As every physician knows, these times are not only seeing an unprecedented avalanche of new medical science, but also experiencing a storm of pressure to change the way that healthcare is organized and financed.
As every physician knows, these times are not only seeing an unprecedented avalanche of new medical science, but also experiencing a storm of pressure to change the way that healthcare is organized and financed. Everyone agrees that the 18% of our GDP going to healthcare is riddled with waste and inefficiency, resulting from inadequate thinking and planning. But so far there is no consensus about who, what, or how to rationalize this vital sector of our lives and economy.
So it was with these issues in mind that I sat down with Lloyd Minor, MD, a board-certified otolaryngologist and dean of the Stanford School of Medicine, to ask for his assessment of our situation. Minor is presiding over a strong medical center and, amidst the construction of 2 new hospitals, a number of initiatives to address the many accelerating challenges confronting the practice of medicine and its academic foundation.
He began by citing the “perverse incentives” economists often mention: the encouragement by our fee-for-service system to do more, but without inherent checks on spending activity that could exist by adding some form of outcome metric. Minor indicated that this lack of connectedness between economic activity and actual results might be gradually relieved as the various parts of the healthcare sector are increasingly integrated through consolidation, the internet, and EHRs.
The, perhaps, inevitable march to grouping hospitals and physicians into various networks has already gained considerable momentum. Currently, 51% of American physicians receive a salary from larger entities and there are almost weekly mergers of hospitals trying to economically survive, let alone thrive.
Minor emphasized that multiple models will exist for the foreseeable future, “at least a generation,” until a consensus emerges, perhaps by agreement, perhaps by constraint as “things that work [well] tend to work over time.”
“Incrementalism is not a bad thing,” he said. And given the extraordinary brouhaha over the Affordable Care Act, as one example, incrementalism might be the only thing, it sometimes seems.
When I turned the discussion to what training programs are doing to meet these unprecedented challenges for young physicians going into practice, Minor said, “It’s a valid concern. We are emphasizing the team approach” as a better way to grapple with increasingly complex challenges.
Stanford, for one, has been doing this for some time, as shown by its students’ refusal to accept a chapter of Alpha Omega Alpha, the national honor society for medical students. The students said they are learning to function well as a team and are not so interested in emphasizing individual activity.
That redirection of medical students’ traditional hyper competitiveness has great potential for positive change, but it remains to be seen if the entire culture at Stanford, and throughout America, can be rechanneled over time.
I asked Minor what his takeaway message is for practicing docs and the civilian population, whose future health is at stake.
“Medicine is the best calling for a career and this is the best time ever to be doing it,” he said. “There are many challenges facing us, but I am confident that by academia and practicing physicians improving our connectedness, we can succeed. I am enormously optimistic.”
We all hope so, too. As my grandmother used to say, “From your mouth to God’s ear.”