In the ever-evolving world of health care, physicians have to be flexible. As technology, regulations and even philosophies progress, it’s important that they be able to transform themselves, and their practices, to meet the changing times.

 

“Today’s physicians need to be able to move between the technology of medicine and the art of medicine,” explained Steven Altschuler, M.D., senior vice president of health affairs, University of Miami, and CEO of UHealth, the University of Miami Health System. “The medical field is very scientific, but there is also an art to dealing with patients and patients’ needs. While physicians’ traditional metrics involved productivity, now the overarching challenge is ensuring patient satisfaction, quality of care and outcomes.”

 

According to Dr. Altschuler, one of the biggest changes that has taken place in the industry is the shift from fee-for-service to value-based health care. “The start of value-based health care coincided with the passage of the Affordable Care Act, as well as with movements by CMS (Centers for Medicare and Medicaid Services) to find ways to incentivize good outcomes, quality of care and patient satisfaction,” he explained. “Physicians need to change their practices to be successful in a value-based health care system. It requires a robust IT system, including an electronic medical record, billing system, and clinical decision support system. The capital expense for a traditional physician in solo practice or in a partnership will be quite extensive.”

 

He adds that another challenge facing physicians today is that the entire industry—from hospitals to physician groups—is consolidating. “You see this in South Florida, where pressure is being put on physicians to join large groups or clinically integrated networks,” he said.

 

The types of patients that physicians are treating in their offices are also changing. “The burden of chronic disease has dramatically increased this population and physician training has evolved to a new care model to care for these patients,” said Dr. Altschuler. “This requires a different level of expertise.”

 

While facing all of these issues can be a challenge, medical schools and residency programs are transforming the way that they educate physicians to help meet patients’ evolving needs by placing an emphasis on outpatient care, team-based care, and the primary care medical home. “The notion now is that primary care physicians are responsible for all health and associated needs of patients—anything from referrals to specialists, to services needed from social workers, to the family implications of caring for an elderly person,” explained Dr. Altschuler. “Practices are now designed to provide all of these services. It’s not uncommon to have a number of nurse practitioners and social workers on staff to deal with all of a patient’s needs.”

 

As technology has evolved, so has the need for physicians to commit themselves to continuing education. “Technology has changed how we do diagnostics and interventions,” said Dr. Altschuler. “Traditionally, you would go to medical school, finish your residency, and sit for a board exam that showed your competencies and knowledge. Now, physicians are required to complete continuing education; they are not board-certified for life anymore.

 

“When I got my board certification in 1984, it was for life,” he added. “Doctors today get board-certified for seven years, and then must meet certain criteria to maintain that board certification.”

 

As for the future, Dr. Altschuler predicts that industry consolidation will continue as physicians continue to join larger groups, moving from solo or two- to five-physician practices because of the economies of health care. “We will also continue to see a very significant consolidation of health insurers, which is going on now,” he said.

 

“On the clinical side, I expect to see much more emphasis on precision medicine—understanding the underlying genetics and environmental factors that affect a patient in order to better design treatments, whether drugs or other therapies,” he said. “And we’ll continue to see a shift from treating disease to prevention and promoting wellness; helping patients change the behaviors that contribute to chronic disease, such as smoking, with the goal of keeping them out of the hospital. Prevention will become equal to, or more important, than treatment.”

 

While there are many challenges to be faced as health care continues to evolve, Dr. Altschuler believes that it is well worth the effort. He said, “Medicine is still a fantastic field and we are blessed to have many, many dedicated doctors out there, working hard to do what’s best for patients.”