What is the future of doctors in corporate medicine?

In an article about the future of doctors in the corporate world , health policy consultant Jeff Goldsmith asks:

"Given the macro trends, what will determine the future role and influence of practicing physicians in the care system? Here are a few questions that need answers:

• Will absorbing physicians’ costs as a “loss leader” generate sustainable economic returns for corporations where the main business purpose of employing them was not the actual delivery of medical care?
• For how long will physicians remain motivated to work for organizations where reducing medical expenses or redirecting patient trajectories after their visits — rather than achieving clinical excellence or meeting patients’ actual needs — is the main objective?
• Will physicians seeking influence over the conditions of medical practice eventually clash with corporate cultures, operational control, and human resource policies?

These questions are not entirely rhetorical, and ultimately pertain to corporate culture and the values that underlie it."

Consider:

1. The employed physician model is nothing new and dates to the Mayo Clinic, Kaiser and many academic medicine centers.
2. Whether employed or independent with privileges at many hospitals, doctors have been the cash cows generating multiples of their salaries for the hospitals by ordering tests and images. Independent and employed physicians generate an average of?about $2.38 million ?each for their affiliated hospitals. That’s up significantly from $1.6 million in 2016, the last time the survey was conducted. Employed doctors are threatening to quit. Whether they do or not is another question, but what happens when their employers lose the cash cows?

3. Doctors are challenging the medical culture of conformity

4. The last medical education reform was over 100 years ago. Teaching the business of medicine and entrepreneurship has become mainstream and no longer relegated to MD/MBA programs, most of which should be terminated or allowed to die a merciful death.

5. "Reducing medical expenses or redirecting patient trajectories after their visits" is part of the quintuple aim and has been ignored by doctors for too long, mostly because they don't have the tools and incentives to manage the costs of care. Value is defined as quality of outcomes per unit cost, not quality v cost containment. It is cruel and unusual punishment to pay doctors for value when we don't give them knowledge, skills, abilities, and competencies to create it.

6. Physician entrepreneurship applies to all physicians regardless of their employment status. The results are goods, services and models that are improving patient care, costs, experience, and elimination of waste and administrivia.

7. Rebels at work are a positive force for change

8. Sick care USA, Inc is a business. As such, we need to reconcile the conflicts between the business of medicine and the art of medicine.

9. BIG TECH, BIG RETAIL and BIG PHARMACY are changing care and business models and challenging the traditional notions of primary care.

10. Change happens in Congressional hearing rooms, not examination rooms. Given the lobbying clout of the medical-industrial complex, doctors are coming to the gunfight with knives.

11. Applicants to medical school are at record levels and their personas have changed. Fewer will roll over when they graduate or take an exit ramp.

12. Doctors have lost trust and branding wars. It is a self-inflicted wound.

13. Welcome to the Undervalued Club

14. Can corporate medicine cure the Sick System Syndrome alone, or do they need to call a doctor?

15, Are you dying to talk to Amedzon support?

16. Academic Medical Centers are consolidating and being encouraged to do so. To ensure their survival, the Association of American Medical Colleges has encouraged AMCs to increase their operational efficiencies through consolidation or affiliation with other health care systems. Recently, the pace of consolidation in the health care industry has exploded, with the volume of transactions (mergers and acquisitions)?increasing by 18% from 2013 to 2014. 7 As health care systems grow as a result of these transactions, the challenges of integrating institutions with different identities, organizational cultures, and decision-making processes become more pronounced.

UCHealth?announced ?last week that it has signed a letter of intent with Parkview Health System in Pueblo for that hospital to become part of the UCHealth system. UCHealth is committing to invest nearly $200 million into Parkview and the Pueblo community, including a donation of $5 million to the Parkview Foundation to establish a long-term fund to support Parkview’s patients, the community, and the hospital. Parkview has a 350-bed hospital and about 3,000 employees. UCHealth expects to complete the integration of Parkview into the UCHealth system in mid-202

How should you plan and prepare to work for The Man/Woman, The Dean Man/Woman or not?

1. Always have Plan B
2. Know what to do when your white coat gets the pink slip
3. Learn medical practice entrepreneurship and intrapreneurship, not just medical practice management
4. If you can't beat them, join them, and change from inside
5. Vote and donate for change
6. Participate in reforming medical education
7. Find a cure for academentia
8. Be a good rebel, not a bad one
9. Practice the 6Rs of career transitioning
10. Take care of yourself and make it personal but don't take it personally

We are witnessing the golden age of physician entrepreneurship. Stay tuned for the intended and unintended consequences of the backlash to BIG MEDICINE v small medicine . Remember, any commodity can be marketed as a luxury item.

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