Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Expand health care systems in a way that is professionally satisfying

Michael D. Shapiro, MD, MBA
Policy
March 24, 2011
Share
Tweet
Share

You try to do the right things to sustain your business. You set high standards for delivery of quality care, follow the basic tenets of marketing, align your organization so that everyone in your firm “gets it,” avoid unnecessary expenses but identify important growth opportunities and prudently invest so that you remain competitive and serve your patients well. But can you afford investing in the assets you require to become or remain successful in this new era of health care reform?

For example, can you afford an electronic health record system? Even absent a Meaningful Use bonus, the penalty looming in 2015 for those who fail to adopt EHR-Meaningful Use creates a financial disincentive for failing to make the leap. Even those who have recently purchased or intend to purchase an electronic system face significant (and expensive) implementation challenges in order to convert to e-charting, let alone use such a system “meaningfully”. Can you afford not to invest in an EHR system?

And what of the SGR-mandated cuts to the Medicare Fee Schedule due to take effect in 2012? What many lay folks fail to understand is that this would, unless Congress acts, not only quite negatively impact Medicare fees, but that our commercial insurance contracts are also at risk as these are typically tied to this very same Medicare fee schedule, albeit a couple of years behind the current year’s rates.

Furthermore, while Paul Revere’s warnings were inarguably of more dire significance, it’s nevertheless true that “The ACOs are coming!” (January 1, 2012), with an attendant, inevitable, continued shift to a pay-for-performance, “captitated” payment system (both government and private) rather than the likely unsustainable pay-per-encounter methodology currently used to compensate physician and hospital services.

Is all of this (and more) enough to make doctors eschew private practice for salaried positions with hospitals or large multi-specialty group practices? Or a career as a physician altogether? Over half of physicians in the US are now employed by hospitals/group practices, the first time since such statistics have been recorded that those employed this way exceeded those in private practice. And with the “individual mandate” to have health insurance on the horizon, it’s likely that the shortage of physicians, especially primary care, will be exacerbated in a few years. This, despite the fact that many medical schools have recently expanded their incoming class sizes, and new US medical schools are being added. Even with 4 years of college, another 4 years of medical school, and several years of post-medical school residency training in a prospective doctor’s future, and with mounds of resulting debt, being a physician and taking care of patients obviously remain highly valued by those who covet entry into the medical profession, and to be sure, those who are from time to time in need of medical care.

Spencer Johnson’s “Who Moved My Cheese?” provides some common sense consultation that is applicable today, even though it was written in 1998. Not specific “how to” advice per se, his story is about change that is scary and potentially life-altering – recognizing when it happens or is about to happen and making adjustments as needed. If the cheese you’ve become accustomed to enjoying is no longer to be found, go forth and find new cheese.

What does this mean for medical practices?

Here’s a present day example. Recently, I attended a lecture by Dr. Patricia Gabow, CEO of Denver Health and Hospitals, a largely indigent demographic health care system in Denver, CO. It was quite remarkable to learn that despite almost half of their patients being uninsured, they found a way to become profitable and sustain this profitability year after year while simultaneously improving the care of their patients. In fact, an obvious conclusion to draw from their experience is that healthier patients utilize fewer costly resources. Thus, their focus is on prevention, reducing hospital admissions and lengths of stay, arranging follow up care to prevent costly readmissions, etc. They implemented a system wide EHR. They employ a large staff of physicians, many of whom are engaged in leading the way toward more efficient and effective care. Their organization is aligned with a common purpose.

Maybe the “handwriting on the wall” is not that we will lose our autonomy or that the physician-patient relationship will suffer, or that the positive aspects of health care in the US will vanish under excessive regulation and fee cuts, but that we can refocus our efforts to create and expand health care systems in a way that is professionally satisfying, provides better care for more of our citizenry while continuing to provide high quality care to those already able to get it, and provides reasonable physician compensation that is in line with the many years devoted to becoming a physician, as well as the costs of this education.

Perhaps this evolutionary process will create systems that will in effect become the new cheese. Are you prepared to go forth and find it?

Michael Shapiro is a nephrologist who blogs at Your Practice – Your Business.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Restricting nuclear cardiac stress testing in favor of stress echocardiography

March 24, 2011 Kevin 3
…
Next

Giving the patient and family precious minutes to say goodbye

March 24, 2011 Kevin 9
…

ADVERTISEMENT

Tagged as: Primary Care, Public Health & Policy, Specialist

Post navigation

< Previous Post
Restricting nuclear cardiac stress testing in favor of stress echocardiography
Next Post >
Giving the patient and family precious minutes to say goodbye

ADVERTISEMENT

More by Michael D. Shapiro, MD, MBA

  • a desk with keyboard and ipad with the kevinmd logo

    How disruption will affect physicians during health reform

    Michael D. Shapiro, MD, MBA
  • a desk with keyboard and ipad with the kevinmd logo

    Market demands determine whether to add physicians to a medical practice

    Michael D. Shapiro, MD, MBA
  • a desk with keyboard and ipad with the kevinmd logo

    Superior customer service to grow your practice

    Michael D. Shapiro, MD, MBA

More in Policy

  • How the One Big Beautiful Bill could reshape your medical career

    Kara Pepper, MD
  • Why the U.S. Preventive Services Task Force is essential to saving lives

    J. Leonard Lichtenfeld, MD
  • Brooklyn hepatitis C cluster reveals hidden dangers in outpatient clinics

    Don Weiss, MD, MPH
  • Why nearly 800 U.S. hospitals are at risk of shutting down

    Harry Severance, MD
  • Innovation is moving too fast for health care workers to catch up

    Tiffiny Black, DM, MPA, MBA
  • How pediatricians can address the health problems raised in the MAHA child health report

    Joseph Barrocas, MD
  • Most Popular

  • Past Week

    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • The hidden dangers of over-the-counter weight-loss supplements

      STRIPED, Harvard T.H. Chan School of Public Health | Conditions
    • Private practice employment agreements: What happens if private equity swoops in?

      Dennis Hursh, Esq | Conditions
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • The hidden dangers of over-the-counter weight-loss supplements

      STRIPED, Harvard T.H. Chan School of Public Health | Conditions
    • Implementing value-based telehealth pain management and substance misuse therapy service

      Olumuyiwa Bamgbade, MD | Physician
    • How an insider advocate can save a loved one

      Chrissie Ott, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • A powerful story of addiction, strength, and redemption

      Ryan McCarthy, MD | Physician
    • An ER nurse explains why the system is collapsing [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • The hidden dangers of over-the-counter weight-loss supplements

      STRIPED, Harvard T.H. Chan School of Public Health | Conditions
    • Private practice employment agreements: What happens if private equity swoops in?

      Dennis Hursh, Esq | Conditions
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • The hidden dangers of over-the-counter weight-loss supplements

      STRIPED, Harvard T.H. Chan School of Public Health | Conditions
    • Implementing value-based telehealth pain management and substance misuse therapy service

      Olumuyiwa Bamgbade, MD | Physician
    • How an insider advocate can save a loved one

      Chrissie Ott, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • A powerful story of addiction, strength, and redemption

      Ryan McCarthy, MD | Physician
    • An ER nurse explains why the system is collapsing [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Expand health care systems in a way that is professionally satisfying
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...