For some physicians, 2012 may be either the best of times, or the worst of times. But mostly, the New Year promises to bring uncertain times to the profession.
Sure, intriguing possibilities lie ahead for physicians who embrace IT, or physicians who seek and gain hospital employment. But what of those doctors who are installing a $60,000 EMR system in their small practice, then can't figure out the system?
And what lurks for physicians who labor under the ongoing threat of reduced Medicare and Medicaid reimbursements?
Uncertainty.
Amid the ambiguity about the business of being a doctor, "there is much despair among the physician population," says Lou Goodman, PhD, president of The Physicians Foundation, a non-profit formed with a $115 million endowment.
The foundation seeks to advance the work of practicing physicians by conducting research and policy studies that impact both practicing physicians and healthcare. Goodman is also CEO of the Texas Medical Association.
His organization's Physicians Watch List for 2012 focuses on issues likely to impact doctors this year, from the changing nature of medical practices to acute shortages of primary care physicians. Never mind the various physician alignment strategies being negotiated, and the flurry of regulatory requirements ahead.
"The ground is changing; it's really a shifting sand," Goodman says. "Physicians want to stay in a stable medical practice, but it's hard for them to make decisions under the economic climate. They might have thought about hiring an additional nurse, or partner, or an assistant, but they aren't doing it. They aren't adding more examining rooms and they aren't expanding. And they are joining hospital systems if they can."
One thing not on the list is continued uncertainty in Washington D.C. about the ongoing SGR (Medicare Sustainable Growth Rate) formula fight in Congress.
The SGR issue is not on the foundation's list because, well, the struggle to get rid of the SGR is seemingly always on physicians' to-do list.
Over the holidays, Congress made some inroads?but not many. President Obama signed a 60-day delay of the 27.4% SGR reduction in physician payments that was scheduled for Jan. 1.
Besides the SGR formula issue, which Goodman calls "being on the edge of the cliff," he and others cite four crucial issues that physicians face in 2012:
1. Physician Alignment: Many doctors are choosing hospital and group settings versus private practice because they feel more employment security, but both sides are having difficulty making the adjustment. Hospitals will "continue to hire and partner with physician practices and that seems to have accelerated with the healthcare reform bill and the accountable care provisions," Linda Green, PhD, a professor of healthcare and pharmaceuticals at Columbia University's Columbia Business School, tells HealthLeaders Media. "If hospitals want to be a part of that, they obviously need the physician piece. A lot of them don't have that."
"These [hospital-physician] marriages are happening at a greater rate. Those [physicians] left out are at an age that they may retire in five years or so, and it's voluntary," Green says. "Those who are younger are definitely looking for dance partners and hospitals right now are welcoming them."
Although hospitals and physicians are getting together, they aren't always a comfortable fit, Green says. "What I'm hearing hospital leaders saying is that getting a physician to truly buy into the program is an obstacle. There is the culture of the physician and the culture of the hospital," she says. "The hospital wants more evidence-based medicine, more IT support, more of a point of service delivery system. It's not the way most physicians operate. A lot of them [physicians] are going to be very resistant."
2. Patient Focus: "All doctors want to have access and availability for their patients," says Goodman. That seems like a given. But as he sees it, the added regulations and administrative responsibilities have physicians focusing less on patients. "Only one physician in 10 believes that health reform will enhance the quality of care they are able to provide to their patients," says Goodman, referring to foundation surveys released in 2011. In contrast, about 56% believe it will diminish that quality of care, he adds.
The need to provide higher quality in an environment characterized by increased reporting, problematic reimbursement and high potential liability will place "extraordinarily high stress" on physicians, particularly those in private practice, says Goodman. In 2012, "physicians will increasingly need to balance these competing factors in ways that do not compromise the care they provide to patients," a foundation report states.
Adding to the concerns: the continual, pressing shortages of primary care docs and other specialties, Goodman says. The Association of American Medical Colleges estimates a current shortage of 13,700 doctors nationwide in all specialties. Within the next three years, that number is predicted to spike dramatically to 63,000.
3. Health IT: With the impending release of the Stage 2 Meaningful Use final rule, physicians will meet impending deadlines to install computerized systems and EMR. In the meantime, physicians point to paperwork as the problem. About 63% of physicians surveyed by the foundation said that non-clinical paperwork has caused them to spend less time with their patients and 94% said the time they devote to non-clinical paperwork has increased. Indeed, many doctors say the "paperwork is killing me," Goodman reports.
Still, is EMR the answer? "Maybe in big practices. But in smaller practices, having an electronic record may take more time than a paper record. It may not improve quality and reduce costs and it may not be as effective," he adds. In a small practice it costs about $60,000 to put in an electronic record system, and they may have an electronic and paper record side-by-side for a year."
Generally, smaller physician practices often "don't want to invest in IT, and would want to affiliate with a larger physician practice or hospital," says Green.
Green noted that the Intermountain Health System in Salt Lake City, UT has installed IT systems that are easier for physicians to use. "Intermountain Health has created IT-supported electronic health records that are intuitive in a way physicians might use manual records," Green says. "It gives them benefits right away, providing information on antibiotics for example, that they would not ordinarily easily get. Once they start using the system they see how easy it is to use."
4. Docs As Business Managers: Whether it's dealing with IT systems or hospitals, as physicians brace for changes in 2012, they should also consider this: Doctors can't be only doctors anymore in an evolving, fast-paced business climate. Being a clinician is only part of the job.
Goodman says that more and more, physicians will be assuming greater "business and people management responsibilities" within practice and hospital settings.
Hospitals are relying on physicians to take on more leadership roles as the facilities expand multidisciplinary care in service lines ranging from cardiology to oncology.
The foundation states in a report, "In 2012, physicians will need to acquire new types of nonmedical leadership skills to be effective in expanded roles while still maintaining their trusted relationships with patients."
Doctors need to develop more as team leaders and as members of a team. In that way, patients can be better served.
As Goodman notes, there's a "new medical landscape" for 2012.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
