Hello, my name is Adam Brodsky and I’m the president of the Society for 2016. As is Society tradition, I’ll be sharing with you some thoughts each month in Round-Up about various issues that we face practicing medicine today.
Before I begin with this month’s topic, I would like you to think for a moment about just how many non-physician voices there are trying to impact the practice of medicine. The list is practically endless: industry groups, hospitals, legislators, insurance companies, pharmaceutical companies, etc.
Now i freely admit that during my day practicing cardiology I almost never give any of these other voices a second thought. I do what I assume most of you do – blank out all the nonsense, simply focus on the patient in front of me and do what is best for that person. However, we all must recognize that eventually our ability to practice medicine the way we want to – the way that is actually best for our patients and best for society – will be adversely impacted by these other voices if there is no strong physician voice. I thank each and every one of you for taking the time to even read these pages. Simply by doing that you have demonstrated your commitment to a strong physician voice. I would also ask you to consider becoming more involved in organized medicine yourself and to ask your colleagues to become involved as well.
Healthcare is changing before our very eyes and there is one thing that is certain; if we don’t take charge of our own destiny others will do it for us. And I can almost guarantee that if and when that happens, we, our patients, and most of society as a whole, won’t like the results.
The theme of this month’s issue is, “The Changing Healthcare Marketplace”. Despite the fact that medicine as a profession represents a series of individual interactions between individual patients and physicians, and despite the fact that attempting to heal another human being is one of the oldest and noblest professions, we all know that the modern practice of medicine is as much a business enterprise as it is a noble art form. While we physicians go about our daily routines treating patients, the landscape in which the business of medicine is practiced is rapidly changing. Many forces are at work in this regard, Nationally, the Affordable Care Act has played a large role. Large insurance companies have merged, wielding even larger market power. We are seeing the rapid proliferation of restrictive networks where insurance companies attempt to save money by limiting patient choice. I have had several patients myself whom I have seen for several years suddenly be told they can no longer see me because their plan changed to a narrow network. On our last visit together, both the patient and I are left to wonder: according to what logic is this supposed to be better for the patient and better for society?
In Maricopa County we have seen the consolidation of health systems into only a few major networks, each trying to force community physicians to declare their allegiance to a single network. Again, we and our patients are left to wonder: how is it in our interests to engage in these marketplace power games? Any large enterprise must adhere to certain business principles in order to remain viable and competitive, and healthcare companies are certainly no exception. However, I am often left owndering whether deep inside the executive suites of these large medical corporations the tail is actually wagging the dog. When company-wide medical practice decisions are more clearly linked to marketing strategy than patient care, when individual physician judgement is brushed aside in favor of universally applied order sets, and when entire cadres of personnel are hired and devoted to massaging data points on electronic dashboards; one is left to wonder if we have drifted too far afield from our original purpose.