American medicine is in trouble, and the men and women who run our country’s medical societies are just the ones to save it.
Think about the trouble, the confusion, the upheaval. Some call it reform. Some call it progress. Some call it just more damn, unnecessary change. Health care is such a politically volatile phrase that it’s tough to have a civil conversation about what’s working and what isn’t. In Texas, “Obamacare” is a four-letter word, a label and a curse politicians use to kill ideas they don’t like.
Everyone’s telling our doctors what to do: Government agencies and insurance companies and big hospitals and big pharma.
Patients are paying more and getting less — except they’re getting more fine print and more denials and more runarounds and more bills. They want their medical care fast and convenient and cheap. And they’re right. We need more well care and less sick care. We need less spending and fewer bills. We can’t afford to take off a whole day to sit for hours in the waiting room with a feverish child.
American medicine needs and is heading toward a big disruption. It’s up to America’s medical societies to make sure that disruption is good not just for some antiseptic Silicon Valley corporation. It’s up to us to make sure that disruption is good for patients and for the physicians who care for them.
Disruptions are already rattling the foundations of our health care system. For example, the number of retail health clinics in this country grew by 445 percent from 2006 to 2014. It’s not surprising. Overhead is low. They’re open late. And the insurance companies and pharmacy chains reap all the profits.
If Uber and Lyft can disrupt transportation, if Warby Parker can disrupt eyeglasses, if Amazon can disrupt bookstores and then a whole lot more, lots of folks are going to continue to try to really shake up medicine. That’s going to happen — but medical societies need to make sure it happens right.
Disruptors rarely care about the destruction they leave in their wake. Aaron Montgomery Ward and Richard Sears didn’t worry about the general store proprietors who lost business to their newfangled mail-order catalogs. Taxi drivers? They can slap Uber decals on the windows of their private cars — or be left in the dust.
But is that how we want to treat our physicians — with years and years of education and training and expertise?
Plenty of people — especially millennials, government types, and insurance companies — think technology can make our health care system more efficient and effective and affordable. That’s probably so. But the so-called automation that’s being shoved down our physicians’ gullets today is making health care less efficient, less effective, and less affordable.
Physicians despise the electronic health records that take them away from patient care for more than half of their workdays. Now consider this. A recent Texas Medical Association survey found that 78 percent of physicians — men and women with a college degree and a doctoral degree and another three-plus years of specialized training — do their own data entry.
According to payscale.com, the mean hourly pay for data entry clerks in the U.S. this year is $12.52. Jim Madara, MD, the CEO of the American Medical Association, was right when he said, “American physicians have become the most expensive data entry workforce on the face of the planet. What a waste. How frustrating.”
Imagine the value medical societies would provide to our physicians if we devised a way to correct that. Imagine the loyalty we would build.
For everyone involved, it comes down to value. The consumers of health care — patients, employers, insurers, and taxpayers — demand value from physicians for their time and their money. Our member physicians demand value, in turn, from their medical societies.
Value, though, is in the eye of the beholder, or the shareholder, or the patient, or the member. Give them what they want — or pay the price.
But can our docs really do that?
Once it was pretty easy. When I was a kid, our pediatrician provided the value my parents expected with a house call and a frigid stethoscope laid on my fevered chest.
Insurance companies and government agencies today have a different expectation. They call it value-based care.
Our physicians can and should play the central role in setting that value equation. Individually, most of them can’t. They don’t have the clout to define value in a way that makes sense for their patients’ health — and for everyone’s money. They don’t have the time or the training or the equipment or the capital to redesign their practices so that they always deliver that value and can vouch for it.
That’s where medical societies come in. We can, we should, and we often do organize those individual doctors into cohesive blocks that have the clout. Clout to stop the idiocy being imposed on them by elected officials, judges, bureaucrats, bean counters, and hospital administrators who have no idea how a physician’s practice can and should run. Clout to bring the physicians’ and patients’ voices to the forefront of the health care value debate.
Plus, we teach our physicians how best to adjust to those changes. We provide them services that they trust to help them make those changes. We offer them guidance on the changes that are coming next so that they are ready and able to deliver physician-designed, patient-centric, value-based care.
And as medical society executives, that’s our challenge. Be relevant. Be authoritative. Be effective.
That’s how we provide value that overcomes the obstacles posed by physician employers who have usurped our traditional roles. That’s how we overcome obstacles posed by a generation of physicians who seem association-averse. That’s how we overcome obstacles posed by hordes of consultants and e-services that are nimble enough to move quickly into the space we have inadvertently abandoned.
If every county, state, and specialty society provides that value consistently, diligently, doggedly, they will come. The members will come. We will no longer have to fight for our survival. We will be the disrupters who blaze a better path for our physicians.
We will be the disruptors who save American medicine.
Steve Levine is vice-president of communication, Texas Medical Association, and president, American Association of Medical Society Executives. This is an adaptation of his installation address, delivered at the AAMSE Annual Conference in July, 2018.
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