Physicians, YOUR future is in YOUR Hands

Physicians need not look at their future role being limited to working on the medical assembly line:

?How many times have you heard the refrain that the day of the independent physicians is over? That all physicians will eventually become employees of the two or three major integrated healthcare systems in every urban area. That physicians will conform to this employment role since they want a quality of life that would conform to a very structured day with limited work hours.

Physicians, you can control your own future, but as with everything else in this world, it will not be delivered to you on a silver platter. If you want to control your future then you need to take ownership of it. You need to be the conductor of your own train or career.

One thing I have learned in my almost 35 years working in a variety of roles and sectors in the healthcare industry is that you never say never when it comes to healthcare. 

 Physicians do have options and this is not just wishful thinking. They are the brightest of the bright. We, as a society, have placed them on a pedestal and rightly so. However, they do not want to be owned. They want to make a difference and I am seeing this more and more with younger physicians.

Physicians have their choice of multiple doors to success and happiness:

While many physicians have gone down the path of being employed by integrated healthcare systems, they are also starting to assume leadership roles in those organizations. They are not satisfied with just working in these integrated healthcare systems and playing by the rules set by others. They want to place themselves in a position to make a difference both for their patients and their healthcare system.

There are also many physicians who want to stay independent or discover that working in large integrated healthcare systems is not the panacea that they once envisioned. Healthcare is local, so, depending upon the region of the country, there are many different paths for independent-minded physicians to take including:

• Horizontal integration of like-kind physician specialties: On a regional, state or national basis horizontal integration of physician specialty practices has been occurring. One example is Advanced Dermatology which is one of the largest dermatology practices in the U.S. with 180 offices throughout the country.
• Vertical integrated multi-specialty groups: Depending upon the community, independent multi-specialty groups can be very successful. The size of these multi-specialty group can vary widely. The larger multi-specialty groups are more common in certain regions of the U.S. and also in some rural areas.
• Primary Care Medical Homes (PCMHs): As I have discussed in prior blogs, PCMHs will be playing a greater role in the evolving world of healthcare. PCMHs’ importance will be enhanced in a risk/value-based world as well as one that focuses on overall population health. As PCMHs gain more importance, they will also be in the position to demand greater compensation from payers that is commensurate with the value they bring to the marketplace.
• Independent physician collaboratives: Independent physician groups are coming together in collaboratives that allow them to operate in a more efficient and high quality manner. An example of such an organization is the Ohio Independent Collaborative.
• Physician-led ACOs: As I noted in my blog on physician leadership, physician-led ACOs have been very successful in the marketplace. As a result of this success, they will become even more attractive as strategic partners by the full range of payers.
• The growth of Medicare Advantage plans could increasingly become the lifeblood for many independent physician practices: As we have discussed in prior blogs, over 1/3rd of eligible seniors are enrolled in a Medicare Advantage plan. A large percentage of baby boomers are selecting Medicare Advantage plans vs. Traditional Medicare. It is not unforeseeable that within 5 to 10 years, 50% or more of all seniors will be in Medicare Advantage plans. Increasingly Medicare Advantage Plans which enter into a risk arrangement with CMS are, in turn, entering into risk contracts with physician-led ACOs to manage the overall care. Medicare Advantage has a potential to be a big revenue source for independent physician practices.
• Collaboration opportunities with integrated healthcare systems: Enlightened integrated healthcare systems are also recognizing the value of partnering with independent provider organizations. These integrated healthcare systems recognize that employed physicians are part of their fixed costs.

As hospitals continue to face the financial challenges of decreased reimbursement from Medicare and commercial payers, as well as facing increased competition in the outpatient arena, forward-thinking, integrated health systems are looking at creative ways to partner with independent physician groups.

Hospitals have a lot of money sunk into fixed costs such as infrastructure, technology and personnel, including physicians. Organizations in all sectors of the economy, including healthcare, need to constantly evaluate the merits of make vs. buy decisions. 

The make vs. buy decision relating to physicians revolves around the merits of increasingly relying on employed physicians vs. establishing collaborative relationships with independent physicians that eliminate the fixed costs of the practice from their books.

• For-profits/private equity/venture capital: As noted in prior blogs, more money is being invested into healthcare than ever before. This funding will create career opportunities for physicians in a variety of roles. Ultimately, these funding sources will fuel innovative approaches that will cause positive disruption in the marketplace from a cost, quality and access perspective. These funding sources recognize the value of partnering with physicians who have strong leadership skills and an entrepreneurial mindset.
•  Physician-owned hospitals and surgery centers: There has been increased discussion by the Trump Administration as well as some members of Congress to lift the moratorium on physician-owned hospitals. If this moratorium is lifted it will increase business opportunities for physicians in a world that will be increasingly market- and value-driven.
• Health Insurance Companies (providing care and in leadership roles with the mothership).

As noted in prior blogs, health insurance companies are moving into the provider side. While Kaiser has always had a dual focus of insurance and providing care, organizations like United (through their subsidiary Optum), Anthem, Humana, and others are entering into this space.

Physicians again can play a role in a variety of ways with health insurance companies. Roles include: direct patient care (especially primary care), leadership roles relating to the provision of direct care, care management and medical director roles, and overall leadership positions within the health insurance company organizational structure.

Health insurance companies are also going global (Brazil, Europe, Asia, etc.), which creates additional career opportunities for physicians. 

Finally, all of these physician roles can be structured in a variety of ways such as direct employment, consulting, contracted, etc.

•  Collaborations with employers: As noted in a prior blog, Paladina Health and Iora Health are for-profit organizations who focus on partnering with employers. These types of collaborations with employers will continue in the future. Physicians could be involved in direct patient care (especially primary care) as well as overall leadership positions within the organizational structure of these types of companies.
•  Physicians working for the federal and state government: Since healthcare is such a regulated industry at the state and federal level, it has become increasingly more important for physicians to play a key role in policies that impact their sector. Physicians will have the opportunity to be employed by state and federal healthcare related agencies in leadership roles or as contracted consultants.
•  Leadership roles in population health and social determinants of health initiatives: In prior blogs, I have written about the importance of addressing social determinants of health as well as overall population health. Civic-minded physicians are in demand to assist in this evolution. Physicians can have voluntary roles serving on community boards, work for non-profits as well as at various levels of government to achieve the goal of a healthier community.
• Consulting: As I have already noted in this blog, I am also seeing more physicians join the consulting ranks in variety of different types of organizations and in a variety of different roles. When you combine a physician’s intelligence, understanding of healthcare, business savvy and leadership skills, you have the makings of a market-attractive consultant.
• Supply-chain opportunities: All of these changes are also creating opportunities downstream into the supply chain with sectors such as medical device, biotech, etc. As we evolve to a risk/value-based world, sectors such a medical device and biotech will be dramatically impacted. Physicians as consultants and employees will be a valuable assets to supply-chain organizations who want to be winners in this new world of healthcare

What are the catalysts that are igniting the increased career paths for physicians?

• Transparency: We have discussed the increased role of transparency in healthcare in a number of blogs, including one that focused on employer disruption. A key ingredient of this employer disruption is the increase in the utilization of cost & quality comparison tools to facilitate healthcare shopping. This enhanced availability of transparency to an audience of active purchasers (see below) of healthcare services creates business opportunities for physician groups or new entries into the market to demonstrate their value difference, especially in the outpatient arena.
•  Active purchasers: As I have also discussed in prior blogs, passive purchasers of healthcare are evolving to active purchasers. Examples include: Traditional Medicare to Medicare Advantage; Traditional Medicaid to Medicaid Managed Care; fully-insured employers to self-insured and employees with consumer-directed health plans. All of these active purchasers will be looking for value in the marketplace, which in-turn creates business opportunities for physicians to meet that need.
• Medicare policies are changing: Historically, as we have discussed in prior blogs, Medicare policies have had a negative impact on independent physicians. But times are changing:

A new focus on reducing physician paperwork and administrative costs: MedPac, the Think Tank for Congress recently recommended repealing MIPS, and they cited as one of the main reasons the increased administrative costs with little value on physician groups. Increased administrative costs as a result of paperwork requirements by Medicare has long been a complaint by independent physician practices.

 Site Neutral Payments

•  Market approach: As we have discussed in prior blogs, the healthcare market is going through a major restructuring and the related disruption. A core example of this restructuring is the evolution of the settings for care. Inpatient hospital admission trends across the country have been going down for a number of years and this trend will continue. Outpatient is where the action is, and this is also the sandbox where physician groups play. The outpatient setting is also increasingly being perceived as a commodity, and in a commodity-driven market decisions are driven by price. From a price perspective, given their lower overhead, physician groups are uniquely positioned to compete.
•  Advances in technology (back-room)

As noted in my blog titled, “The return of the for-profits, let the race begin,” in the 1990s, MedPartners and Phycor were national organizations that attempted to consolidate independent practices by handling the backroom, billing, managed care contracting, etc. Health South built surgery centers and leased them to independent physician practices. 

In many ways they were ahead of their time from a number perspectives. The combination of the growth of Medicare Advantage, increased cost/quality transparency tools utilized by active purchasers of healthcare services and advances in technology has created a better business environment for these types of backroom organizations.

Today, there are a number of national and regional players that operate in this arena. Examples including organizations that provide independent physician groups with the data that need to manage their practice, and organizations that will perform billing, EMR and managing care contracting services for independent physician practices.

• Increase availability of capital: (see blog titled the Return of for-profits)

1.    As noted previously in this blog, there is lot of investment capital to allow physicians to expand their practice.

2.    Given the dollars in healthcare (18% of the Gross Domestic Product) investors recognize that if they can be part of creating the better mousetrap that provides increased value in the healthcare marketplace, they would be greatly rewarded.

•  Increased advances in the interoperability of Electronic Medical Records (EMRs) across care settings will create opportunities for physicians:

Increased interoperability of EMRs will provide consumers with greater healthcare choices. This interoperability will allow the primary care medical home to have access to medical records from all types of providers of care. 

The increased interoperability of EMRs will also enhance the value of the primary care medical home as the true hub for all care information about the patient.

Increased interoperability of EMRs will also allow independent physician groups to play a role in the continuity of care of patients with chronic diseases.

Concluding Comments:

Physicians, your future is in your hands. I believe that society is also a winner when we are able to unleash the true power of the physician. 

That true power would then be seen in the integrated healthcare system that rises to the next level as the result of enhanced leadership roles of physicians.

That power of the physician would also be seen and demonstrated in a variety of other roles with a variety of organizations as noted in this blog. 

Physicians need to find the setting and the role that best suits their goals, passions and skills sets.

Ultimately, to optimize their choices and value, physicians need to first start their career journey with an honest assessment of themselves and their ability to be leaders and impactful in the arena that they choose.

They then need to develop the leadership skills that allow them to go successfully down the career path of their choice. As stated previously in this blog, that career path will not be handed to physicians on a silver platter, they need to work for it.

As was discussed in a prior blog on physician leadership, it is the soft skills that distinguish physician-leaders from physicians.  The development of these soft skills will not only make physicians better caregivers, but also create even more career options beyond that of direct patient care.

By developing their leadership skills, physicians will position themselves to control their own destiny, which will not only benefit themselves, but also our society.

Thomas Campanella is the director of the Health Care MBA and an associate professor of health economics at Baldwin Wallace University near Cleveland, Ohio.

If you are interested in receiving a monthly summary of all of my healthcare blogs, you can respond to me on LinkedIn or e-mail Tom Campanella ([email protected]) with your contact information.

Source of pictures: pixabay.com & pexels.com