I spend way too much time worrying about “silly” things, things I have no control over. I know this because my wife frequently catches me in the act and urges me to relax, to focus on what I can change. But despite her best efforts, I recently fell off the wagon again and became obsessed with a simple, seemingly innocuous question: Are physicians still relevant? Admittedly, the question appears somewhat absurd. After all, doctors do still succor the ill, a clearly worthy endeavor. But their relevance in our society is, in fact, dwindling rapidly. Allow me to explain.
At one time, physicians enjoyed a virtual monopoly on medical advice. There was no Internet for patients to turn to, no social media to consult, and there were no direct-to-consumer pharmaceutical advertisements “educating” the public about therapeutic innovations. There were also no supermarket chain store clinics or mid-level providers. In fact, there were no “providers” at all, only doctors. And terms like “wellness,” more marketing concept than physiological state, were unheard of. So unless you were sick, you really had no reason, or time, to contemplate your health. But if you did fall ill, an independent physician was your only choice.
Back then, physicians also exerted considerable control over their professional lives. There were no third-party payers, no unnecessary layers of administration, and there was little government intervention in medical affairs. No bureaucrat would dare tell physicians how long to spend with their patients, what medications to prescribe, or how much their services were worth. Doctors provided a unique, valuable service, and then their patients simply paid them, confident that, for better or worse, a physician’s advice was always his or her own. Independent physicians ruled; their control over a rudimentary industry was complete.
Fast forward several decades, and it’s a brave new world. Health care is no longer the quaint, intimate village it once was, a place where unrushed, independent physicians served patients with unfettered therapeutic autonomy. Instead, it is now a massive metropolis where “employed” physicians roam the streets aimlessly, impotent drifters struggling to engage nameless patients for more than a few minutes at a time. They wander through once familiar territory, amidst towering glass buildings and blaring neon signs built by the bureaucracies now in charge, waiting for instructions, for permission to practice the very profession they created. Their sincere, objective counsel is no longer audible above the big-city cacophony of technological “progress,” corporate profit motive, and government mandate.
Despite the foul smog of competing interests that permeates this new delivery paradigm, one thing is clear — physicians are no longer calling the shots. And each time a physician is instructed to add medically irrelevant information to a patient’s medical record for billing purposes, each time she must alter a successful therapeutic approach to accommodate a change in insurance company policy, each time administrators force him to discharge a patient prematurely or see more patients in less time, each time any physician relinquishes any professional control whatsoever, the medical profession dies a little; it sacrifices a bit of its collective integrity and ceases to be truly relevant.
This is because relevance requires two critical elements: access and trust. Unfortunately, our system prevents physicians from meaningfully pursuing either of these. For example, we now generally equate “access” with health insurance. And doing so allows some to declare victory each time a new patient registers on Healthcare.gov. But quantifying access requires a broader perspective. Does five minutes with a physician constitute access? Does access require seeing a physician at all, or will a mid-level suffice? True access requires ample time with an independent physician, and our system is increasingly incapable of facilitating that.
And trust, an equally important component of relevance, cannot exist when a physician’s integrity is repeatedly compromised by a system that allows third-party payers, government bureaucrats, and health system administrators to subjugate a physician’s training, independence, and judgment for the sake of profit or political expediency. How can physicians establish trust with patients when their thoughts and actions, their practice models and therapeutic approaches, even the legitimate right to define quality in their profession, are no longer their own? The answer is that they can’t.
The tyrannical politico-corporate complex now firmly in control, the widespread dissemination of medical information facilitated by technological innovation, and the ever increasing reliance on non-physician providers have driven physician relevance to an all-time low. But, short of major legislative reforms unlikely to occur in the near future, here are a few things the profession can do to decelerate its frenzied sprint toward irrelevance.
Medical education must meet the demands of our time
The profession has refused to aggressively restructure, shorten, and improve medical education to meet the needs of today’s primary care patients. And so the market has, in effect, relieved it of that responsibility. Many have cited reduced professional standards and compromised clinician quality, both unfounded assertions, as reasons to not change the process by which physicians are trained. But professional vanity and blind loyalty to tradition, the same egotism that leads some to look down their noses at nurse practitioners, are more likely the culprits. And the profession will pay dearly for its continued hubris.
Diagnosing disease, dispensing medical advice, and prescribing medication, activities once exclusively reserved for physicians, have increasingly become the purview of numerous other “providers.” And a dangerous precedent has therefore been set, one intended to prove that medicine can be practiced without physicians, that pieces of their job description, critical ones, can be easily reassigned to others. Allowing that precedent to take hold will further fragment patient care, ensure decreased autonomy, exert downward pressure on compensation, and promote enough infighting to guarantee that no collective voice opposes corporate or government interests.
We should not only provide a path by which talented nurse practitioners can become full members of our profession but also ensure that a retooled, agile medical education system can produce clinicians like them in the future. There is simply no reason not to do this. A family physician is no less a doctor than a neurosurgeon despite having a vastly different skillset and less years of training. And we implicitly trust them to not cut someone’s brain open, even though, legally, they could. The profession must produce a reinvigorated general-practitioner-type role to deliver a powerful message — that the practice of medicine requires a doctor. Failing to do so will make all physicians less relevant.
All physicians must embrace a “concierge mentality”
Our current health care system has left many patients dissatisfied with both the quality and quantity of care they receive. This has created considerable opportunities for independent physicians to creatively address these gaps in patient care and simultaneously develop additional revenue streams by embracing what I refer to as a “concierge mentality.” This approach involves consistently searching for value-added services that complement a payer-dependent practice and exist wherever physician expertise and professional preferences intersect with insured patients’ unmet, unreimbursed medical needs.
Regardless of specialty, this iterative process helps identify affordable services that provide patients with real value and augment physician career satisfaction. Moreover, proactively engaging in this process will not only financially diversify an existing practice but also facilitate, if necessary, a transition to a direct-pay, concierge, or hybrid model. In the coming years, independent physicians’ relevance, their leverage with payers, their very viability as businesses, will increasingly depend on their ability to secure diverse sources of income and provide truly differentiated services.
Physicians must become effective marketers
Exceedingly short, poorly reimbursed office visits dominated by administrative tasks; weeks, months, or even longer between visits; an ever growing body of easily accessible, consumer-oriented medical information, some good, most bad; entire “health-related” industries competing for patients’ attention; harsh socioeconomic conditions driving poor health behaviors — these are the realities of today’s patient care environment. A huge chasm exists between a physician’s ability to sustain meaningful, ongoing relationships with patients and patients’ need for high-quality, objective, relevant health information.
Physicians must embrace a scientifically robust variation of content marketing to bridge this gap. This doesn’t mean they should slick their hair back, take to the airwaves, and implore patients to “come on down to Crazy Dr. Bob’s Health Shack!” It simply requires a technology strategy that successfully keeps patients engaged between visits through HIPAA-compliant use of the Internet and social media. This not only allows physicians to serve as reliable “digital tour guides” but also allows them to meaningfully influence patient behavior in inexpensive ways that can improve outcomes. Creatively using technology to both develop your professional brand and extend your clinical reach is now more critical than ever.
Payers have a vested interest in ensuring that patients view all doctors as cheap commodities, that your presence on some preferred provider list is the sole factor determining whether individuals become, or remain, your patients. The only way to retain some leverage with payers, or justify the monthly fees of a concierge model, is to maintain a truly engaged patient panel that sees differentiated value in your approach. And ten minutes a month is simply not enough time to accomplish that or remain relevant in patients’ lives, no matter how competent and compassionate the clinician.
What do you think? Are physicians as relevant in our society now as they were decades ago?
Luis Collar is a physician who blogs at Sapphire Equinox. He is the author of A Quiet Death.