Sunday, February 14, 2010
Interviews with health leaders - Interviews for ModernMedicine.com
Physicians Caught Between Blue Beast and Red Tide
I’m in the midst of conducting 12 Interviews for ModernMedicine.com, an online medical journal dedicated to helping and informing independent physicians in small practices.
These physicians form the backbone of American medicine. They deliver 80% of U.S. health care. Unfortunately, surveys indicate physicians are unhappy. Many are retiring early, not accepting new Medicare patients, and choosing new business practice models and careers outside of medicine.
As I see it, physicians are caught between the insatiable Blue Beast and the relentless Red Tide. These rapidly moving forces are not the same as a Rock and a Hard Place, which are stationary.
• The Blue Beast is the mixed U.S. economy. It is based on large, mostly unionized companies, like ATT and the Big Three auto makers , and government with its millions of union workers, the medical industrial complex, large universities , and the huge educational sector. The Democratic Party feeds the Blue Beast. The Party is built Blue, thinks Blue, and brings big green to the Big Blue. The Blue Beast is in trouble. Because of global competition and a deep recession, the Blue Beast can no longer keep wages high, and protect the security of all. Its legs have become unsteady and its footing uncertain.
• The Red Tide is a mixed, sometimes inchoate, bag. It is made of up of an increasingly disenchanted middle class, angry Tea Parties , opportunistic conservatives, and uncertain Republicans It distrusts big government, big budgets, big debt, and it wants to boot out an incumbent members of both parties. It is dedicated to bringing the Blue Beast to its knees and replacing it with something – anything – that is more efficient, less costly, and more in touch with reality and their needs. It knows what it wants but as yet does not know how to get it.
It is in this unsettling setting in which I am conducting these interviews. I have done six interviews so far.
• First was Dr. Tom Coburn, Republican Senator from Oklahoma. Dr. Cobur dubs himself a family obstetrician. He is a conservative . Health reform, he says, is in trouble. He believes the Blue Beast created much of the current trouble, by mandating what to pay doctors, and by doing so,it created the primary care shortage. He takes a sanguine view that doctors will do fine if they care well for patients. Coburn believes in market forces as the best solution to health cost problems.
• Second was Dr. Louis Goodman, CEO of the Texas Medical Association and President of The Physicians’ Foundation, a not-for-profit organization comprised of executive directors of state and local medical societies. The Foundation derives its funds from a 2003 court settlement with national HMOs . It is dedicated to protecting the nation’s independent physicians and issuing grants to make these physicians more efficient , productive, and profitable. Goodman believes tort reform is necessary to achieve this goal.
• Third was Dr. John Connolly, president and co-founder of Castle Connolly Medical Ltd, an organization that publishes books on America’s Top Doctors, most of whom it identifies as top-ranked specialists in America’s teaching hospitals and academic centers. The organization is now 18 years old, and it has published a series of books containing information on more than 3000 doctors in these centers. Castle Connolly has a database of more 25,000 doctors and has an elaborate process for winnowing out the top specialists. Connolly believes Americans want access to the very best doctors and are willing to pay for their services. He says current health care proposals threaten the very existence of these centers because of the emphasis on cutting Medicare funds and rationing high tech services.
.Four was Phillip Miller, vice president of corporate communications for the Merritt Hawkins Group , the nation's largest physician recuriting firm, and AMN Healthcare, a leading medical staff company. I interviewed Phillip because he is the author of multiple books on the physician shortage and related topics, such as the burgeoning locum tenens industry. He is a man with a foot on the ground, solidly placed where recruiting is taking place - in hospitals and medical groups. In his interview, he speaks of the shortage of medical man hours, due to such factors as specialization of doctors in high pay specialists with shorter work hours, the search for a balanced life style, more women physicians, early retirement, departure to other fields, and federal caps on training programs.
• Five was Daniel Palestrant, MD, a general surgeon and entrepreneur who founded Sermo.com nearly four years ago. Sermo is a social networking site, limited to licensed physician, and dedicated to airing their views, finding where doctors stand on clinical and social and reform issues of the day, and survey their members, now 115,000 strong. Sermo uses the information gathered to further the cause of independent physicians. Palestrant believes that the government and the medical profession are at odds, that the government will take antitrust action against physicians and insurance companies, that more and more doctors will drop out of Medicare, that the American Medical Association no longer serves doctors, and that doctors will increasingly turn to cash practices to avoid third parties.
• Six was Ron J. Pion, MD, a 78 year old Obstetrician-Gynecologist dynamo in Los Angeles, who has been a successful medical educator, founder of a hospital satellite network, advisor and founder to large medical –industrial enterprises, and an telecommunications entrepreneur. Doctor Piom believes the near and long time future of medicine lies in applications of the Internet and telecommunications to patient care inside and outside the office. Physicians, he says, hold their destinies in their own hands, and those destinies reside in computer generated data, knowledge, and expertise applied at the point of care and beyond.
If any of my readers out there have any suggestions of other people I might interview who you believe have a credible vision of the future, please let me know who they are.