The President’s Podium: Physician, Inc.

By Ronald Dunlap, M.D., President, Massachusetts Medical Society

In my first post on this site last August, I called attention to a survey of DSC_0003 Dunlap 4x6 color 300 ppi_editednearly 3,500 physicians that found that 60 percent of physicians would not recommend their profession as a career.

I suggested that the finding was not surprising, as the high level of discontent within our profession is due mostly to the growing business and administrative requirements of medicine that we must meet and maintain. As we began our medical careers, few of us thought we would become “providers” in the health care “industry.”

The March edition of our member newsletter, Vital Signs, recognizes this reality with the theme of The Business of Being a Physician.  My President’s Message in that issue said “we cannot pretend that we can divorce ourselves from the financial realities battering the health care industry.”  Like it or not, the establishment of business principles in the profession of medicine long ago stopped being a trend; it has been a reality to an increasing extent, and is now widespread.

The business and financial aspects of medicine weigh on all of us. They threaten the viability of many practices and push physicians to make hard choices about their profession and careers.  They intrude into the physician-patient relationship, steal time from engaging our patients, and erode the control we should have over how we practice medicine and how we care for our patients.

The legislative, regulatory, and commercial mandates and requirements continue to increase. Some of these changes are positive; some not so much so. Collectively, however, they present enormous challenges.

At the Federal level, the Affordable Care Act has set regulations on such areas as quality reporting, physician ownership and referrals, medical homes, accountable care organizations and payment practices.  The presence of the Independent Payment Advisory Board, despite its inactivity, still looms, and the explosion of billing codes, known as the ICD-10, is scheduled to take effect later this year.

At the state level, legislative efforts such as Chapter 224 have added more requirements: insurance regulations governing such newly-named entities as “Risk-Bearing Provider Organizations,” proficiency with electronic medical records, and price transparency, just to name a few.  Regulations and requirements from insurers and regulators further add to our administrative load.

We are being inundated with compliance measures and calls for metrics and analytics and other databases, even when many practices are ill-equipped to provide such information given inadequate or nonexistent health information technology systems.

The Medical Society continues to speak out on these issues. In testimony before the Massachusetts Health Policy Commission in February, I pointed out that the rising number of requirements asked of physicians takes time away from patient care, adds to administrative demands, and raises the costs of practicing medicine.  I further said such requirements will drive small to mid-sized practices to merge or align with larger entities that have the ability to meet such requirements and that this could lead to further consolidations and higher costs in the health care market –a phenomenon already well underway in the Commonwealth.

On the national level, rising physician frustration with the direction of medicine is leading more of our colleagues into the political arena. A New York Times report of March 8  noted that “a heightened political awareness and a healthy self-regard that they could do a better job, are drawing a surprising large number [of physicians] to the power of elective office.”

Such political activism by physicians is rare at the state level.  Whether more physicians in national office, while a hopeful sign, will affect change remains to be seen. But it is likely to alter one critical dynamic: bringing added weight to the voice of physicians in the conversation about health care.  That is a key development.

It is imperative that those who propose changes to the practice of medicine recognize and understand how the consequences of those changes – intended and unintended – will affect the practice of medicine.  Who better to tell them than those of us on the front lines of patient care?  We must accept that we’re now part of an “industry” and that the “business of medicine” is here to stay due to cost constraints. It is necessary however, for physicians to have an unmistakable and conspicuous voice in how that business operates.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.   

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