The Independent Physician’s Dystopian Future

At the heart of any economic engine, there is an indelible truth: The masses work for the powerful because the powerful sell to the masses.

Physicians, like it or not, in-network or out, work for health plans who sell to or serve the masses. The alternative? Scrape a living from the few elite or many poor who live outside of the insurance world.

Here is the future for physicians who refuse to prepare, not in the next 10 minutes or even 10 weeks, but increasingly and inevitably over the next 3 years: You will be dying mom and pop store owners in a big-box health plan, hospital system world. And, you will suffer the same fate - wearing a branded apron working the specialty aisle for the big box healthcare retailer that dominates your area.

Health plans sell policies to the masses, wholesale to employers, and, now, retail through the exchanges. They set the prices. You either accept them or go out of business, and will eventually go out of business by accepting them. You are, and will be, at their mercy unless you begin to transition today from fee-for-service to payment for how good your work is, not how much work you do. Even that will not be enough unless you band together in great numbers with the right technology, business model, and organization to be able to compete with size, efficiency, and brand.

The catalyst is the quantum shift from wholesale, employer-provided insurance to retail-insurance exchanges. Not the one-size-fits-all public exchanges, but, the public exchanges where real competition on quality and value is blooming.

Some health plans are embracing radical change, or, at least flirting with it by partnering with physicians instead of hospitals to deal directly with self-insured employers and employees alike.

Visionary, entrepreneurial physicians are already hard at work on ways to break free from fee-for-service and hospital system bondage, and are being joined by their peers alert enough to see the tidal wave of change on the near horizon to build a new, sustainable healthcare delivery system.

They will become the new power elite, serving and selling to the masses what the masses want and need.  That is, if they survive their biggest, most powerful threat: new federal government regulation spawned by the rush to preserve the power entrenched by trillions of dollars in a 10-year cycle that may be eliminated from federal Medicare and Medicaid budgets by a truly efficient system.

Budgets are power in Washington, D.C., and power is almost never ceded except to greater power, which brings us back to the opening theme: The powerful sell to the masses.