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Transforming healthcare is more about patients than physicians

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Paul H. Keckley, Ph.D.,  managing editor of The Keckley Report, is a well known healthcare researcher. He had some interesting words last week for the new U.S. health and human services secretary, Tom Price, M.D.,  a former orthopedic surgeon, who has made clear that he’ll prioritize the interests of physicians in Trump administration health policy.

Among Mr. Keckley’s observations:

“{R}unning a medical practice is a tough business: coordinating care with multiple payers and capturing mandated quality measures costs $40,069 per physician (Caslino et al Health Affairs 3/16). More than 250,000 have elected to work under employment agreements with hospitals to mitigate the hassle. Federal regulations mandating the implementation of electronic medical records, quality reporting and participation in value-based purchasing programs have led the majority of physicians to suspect the profession’s future is not bright.”

“U.S. physicians are paid well: median compensation for physicians varies widely by specialty, with the lowest paid (hospitalists, psychiatrists, intensivists, internists, pediatricians, and family physicians) earning 5 times the average U.S. household and the highest specialties (orthopedics, invasive cardiology, plastic surgery, gastroenterology, and radiation oncology) earning 11 times the average. And for many specialties, additional income is earned from in-office procedures, ownership of diagnostic and surgical facilities, and practice related investments.”

“Most physicians aren’t happy: the average physician waited 9 years after undergraduate school to begin practice (AMA) and three in four left with debt averaging $166,750 (Nerdwallet). Per the Physicians Foundation Survey, the majority are dispirited and burnout is an issue for growing numbers. While the majority would choose medicine as a career again and incoming MCAT scores remain high, the intangibles of the profession seem to be fading among many medical students.”

“Demand for physician services is increasing faster than the supply….Given the doubling of the senior population in the next two decades and increased role of mid-level practitioners, it’s difficult to know for sure how the profession should address its demand. But it’s clear how patient care is delivered is likely to change as technologies and incentives change. ”

“{F}or the profession to maintain its central role in reforming healthcare, it must be more effective in addressing four issues for which it will likely be held accountable:”

  • “Health costs and affordability.”
  • “Patient adherence: Patients rely on their physicians for treatment recommendations, and 80% augment these with their own online searches. But patient adherence to treatment recommendations is problematic.”
  • ”Weeding out bad actors: for $9.95, anyone can obtain a report on disciplinary actions taken by the Federation of State Medical Boards against a clinician. But physician misconduct and impairment, conflicts of interest that might influence a treatment recommendation, and non-adherence to evidence-based practices far exceed these official reports.”
  • ”Integrating technologies that improve care coordination and outcomes: two in three U.S. adults believes telehealth and online interaction with their physician would improve care and they expect to pay for this service.”

“Transforming healthcare is not about hospitals, insurers and the profession of medicine. They play key roles, but it’s ultimately about patients—the role they’ll play and the choices they make.”

To reas his entire essay, please hit this link.


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