Many physicians are expressing unhappiness with their career choice – or, more specifically, how their career choice isn’t what they envisioned. Much of this dissatisfaction has to do with loss of autonomy regarding what’s best for each individual patient. Insurers, hospitals, and the government all seem to have input into decision making – and all essentially demand compliance. The reality is, this isn’t likely to change. The days of maximal autonomy for physicians are behind us.
Cookbook Medicine is Here to Stay
Treating patients the way physicians were taught in residency or picked up from articles, conferences, and experiences along the way isn’t a recipe for improving the health status of a population or even getting the best result for an individual patient. Evidence-based practice guidelines, often promoted by specialty-specific professional organizations, are gaining traction in global efforts to standardize care, minimize practice variation, and achieve better, more predictable patient outcomes.
Many physicians lament this loss of clinical autonomy and decry “cookbook medicine” that doesn’t take individual patient circumstances into account. The fact is individual physicians won’t be able to make decisions without scrutiny, because information technology is making it increasingly clear that, in most cases, large variations in care waste resources (and money) without concomitant patient benefit. Physicians need to give up tilting at this windmill and accept the “new order” of health care.
Healthcare Reform Presents Physicians with New Leadership Opportunities
That said, HSG sees a key, rapidly-evolving role for physicians in the emerging “new order” of healthcare – active leadership. This developing alternative will be good for physicians – and for healthcare. The new requirements demanded by government and private payers actually put physicians in the driver seat. Government-driven programs require the combined use of robust data and multi-disciplinary knowledge to collectively develop plans for treatment and proactive intervention processes. Although many disciplines will be intimately involved with this process – from information specialists to nurses and pharmacists — we see physicians as being the guiding light and the glue necessary to guide processes designed to improve patient outcomes.
The implications for doctors are enormous. While required to work within teams, physicians’ role in defining care processes will grow, not diminish. Their influence over the provision of healthcare will expand, not contract – as long as they actively seize this opportunity.
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In the 1990s hospital, the key measures of success were predominantly service and financial measures:
- Are patients satisfied?
- Is the ER throughput okay?
- Did we achieve a positive operating margin?
The state of IT at the time allowed only rudimentary measurement of quality. With the evolution of core measures, the government began to focus performance improvement efforts on clinical process measures, e.g., Did the patient receive the right drug during the appropriate window of opportunity?
In the new world of clinical integration, the relevant questions will continuously evolve:
- Did your patients get well in the projected time frame without preventable complications?
- Is the patient’s quality of life maximized according to their circumstances?
- Did other provider networks produce the same results more efficiently or were their results better?
- How is the population at large doing?
Physician insights are crucial to answering these questions and driving systematic improvement.
The Increasing Need for Physician Leadership
As we help clients with strategic planning initiatives and physician alignment strategies, the physician-centric dynamics are becoming increasingly clear. Clients who had no physician executives 15 years ago suddenly have three or four serving in diverse leadership/management roles in both the employed physician network and the hospital or health system — Medical Director, CMO, VP of Clinical Integration, VP of Quality, CEO. Active physician involvement and proficient leadership must permeate all organizational levels to effect optimal outcomes. We expect this trend to continue. It’s difficult to envision a successful healthcare organization without deep physician engagement.