What I Do
As a member of several boards and committees, I have had the opportunity to speak with a lot of physicians on what they see as the problems. I have also collaborated with physicians who are in leadership positions within their health systems and are trying to do the right thing for everyone.
The challenges – and my experience addressing them
Changing Payment Models
We need physicians with expertise and on the front lines of these changes to help shape what the right quality metrics are and to ensure that physicians are not held accountable for outcomes they have no control over. I have been on the frontlines learning about alternative payment models and am leading my fellow colleagues to CINs and APM within MACRA. These solutions need to be creative and customized so as to work in all practice settings.
Reducing administrative burdens and protecting time with patients
Each of us has seen firsthand how increasing administrative burdens have led to early retirement among our older colleagues. This is directly related to new proposed mandates and ripe for negotiation. For example, I worked with some insurers in my area to create a “gold circle” where physicians who have had 90% of pre-authorizations approved are not required to go through these (but remain subject to random audits). When we unite as a single House of Medicine, we can work through some of these problems together.
Technology Sticker Shock
Around the world, banks participate in interoperable payment networks. This lowers costs and speeds transactions. Similarly, we need EHR to be fully interoperable. But few solo or small practices can bear the cost of technology and stay afloat financially. I led the effort for our small clinic to be paperless in 2012; I have brought this to our AMA in the form of written resolutions.
Stress and Work/Life Balance Issues
It has always been tough to avoid burnout given the high pressure we operate in when we make life-altering decisions on a constant basis. Being held accountable for issues we cannot control only adds to this stress. We need practicing physicians with real-life experiences in the clinic to lead the way with these new models being tested.
Scope of Practice Issues
The authority of CRNAs has been a hot-button issue for our colleagues within American Society of Anesthesiologists as APRNs make other incursions throughout medicine in the states. Meanwhile, the VA’s pursuit of the nurse-only model may be the first of many aggressive new challenges that we will see that will test the notion of physician-led care. This affects employed and non-employed physicians equally because we all face autonomy and decision-making challenges if the team is led by a non-physician. We need to be vigilant to protect patient safety as efforts to lower health care costs turn increasingly to expansion of scope for non-physicians.
Increasing Medical School Debt
According to an AAMC report, the cost of non-resident tuition mushroomed from an average of $25,000/year to $60,000/year between 1997 and 2016 (non resident tuition). This may increase the growing shortage of primary-care physicians as medical students opt for higher-paying specialties. While our AMA works to reduce the number of years of physician training, we need more solutions to this problem. With their much-shorter education requirements, more college students with an interest in medicine are choosing to become PAs or APRNs.