The Physician Empowerment Movement
Physicians are central in determining health access, coverage, and reform. After all, physicians are the primary professionals licensed to practice medicine and deliver care. Yet physician voices remain curiously muted. Pundits, politicians, employers, health plans, and health-firm executives dominate the discourse about healthcare change. There are many reasons for the silence:
- Physicians are too busy making a living and dealing with regulatory burdens and managed care hassles.
- Clinicians don’t have time or money to attend all those sessions, conferences, and high-level pow-wows where decisions are made.
- Most doctor groups are small. Everyone in the practice seems to have veto power.
- These groups lack the structure and business know-how to compete or counter hierarchical corporate giants.
- The AMA, physicians’ chief national presence, has lost credibility and members. Only about one in four physicians now belongs.
- Physicians lack skill in organizational hardball and in stanching the flow of big money in the healthcare sector, which now represents one-sixth of our national economy.
- Demoralized physicians feel impotent and don’t think they can make a difference in a dysfunctional system. They are overburdened by third party administrative expenses that are beyond their control.
Signs of Change
There are signs things are changing, however--doctors are marching on state capitols and Washington, D.C. over Medicare cuts, suing health plans over quality rankings and patient steering, engaging in battles with community hospitals over doctor-owned facilities, and resisting pressures from health plans and governments to install electronic medical records (EMRs). No signs exist, however, of widespread unionizing.
Other events happening include:
Demand-driven leverage. Physicians are in short supply. This problem dates back to the 1980s and 1990s when medical schools capped enrollment. Schools foresaw a doctor glut; they were wrong. In a now famous 2002 Health Affairs article, Richard Cooper, MD, predicted a 50,000 shortfall by 2010 and 200,000 by 2020. The shortage is most severe among family physicians and general surgeons and bites most deeply in rural America.
This high demand gives doctors more power to dictate the terms of their employment. New medical schools, accelerated enrollment in existing schools, nurse practitioners, physician assistants, and retail clinics, will not close the physician gap soon--it takes five to six years to produce a newly minted family physician, and six to 10 years to educate a competent specialist.
A sense of outrage. Physicians are also mobilizing out of a sense of outrage. They are beginning to suspect something is rotten in the state of Denmark. Medicare payments, slated to drop 10.6% this year and 15% next year, are becoming so low physicians are turning away new Medicare patients to meet payroll expenses and the bottom line. Health plans predictably follow Medicare payment patterns in lockstep. This means across the entire public and private system doctors will bear the full brunt of cuts to contain runaway Medicare costs.
Physicians don’t want to keep begging government for adequate payments. We are not beggars; we are highly trained professionals trying to make a difference in the lives of our patients while trying to make a living. Many physicians are outraged that senior hospital executives pull down over $1 million annually while health plan CEOs average $10 million to $15 million, with some, like Bill MGuire, MD, of UnitedHealth, accumulating fortunes exceeding $1 billion.
Another large physician organization rises. In the early 2000s, 19 state and local medical societies lodged a class action suit against major U.S. health plans for delaying, lowering, and artificially bundling physician fees. The physicians won the suit in Miami federal court in 2003. Since it was logistically impossible to pay back physicians individually, terms of the settlement were for Aetna and Cigna to spend a total of $35 million to create two 501C3 foundations to give grants to physician organizations that created models to install EMRs and took other measures to improve efficiencies, patient safety, and outcomes.
The agreement was that Aetna would contribute $20 million and Cigna $15 million to form two foundations. The original health plan investments have grown to over $100 million. Those foundations subsequently merged to form one: The Physicians Foundation for Health System Excellence, which has given over $20 million in grants to physician groups around the country. The foundation is conducting a massive nationwide survey to highlight the collective opinions and troubled economic status of physician practices, many of whom are barely making a go of it, and to serve as a unified physician voice for correcting deficiencies and improving the system.
Internet empowerment. Although many Internet firms--WebMD, Revolution Health, Google, and Microsoft--talk glowingly about the Web empowering consumers, physicians are starting to realize the power of the Internet to mobilize and transmit information about their concerns as well.
Examples of these sites are:
- Physicians Interactive, Inc., which claims it represents over 500,000 physicians. It is a leading source of non-biased, credible, engaging, and relevant research information about medications.
- DoctorsHangout, a social networking Web site for medical students and residents.
- AskDrWiki, a continually updated Web site created by four cardiology fellows at the Cleveland Clinic and edited by cardiologists across the United States. Look for more wiki, physician-run Web sites to come online. These sites tend to non-profit and devoid of advertising, a business model that appeals to physicians.
- Sermo, a free, physician-only social networking site that now has over 60,000 participating physicians. “Sermo” is Latin for “conversation,” and Sermo calls itself a conversational Web site. It rests on the premise that doctors, as part of a sisterhood and brotherhood, want to help each other and will freely, anonymously, and candidly exchange views on a secure Web site. Their views, says Sermo, possess the power to predict trends and to gather relevant and early information to improve the healthcare system. Sermo hopes to eventually have over 100,000 participating physician members and now has partnerships with the AMA, Pfizer, Inc., FDA, CDC, and publishing organizations. It is rapidly becoming a powerful tool for leveraging information found only in physician offices and in expressing the collective voice of physicians, not only to its partners but to the public at large. A group of Sermo physicians will soon be releasing an “Open Letter to the American Public,” signed by thousands of practicing physicians and appearing in various major media outlets.
Physicians find their voice
For various reasons, including the feeling that the deck is stacked against them by government, health plans, and others, physicians are collectively mobilizing, uniting, expressing, and empowering themselves. This empowerment is partly due to a sense of outrage at current practice conditions, system inequities for patients, and a desire to improve care. Physician shortages, the demand for more physician access, the laws of physician supply and demand, emboldened physician organizations, and social networking physician Web sites contribute to this new sense of physician empowerment.
Richard L. Reece, MD, is a pathologist, writer, editor, speaker blogger and consultant in Old Saybrook, CT. His latest book, Innovation-Driven Care: 34 Key Concepts for Transformation, was published in March 2007. His blog may be accessed at www.medinnovationblog.blogspot.com. He may be reached at firstname.lastname@example.org.
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