A Conversation: Status and Morale of Physicians on the First Anniversary of Health Reform

March 23, 2011 – Oft times, you can learn more quickly about the state of affairs of what is going on from a casual conversation than from a structured article based on extensive research.

Yesterday, I had a conversation with John McDaniels, who is CEO of a national practice management firm called Peak Performance Physicians. He has given me permission to print what was said during our conversation. John was in Las Vegas, though the basis of his consulting business is in New Orleans.

“ I would describe physician attitudes on reform as somewhere between panic and disarray. More and more doctors are seeking hospital employment. The younger doctors are more interested in security and life style than in making money in private practice. They know the opportunities to make money are not anywhere near what they used to be. "

“The older doctors, 60 or plus, are just seeking to cash out, work for a few years, or retire. We are seeing an awful lot of hospitals employing doctors, and doctors seeking employment.”

“Now, having said that, we are also working with a company that joint ventures with doctors on surgical centers. The last thing the hospitals want is for a physician partner to become an employee because hospitals lose revenue. We are working on what we call practice leasing. A company manages the practice at a fixed percent of collections. It gives the doctor security, but there’s no employment. The doctor remains in private practice. Both sides have the opportunity to produce. Both sides benefit. There is no capital required for the hospital or the company to buy the practice. It’s kind of like living together versus being married. They have a relationship but it’s not very formal.”

“There are all sorts of confusion about health reform and accountable care organizations. The future is clinical integration. The large clinics can achieve clinical integration because they can basically dictate to their physicians on how to treat certain diagnoses. “

“But what do you do in a private hospital setting in which you’ve got all private doctors? How do you get them on the same page? That’s the challenge. The systems can dictate, but most doctors are not in systems. This creates an awful lot of confusion. But clinical integration is great for me and other consultants.”

“ Right now, there is as much uncertainty as I have ever seen. More and more doctors are opting out of Medicaid and Medicare. That will create a tremendous access problem in the near future. This is already occurring in Massachusetts. Right now the waiting time there is 60 days. When the waiting time reaches 6 months in Massachusetts and elsewhere, Washington is going to have a real problem.”

“There is another huge problem as well. I am in Nevada right now, and my neighbor is an air traffic controller. We have interesting conversations about “highly reliable organizations.” The airplane industry tends to be highly reliable, but hospitals are not. Basically, in hospitals, every day we kill two plane loads of people. Hospitals are highly unreliable. But simple things, like checklists in the OR and on the wards and more attention to respirators, IV lines, and catheters, we could save a lot of people. Pilots are not afraid of being questioned about their procedures, but for some reason, doctors are. Why are hospitals so unreliable? Is it because patients are so fragile and sick and variable? Is it because doctors are arrogant? Is it the lack of system approachs to systemic problems?. Those are topics for you to contemplate.”