Thursday, July 23, 2015

Physician Pride and Autonomy

That the Accountable Care Act has wounded the pride of doctors and eroded their autonomy there is little doubt. Patients with primary care physicians are flocking to retail clinics staffed by nurse practitioners and physician assistants and to urgent care centers when they have no primary care doctor. Politicians are saying only the government, not physicians, can be trusted to deliver care. Doctors are rushing into hospital employment because they cannot afford to maintain private practices because of low reimbursement and government regulations . Americans are being told that only comparative data generated by computers can be trusted, not clinical judgment and experience, as a basis for paying physicians and judging “value” of services. Doctors are being replaced by nurse practitioners and physician assistants, or teams of other care professionals, to provide “coordinated care across the continuum.”

To make matters worse, there is no unifying national organization representing physicians to respond to these challenges to physician pride and autonomy. The American Medical Association is no longer respected and has declining membership. Organizations like Sermo, the Physicians Foundation, medical societies and academies represent different physician constituencies, and groups like the American Association of Physicians and Surgeons, or the Free Market Medical Association are regarded as too conservative.

The American public is confused. They consistently disapprove of ObamaCare, usually by double digit margins. They want to see a doctor but are having a hard time finding one. More than one-third are now enrolled in Medicare (55 million), Medicaid (70 million), health exchange plans (10 million), and at least one half receive government benefits in one form or another the VA, food stamps, disability payments, Social Security.

It is in this setting that a new physician organization, the United Physicians and Surgeons Association (UPSA), has been formed to address physicians dilemmas. UPSA will meet in Keystone, Colorado, on July 24-26 at a physician summit meeting to consider physician options and how to respond to ObamaCare, which appears to be here to stay, to bundled payments for episodes of care rather than fee-for-service, to declining physician reimbursements and regulations, to online virtual relationships between patients and doctors, to the constraints of hospital employment and its high costs for patients, to walk-in clinics as an option to physician office visits, to how to use new social media and mobile device innovations to improve care and convenience and market their services, to market -based alternatives, such as direct ambulatory primary and surgical care devoid of 3rd party involvement, to and high deductible savings accounts, in which patient mus pay up to the amount of the deductible. In the age of a rapid changing culture in which physicians are considered as just another market commodity, and which are sometimes viewed with irreverence, there is no single magical answer to these various challenges. Thee are only niches to be filled, and alternative consumer-friendly markets to be developed.

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