HLM: Will these inefficiencies be addressed more quickly with the advent of physician-employees, or will it make matters worse because salaried physicians will lose their sense of urgency?
Shipman: All employed settings aren't the same and it is not intrinsically the case that private practice doctors have more of an incentive to be efficient than the employed physicians. In some cases, the risk of changing the practice model feels greater in a private practice setting.
What is needed is a revamping of the way medicine is practiced and what a physician does on an hour-to-hour, day-to-day basis. That change may be more risky when everything is on the line by virtue of your role as the breadwinner for the practice. Whereas, in an employed or larger setting, there may be greater opportunity to push for those changes or to enable those changes in the way care is delivered.
HLM: Who needs to lead this efficiency movement?
Shipman: It's an opportunity that physicians shouldn't pass up. They have an opportunity to be in the lead here. They understand better than anyone where their inefficiencies are.
The problem for primary care physicians is that they spend so much of their time running at full speed just to keep up they don't have the time to reflect on how it can be done better. At some level if the physicians don't take the initiative and the screws keep getting tightened down in driving for greater efficiency in overall healthcare delivery and reduced or controlled costs others will step in and push forward.