The Bigger Picture: A Year for Empowerment

Sixty percent of physicians are so fed up with the state of our healthcare system that they have considered leaving medicine.

That’s according to the new American College of Physician Executives’ (ACPE) Physician Morale Survey. The big problems: low reimbursement, loss of autonomy, bureaucratic red tape, patient overload, and diminished respect.

This issue of Physicians Practice won’t make you feel any better. As our cover story points out, managed-care companies are paying even less, leading to a further drop in income and autonomy.

It’s tough out there.

But how you respond is up to you.

I’ve just returned from two weeks on the road meeting physicians and medical managers from all over the country. And I’m sad. Most physicians are so hurt, they aren’t thinking straight, have no energy, and waste time feeling anxious and angry.

Here what one typical physician wrote in response to the ACPE survey: “The practice of medicine continually gets worse and worse, more intolerable, more onerous, with absolutely no hope or reason for any optimism either in the near or remote future.”

I don’t argue that forces are aligned against physicians, but throwing up your hands only makes it worse.

Instead, I suggest facing the healthcare system’s new economic realities head-on. No one is going to start showering you with cash and love anytime soon, so you may as well get used to the current environment and start planning for your future based on the way things are - not on how they should be. Does your heart race just thinking about your staff’s needs? Did your jaw clench when you read our cover story? OK. Breathe deeply and decide how you want to respond.

Last week I met a solo internist who attended a lecture I gave on collections. She looked stunned as she described a piece of paper her manager had recently given her listing hundreds of her current patients who owe her more than $1,000 each. She seemed at once dismayed and angry that those patients had betrayed her trust in them, and yet she was unsure whether she could really ask them to pay up when they needed care. She was frozen in her angst. If she could openly address her business and emotional predicament, she might be better prepared to take action.

She does have choices, after all, for dealing with these severely indebted patients. She could see them and accept the losses, have her manager meet with each one to set up a payment plan, or dismiss them from her practice. Each choice has ramifications, but at least she’d be making a choice rather than just giving up hope.

Another physician I met last week wanted to know how to get more preventive care, including annual visits, covered for her Medicare patients. Right now, she provides preventive care but bills it as problem-focused care so Medicare will cover it. This is an exercise in denial and self-loathing. It’s also illegal. Apart from the “Welcome to Medicare” physical, the program does not cover preventive exams and won’t do so anytime soon.

This physician has options too. She can empower herself by recommending the physicals to her patients, telling them they’ll need to pay out of pocket. Remember that seniors vote. If they know the situation, they may want to do something about it. She can also reconsider the value of an annual preventive exam for a patient with multiple chronic conditions who she is already seeing monthly. Or she can say to hell with Medicare and go cash-only. Again, these aren’t easy choices, but at least they are steps she can take based on her own convictions. Beats being trapped by the system.

So here’s a gentle call to action. OK, perhaps more of a kick in the shins: You and I, over the next year, aren’t going to change the U.S. healthcare system. But we can respond to the system in a way that makes life more bearable and even hopeful. Subversive? Maybe not. But then again, if a branch is in your way, it’s sometimes more effective to bend it back than to try breaking it.

Pamela L. Moore, PhD, is senior editor, practice management, for Physicians Practice. She has been writing for physicians on practice management topics for eight years, and she is a recognized speaker and commentator on healthcare management. She can be reached at pmoore@physicianspractice.com.
This article originally appeared in the January 2007 issue of Physicians Practice.