Thursday, June 13, 2013

For New Doctors: The New Commencementarians
Commencementarian  – A person accomplished in the practice of new beginnings
I dreamt last night  I gave a commencement talk before graduating medical students. 
Here is what I had to say.
You are about to enter a  brave new medical world convulsed by health reform.   As a person who has tracked health reform  over the last 30 years, here is what  you can expect.
It will be a new world, full of new beginnings.
Consolidation – You can expect to work for an organization,  either as an employee or as its leader. For the most part,  hospitals or “integrated healthcare organizations” will own these organizations.  You will will be expected to comply within the organization’s rules.  You will be expected to comply with government regulations.  You will be expected to be creative in making the organization more efficient,  more patient-oriented,  safer, and more competitive with a larger market share.  By 2015,  these large organizations will own 75% of physician practices,  for only large organizations will have the capital,  resources, and technologies to function  in the new reform environment.
Coordination -  You can expect to hear a lot about “coordination” and to be an integral part of  “coordinated, “ integrated,” and “aligned” organizational activities.  These activities will revolve around providing more comprehensive,  essential,  accountable,  and measurable practices focusing on prevention, genesis,  genomics, and treatment of chronic disease.   You can expect that  “big data” will be used to measure the success of these activities.   As W. Edwards Deming (1900-1993), the father of modern statistics, declaimed, “ In God we trust,  all others bring  data.”  You will be expected to follow protocols, guidelines, and algorithms.   If you are a primary care physician,  you will be expected to lead the clinical team, to be knowledgeable in “population health,” and  to be skilled in health information technologies.
Commentarianism -  If  you belong to  an independent  maverick, entrepreneurial,   risk-taking subgroup,   you will be expected to provide cost-lowering,  convenience-generating,   disruptive-producing ideas  that change practice and the status quo  as we now know it.   If your ideas have mass applications,  your ideas can be expected to attract venture capitalists.   You can expect most of these ideas will involve  information technologies, to lend themselves to finger clicks and flicks of your fellow physicians  and  healthcare entrepreneurs.   Many of these innovations or apps will fall within the realm of telemedicine,  monitoring patients outside the hospital,   creating new  virtual doctor-patient  communications  not requiring  the physical presence of either party, and in new payment mechanisms, such as concierge practices,  cash-only arrangements,   and bundled-payments,  outside the reach of private and government third parties.   
Tweet:   This year’s medical school graduates can expect a Brave New World,  with consolidation,  coordination, and entrepreneurship as main themes.





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