keep doctors and patients central in America’s health care system. The solution is to allow care delivery to proceed as usual, valuing it appropriately and fixing areas that need improvement. It will take continued work, but together doctors and patients will prevail.