One of the biggest points of contention in the ongoing discussion of burnout is that the system of health care is flawed. The endless bureaucracy, decreasing physician pay, and increasing meaningful use requirements that spawn endless clicking on an already inefficient electronic medical record platform have become unbearable by most practicing physicians today.
Furthermore, all the talk about mindfulness only riles up more anger in physicians as they feel they are being blamed for their burnout. While there is a case for physicians taking personal responsibility for their own self-care skills (or sometimes lack thereof), we must acknowledge the flaws of our current medical system. The shift to this “value based system” is a bad idea; not only because it does not reflect the true value of the work we do, but also because this devaluation is causing physicians to be required to see more patients in less time (as if 15 minutes was not bad enough) putting physicians even more at risk for burnout, depression, and suicide, and putting patients at risk for increasing medical errors.
This way of operating is clearly not sustainable: not for doctors, not for patients, and not for the system as a whole. Like the real estate market, our health care system is doomed to implode if nothing changes. However, the question persists: “If the system must change, how can we as physicians be at the source? Where can we be responsible in creating a new paradigm for the practice of medicine?”
With this mindset, I’ve been on somewhat of an inner quest. Over the last year or so, I have looked into various medical models, seeking out something that would give doctors back their autonomy, joy, power, and freedom. I envisioned a model that involved physicians coming together and forming their own cooperative that provided primary and specialty care to patient in a membership environment. This would be a direct pay model, with access to participating radiology centers, pharmacies, and laboratories. I began a search to see if there were existing models, already in place that I could glean from, and I soon discovered that I was not the only person thinking along these lines.
One group of physicians out of Oregon took to this cooperative business model, starting their physician-patient cooperative in 2005 initially as a non-profit to positively impact the status of health care. It has grown to be a rather robust multi-specialty organization with clinic and employer group locations in Texas, Oklahoma, Arizona, and New Mexico. Furthermore, the clinic includes not only traditional primary and specialist care, but also complementary/alternative therapies such as acupuncture, naturopathy, chiropractic, and nutritional therapies. They run off a tiered membership model that allows for flexibility of access for the patient, as well they have an employer membership option.
While, I’m not completely privy to the inner workings of this model (physician membership, compensation, profitability, and overall sustainability), for this organization at least, it seems to be a successful model that has allowed for a more expanded yet affordable access to care for the patients, while putting the power of medicine back in the hands of the physicians. It’s worth exploring how this and similar models could become more of the norm rather than the exception.
As I learn more, I am sure that all of the pros and cons of this model will become evident, but I believe that physician cooperatives could be a game changing model for physicians that creates the best of both worlds: access for patients, and the opportunity for physicians to once again truly practice medicine on their terms.
Maiysha Clairborne is an integrative medicine physician and can be reached at The Stress Free Mom MD. She is the author of The Wellness Blueprint: The Complete Mind/Body Approach to Reclaiming Your Health & Wellness.
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