What is happening in medicine? How will these changes affect our patients? How will they affect how we deliver health care? These seem to be the questions asked most often amongst physicians across the country. I do not profess to have a crystal ball nor can I state with any certainty what the profession we chose to dedicate our lives to will look like in the near future. However, there is one thing I can say with 100 percent confidence. The world we practice medicine in today will look vastly different in the next few years. Change is here, and it will continue to be forced upon us all at breakneck speed.
Let us look at some facts. According to the Center for Medicare & Medicaid Services (CMS) and the Bureau of Census, as of 2014, health care spending in the United States topped 3.0 trillion dollars or approximately $9,523 per person per year. We spend more than any other country on health care per capita. We spend two times as much as Switzerland, which has the second highest per capita health care cost. In terms of economic output, health care spending now makes up 17.5 percent of the entire nation’s gross domestic product (GDP) in that same year. The United States spends more than any other country per capita on health care; yet according to some estimates, we still have 50 million people without basic health coverage. The National Health Expenditures (NHE) per capita has increased at a faster rate than the consumer price index (CPI) for every year since 1980.
It is also a well-accepted fact, that more health care resources are needed as a person ages. If we take the demographic changes occurring in the United States into account, the funding for health care services takes on a more desperate tone. In 1950, the U.S. population of 65 years of age and older was 8.1 percent. This number is expected to increase to over 20 percent, or 1 in every 5 people, by the year 2050. Let’s look at another way. In 1953, there were 14 workers actively supporting the Part A payroll tax for every Medicare dependent. In 2010 the dependency ratio was 3.6 to 1 and by 2030 it is expected to be 2.3 to 1 workers per Medicare dependent.
I was recently at a workshop and heard this story that I would like to share. I am fairly certain it is not true, but I still think it helps illustrate where we are at this point in time. There was a time when there were blacksmiths on every street corner. Their main source of income was fitting horseshoes for the horses that pulled wagons. They worked very hard and did very well for themselves and their families. Business was very good, roads were not built yet, and horses required frequent horseshoe changes. The horseshoe market was booming.
One day while the blacksmiths were pounding away making horseshoes, they heard a strange noise, and when they looked up, they noticed a motorized car drive through the intersection. They all took notice for a moment and soon went back to making horseshoes. However, there were two blacksmiths that decided maybe they needed to change their business model. These two blacksmiths names were Goodyear and Firestone. I think you know the rest of story.
So what does this mean for us and for the patients we treat? It is plain and simple: We will be asked to do more with less. No matter what side of the aisle you stand, this fact is indisputable. To resist just for the sake of resisting change is not the answer. I believe physicians need to take an active role in ensuring the quality of health care delivered to our patients is not forgotten. When I was in Washington D.C. recently discussing the problems we face in health care, I realized that anytime policy makers wanted to place a new regulation in effect they were certain to add the word “quality.” We need to be certain that those coming up with these new rules for this very complex system do not just use the word “quality” when what they really mean is “cheap” or “cost savings.”
We are the true patient advocates. Patients trust us during their most vulnerable times. We have all felt the rush of adrenaline when our actions have saved a person’s life, and the pride we feel when our patient’s medical condition improves because of the care we have provided. We have all lost many nights of sleep and felt the sense of helplessness when the Lord decides we have done all we can as doctors and Heaven has called our patient home. Let’s not let change happen to us. Let’s decide to help direct that change. Let’s get involved and fight for what I still feel is the most noble of callings, to heal others. Let’s not be blacksmiths.
John Gonzalez is a urogynecology physician who blogs at LiberatedMD.
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