Doctors are the solution, not the problem

We all know that Sickcare USA needs a Big Fix?and I've suggested how to get it done. Many, including doctors, think doctors?are part of the problem instead of the solution. I disagree, and in fact, more and more see evidence that doctors are flexing their muscles, hearts and brains to not only restore the integrity and professionalism of medicine, but increasingly are being imaginative, creative and entrepreneurial on behalf of their patients and themselves.?

While it is true that as members of the biomedical-industrial complex, doctors have contributed to the perpetuation and growth of a dysfunctional reimbursment based practice model. In addition, while many claim they are advocates of their patients, many don't walk the talk. For example, as surprise medical billing has emerged as a hot-button issue for voters, doctors, hospitals and insurers have been lobbying to protect their own money flows. All that lobbying meant nothing got passed last year.

Meanwhile. for an increasing number of Americans, sick care is unaffordable.

California’s Office of Health Care Affordability faces a herculean task in its plan to slow runaway health care spending.

The goal of the agency, established in 2022, is to make care more affordable and accessible while improving health outcomes, especially for the most disadvantaged state residents. That will require a sustained wrestling match with a sprawling, often dysfunctional health system and powerful industry players who have lots of experience fighting one another and the state.

Can the new agency get insurers, hospitals, and medical groups to collaborate on containing costs even as they jockey for position in the state’s $405 billion health care economy? Can the system be transformed so that financial rewards are tied more to providing quality care than to charging, often exorbitantly, for a seemingly limitless number of services and procedures?

The jury is out, and it could be for many years.

California is the ninth state — after Connecticut, Delaware, Massachusetts, Nevada, New Jersey, Oregon, Rhode Island, and Washington — to set annual health spending targets.

However, the tide is turning.

First, while relatively few doctors have an entrepreneurial mindset, that is changing. The startup and entrepreneurship bug has infected undergraduates, medical students, residents and fellows and practitioners. Recently, as an example, I had a chat with?a program director friend who said she is having to respond more and more to resident applicants who are asking, " How will?you support my innovation during my residency". It seems you simply can't have GME credibility these days unless you make or buy an accelerator.

Second, the medical educational establishment is increasingly responding to the market demands of communities that want doctors with 21st Century competencies in data analysis, population health, disease prevention and wellness, personalized medicine using up to date results of NextGen sequencing and proteomic research.

Third, doctors are pushing back against their medical association and board leadership who are not representing their interests and demanding a rethinking of CME and board renewal certification and competency requirements.

Fourth, clinical researchers are reformulating their relationships with other members of clusters, including new funding sources, industry partners and entrepreneurs. They are vocal about their concerns as we attempt to get health information technologies right and are demanding a seat at the table earlier and earlier in the research and development process prior to deployment.

Finally, more and more physicians are assuming leadership positions in health systems, industry, hospital administration and policy making positions. I attended a session with a former Commissioner of the FDA, Dr. Robert Califf, an academically trained research cardiologist, and was impressed with his openness and thoughtfulness about complicated questions that, as yet, have no answers.

There are many possible reasons why some sick care administrators, some of whom are doctors or so called physician executives, feel the way they do about the clinical doctors on their staff:

1. They have different priorities
2. They are compensated in a way that drives their behavior
3. They are terrible leaders and simply bad bosses
4. They are profit driven instead of mission driven
5. They have different planning horizons
6. They don't believe doctors have the knowledge, skills, abilities or competencies to run the business of medicine
7. They don't have the necessary people, managerial or entrepreneurial skills to create a value based, mission driven organization
8. They resent or simply don't like doctors who work for them
9. They don't know how to bridge the cultural divides that exist between clinicians and administrators
10. The board of directors sets benchmarks and goals that are not aligned with those of the medical staff

Increasingly, doctors are part of the solution. And, no, they are not terrible business people.?In fact, they realize that the business of medicine is as important and part and parcel of the practice of medicine if they are to serve as the stewards of dwindling and precious sick care resources.?

However, when it comes to fraud, abuse and financial conflicts of interest, doctors are part of both the problem and the solution.

Congratulations to all my colleagues who, every day, in their own way, are creating user defined value and the future of care. Despite the naysayers, now is an exciting time to be in medicine, assuming our rightful place.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack