Medicine’s Leadership Crisis

Leadership and learning are indispensable to each other.

John Fitzgerald Kennedy(1917-1963), Remarks prepared for delivery at the Trade Center in Dallas, November 22, 1963

August 27, 2011 – This message will be brief. We have just received notice to evacuate our Old Saybrook home, which is 13 feet above sea level. Perhaps this is fitting. I was going to write a blog on the evacuation of medical leadership .

American medicine faces a leadership vacuum, and we must learn to deal with it.
Some members of the House of Delegates are openly revolting against the AMA’s support of Obamacare and its individual mandate. The AMA is hemorrhaging membership. Only 15% of doctors belong to the AMA.

Doctors responding to a 2010 Physician Foundation survey on health reform mailed to 40,000 doctors in active practice indicated widespread discontent: 86% felt they had not been adequately consulted on health reform, 56% said quality of care would decline under reform, 93% said reform would compel them to close or significantly restrict their practice to Medicaid patients and 87% said the same for Medicare recipients, 80% surveyed said reform would result in the erosion of traditional, independent practice.

American medicine is adrift. It seeks leaders to lead them out of the reform abyss. But medical leadership candidates are split. Some favor a resurrection of primary care, focusing on Medical Homes and an overturning of the Relative Value Update Committee. Others say we ought to repeal Obamacare altogether, while others say we ought to defund and dismantle it piece by piece. Young doctors seek refuge in highly paid specialties and hospital employment, as older physicians enter concierge practices.

This drift is also taking place at the national political level. You hear frequent complaints about the lack of Presidential and Congressional leadership. Only one thing seems clear. This Center Right country is moving further right with 73% of people now saying they are conservative.

Given this trend, it seems to me Medical leaders ought to prepare us for more market driven solutions: cash-only and concierge practices, health savings accounts with high deductibles, more freedom of choice among patients and doctors, shopping for plans across state lines, possible block grants for Medicaid and vouchers for Medicare, and private contracting between patients and doctors outside of Medicare and other third parties. These may be some of the alternatives if the individual mandate or Obamacare itself are declared unconstitutional.

It is more likely, however, the eventual system with be a blend of government-driven and market drive health care. Whatever transpires, physician leaders should be aware physicians have great leverage in defining the final product, for they must deliver the care. We must learn to adapt to the new realities.