Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Reclaiming the future of health care

Philip A. Masters, MD
Policy
March 13, 2020
57 Shares
Share
Tweet
Share

acp new logo

A guest column by the American College of Physicians, exclusive to KevinMD.

Although I work for the American College of Physicians, I’m writing this as a general internist who has practiced both primary care and hospital-based medicine for over 25 years.

Hopefully by now, you are aware of Better is Possible: The American College of Physicians’ Vision for the U.S. Health Care System published in January.  As a point of disclosure, I had no direct role in developing this vision statement.  However, as a practicing physician, I can’t help but see it as a major step toward the medical profession reclaiming the direction of health care in our country.  Let me explain.

When I began my career, medicine was a markedly different world.  Physicians occupied a much more central role in how health care was provided.  Fee-for-service was the predominant payment model, and insurers, health care organizations, and businesses held far less power and control over how medicine was practiced.  However, the rapid expansion of our country’s extraordinarily unusual health care infrastructure in which massive amounts of money flow in a system driven largely by market forces, the stage was set for development of the health care system we have today.   And frankly, at that time, I couldn’t have imagined that we would ultimately end up with the health care system we have today.

Unfortunately, organized medicine did not respond to the challenges posed by these external forces in a unified, collective manner.  The independent nature of physicians has always encouraged internal fragmentation within the medical community, and segments of the physician workforce responded to differing incentives, ranging from those focused on holding true to the traditional precepts of medicine to those more highly motivated by preserving income and control.  Doctors have seemingly never been able to speak with one voice, with the result being a remarkable diminution in physicians’ ability to guide the systems that provide care, a role subsequently taken over by others.  The consequence has been a system driven far more by competitive advantage and profitability than by core medical values based on patient and societal wellbeing.

Those of us who have been in medicine long enough have been whipsawed through change after change in the health care system over the years – a shift from fee-for-service to managed care to accountable care organizations; mergers and demergers; vertical and horizontal integration; the rapid growth of lucrative for-profit medical businesses; movement away from primary care to a focus on high reimbursement specialty “service lines,” the outsized role of the pharmaceutical industry, and many others that are certainly not driven by the desire to provide optimal patient care.

And we’ve also experienced the profound implications these systemic changes have had on patients.  Despite the amazing strides that have occurred in the science of medicine and the ability to effectively prevent, diagnose, and treat disease, the current system that could provide this incredible care is simply too complex, too difficult to navigate for individual patients, inaccessible to many, and often glaringly ineffective in providing the care that is needed.

And as clinicians, almost all of us have had to deal with the practical implications of this system in caring for patients.  Being in a generalist and primary care field, these challenges are particularly difficult.  Over the years, I’ve consistently been compelled to actively “workaround” the system on behalf of my patients.  This has included things such as seeing uninsured patients without charging them, and at times even “sneaking” them onto my schedule so they won’t be billed.  I’ve spent hours and hours attempting to manipulate the system to get my patients the care they need when they either don’t have access to it or cannot afford it.  And yes, despite the obvious ethical and boundary issues involved, I’ve even paid for medications for some of my patients who could not afford them whose health and wellbeing would be in jeopardy without them.  And I’ve experienced the eternal heartbreak of simply not being able to provide the care I know would help my patients live better lives solely because of systemic obstacles.

And this is not to mention the associated administrative burden that is an integral part of our current health care system – the extraordinary amount of time spent on documentation, pre-approvals, “peer-to-peer” discussions, and a wide variety of activities that are only marginally related to actually caring for patients, if at all.

A just, fair, equitable, and effective health care system simply doesn’t treat patients the way ours does, nor does it make physicians work this way in attempting to provide care for them.

The New Vision painstakingly documents the data underlying these issues we all encounter on a daily basis, and draws the only reasonable and logical conclusion from this evidence – that our current system is irrevocably broken, and that if we are to return to our prime role as caregivers that the system needs to be truly fixed.  And perhaps most important, that patients and physicians need to be central to this process.

It is almost certain that many will not agree with the potential solutions for how to solve these structural and functional problems put forth in the New Vision, and that is both expected and welcome.  A spirited debate around issues of such great importance is a sign of both a healthy profession and society.

However, of greater significance is that the New Vision represents a clear and definitive starting point for physicians to collectively recapture the conversation around health care, and more importantly, reclaim our central role in influencing the trajectory of how medicine is practiced in our country – if we choose to take the challenge.  And as a physician who has struggled, along with my patients, to achieve even basic health outcomes in our current system, I believe it is an opportunity we need to heartily embrace.

Philip A. Masters is vice-president, Membership and International Programs, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

Image credit: Shutterstock.com

Prev

COVID-19 coronavirus needs apolitical truth-telling

March 13, 2020 Kevin 0
…
Next

An ER physician's advice to the general public: How to flatten the curve

March 13, 2020 Kevin 11
…

Tagged as: American College of Physicians, Public Health & Policy, Washington Watch

Post navigation

< Previous Post
COVID-19 coronavirus needs apolitical truth-telling
Next Post >
An ER physician's advice to the general public: How to flatten the curve

More by Philip A. Masters, MD

  • Reflections on caring for parents with dementia

    Philip A. Masters, MD
  • Reflections of an aging physician

    Philip A. Masters, MD
  • Doctors can get angry, too

    Philip A. Masters, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Why health care replaced physician care

    Michael Weiss, MD
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA
  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA
  • Health care in American is on life support, and the future is uncharted

    Manoj Jain, MD, MPH

More in Policy

  • The realities of immigrant health care served hot from America’s melting pot

    Stella Cho
  • Healing the damaged nurse-physician dynamic

    Angel J. Mena, MD and Ali Morin, MSN, RN
  • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

    Mohammed Umer Waris, MD
  • Breaking down the barriers to effective bar-code medication administration

    Amy Dang Craft
  • The locums industry has a beef problem

    Aaron Morgenstein, MD
  • Canada’s health workers are sounding the alarm. We must act, now.

    Ivy Lynn Bourgeault, PhD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
    • What I think it means to be a medical student in the wake of AI

      Jackson J. McCue | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Marginalized Groups May Benefit More From Decreasing Air Pollution
  • Pitolisant Safe and Effective in Children With Narcolepsy
  • Functional Neurological Disorder Emerges After COVID Infection, Vaccines
  • Neuromodulation of the Peroneal Nerve Safe for Overactive Bladder
  • Clinical Challenges: Test Your Knowledge of Atopic Dermatitis

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
    • What I think it means to be a medical student in the wake of AI

      Jackson J. McCue | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...