Sunday, April 22, 2007

The Second Oldest Profession

Why is it pundits and managers so often complain,
that organizing doctors is akin to herding cats?

You hear this cat tale often when experts try in vain,
to get doctors to declare and follow performance stats.

You hear it when they try to corral them into large groups.
Don’t doctors realize they’re just one of the many troops?

Why is organizing doctors like getting eagles to fly in formation?
Don’t doctors know they’re just another cog in a big organization?

Don’t doctors know birds of a feather,
By definition should stick together?

Don’t doctors know good care takes collaboration,
to solve sticky problems requiring quick resolution?

Don’t doctors know team-based medicine is where it’s at,
where most problems should be solved right off the bat?

Don’t doctors know the digital electronic medical record,
ought to be used routinely in practices across the board?

Don’t doctors know digitally tracking all clinical acts,
will allow standardized consistency based on real facts?

Don’t doctors know regional practice variation,
defies all managerial and logical rationalization?

Don’t doctors know their archaic one-on-one culture,
makes them sometimes look like a clinical vulture?

Don’t doctors know fee-for-service makes them look greedy,
especially when caring for the sick, the infirm, and the needy?

Don’t doctors know their practice will be labeled reprehensible
For all outcomes even if patients don’t behave commonsensical?

Maybe, just maybe, some doctors do know,
Which is why to culture changes they say No.

Doctors are, after all, the second oldest profession,
the latest in a distinguished long historical procession.

Many doctors feel, you see, everything under the medical sun,
can be most ideally and most personally dealt with one-on-one.


Doctors, medical group leaders have said for years, should practice in big groups In big groups, there’s simply more there there – more infrastructure, more efficiency, more teamwork, more economies of scale. Besides, as an added benefit, big groups are the way doctors can retain their independence – by working for themselves rather than hospitals and by being big enough so managed care plan can’t ignore or exclude you.

Now a downside looms to getting bigger. Large, independent, multi-specialty medical groups models are showing an inability to perform economically. The demands for capital, more specialists, more management expertise, and more infrastructure, e.g. IT systems, are becoming too much, The mounting overhead is making it impossible to reward group members sufficiently and to recruit new physicians. New health care markets are calling for consolidation of group practices model with not-for-profit community hospital and health system business model ( Zizmer, Daniel., and Person, Peter, “What Does the Future Hold for Larger, Independent, Multispecialty Group Model? Is a “Tipping Point on Model’s Horizon”, Group Practice Journal, April, 2007).

Maybe the lesson is: if your group practice is composed mostly of primary care physicians, you can never get big enough in today’s health care economic world to generate enough revenues to sustain yourself. Maybe the doctors who didn’t join these groups in the first place knew something. Maybe the fact that the percent of doctors in groups of 50 or more has never exceeded 12 percent of America’s physicians means something. Maybe more doctors are deploying information technologies and Internet access to enable themselves to practice solo signals a new trend :Maybe, by using information technologies, you can stay small, act big, be happy. and remain more personal with your patients too. Maybe solo practice will become the innovative thing to do. Maybe. But don’t count on it

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