It is reported that there are more than 400,000 pages in the Federal Register of regulations, rules and requirements controlling and regulating doctors. Frightening stories of Medicare audits abound. In 2003 physician payment was cut almost five percent. This cut caused considerable physician discontent and anger towards Medicare. In 2004, 2005, 2006, 2007, 2008 and 2009, payment cuts were scheduled, but at the eleventh hour, Congress held those cuts but did not stop them. Therefore, in 2010, a combined scheduled cut of 21.2% is mandated by the Sustainable Growth Rate Formula. Medicare CPT recalculations in individual specialties have further whittled down payments to physicians every year since 2000. Insurance companies peg physician payments to Medicare. Insurance panels decide treatment protocols and medication formularies. Physicians must comply or file time-consuming appeals. Congress is pushing to institute Pay-for-Performance, implying that physicians are not doing their best, and “others” are needed to determine the best treatment protocols.
What is happening here? The government, insurance companies and other entities have pushed for a more prominent and controlling role in healthcare. Physicians have conceded and not fought back. Physicians, for the most part, are interested in practicing medicine, not being involved in politics. Other forces have had their way and have undermined physician influence in the healthcare discussion and in the direction of healthcare policy. Political and insurance entities have begun controlling physicians and the healthcare agenda.
The uncertainty and upheaval in healthcare has had profound effects on physicians. These effects have been observed in Florida hospitals and have had influence in physician-hospital activities. A better understanding of the problems facing Americas doctors will help overcome potential conflicts, improve understanding, communication and physician-hospital efficiencies.
Physicians have become disgruntled and unhappy. Many feel they cannot practice medicine the way they were taught or the way they think it should be practiced. They are unable to spend time with their patients and have lost much of their patient-doctor interpersonal interaction. Physicians have been trained to be leaders and have become accustomed to being leaders; now, they have, out of necessity, become followers. The normal pressure and stress of the profession has become compounded by the recent changes and the threat of future changes.
The response to these circumstances depends on the physicians age, length of time in practice and character. The new and young physician looks for a “job” with set or limited hours. Family, hobbies and outside interests are of importance in his/her vocational choices. The older physician begins to think about an earlier retirement. Apathy and resignation is common to all groups and unconfirmed reports of increased aggressive behaviors and even suicide have been suggested.
Clearly, this cannot be good for hospitals. Apathy, fragmentation of the medical specialties and a disconnect of physicians with hospitals is detrimental to all involved in healthcare. What we are doing now is not working.
Integrating and enhancing communication across medical disciplines and with hospital administrations, working together for our mutual interest and recognition of each others unique problems will provide a better chance for political success in influencing government policy in healthcare. Competing for influence and control will be counterproductive in the long run. Controls, regulation and suppression of initiative will not work. Instead, unity, mutual respect, assistance and working together for common and individual goals will benefit both physicians and hospitals. Better understanding and free-open dialogue may help to find common solutions to the problems created by the changing environment. Interactive discussions will help bridge communication barriers and allow physicians and hospitals to be a stronger voice in public policy and improved healthcare.
