Friday, February 3, 2012

Are Physicians Becoming Extinct as Solo Practitioners?


While watching the  Presidential debates and listening to economists seeking the mysteries of how not to spend more than we ‘make’, it became to me that the health care industry suffers from the same malady that our economy faces.

Technology has accelerated and has outstripped our economic structure to adapt and transform. The same is true for health care. Much of it filters down to physician offices, medical staff structure, pharma, and hospitals.

Rapid obsolesence is least often recognized initially by the species that is about to disappear until it is moribund.  Early adjustments fail to correct the stresses, and finally it crumbles.  In the process the species dwindles and it’s population declines. Such seems to be the fate of primary care and solo practitioners. Studies of physicians who practice as solo practitioners reveal a dramatic shift to group pracice and to being employed by a group practice or hospital  as opposed to being employers. What and when wil the “extinction event” occur?

American physicians are hell bent to maintain autonomy and some semblance of rule and control of their workspace.  Opinions on this are wrought with emotion. So we as physicians are at the point of “I am mad as hell, and I am not going to take it anymore”. In many ways this self-serving emotion flies in the face of mounting evidence that it takes a ‘team” to treat illness and even more so with serious illness.

Much of our economy derives success on productivity. In medicine we have formerly measured productivity with volume of patients seen and/or income.

We now see productivity in health care beginning to be measured with outcome studies,, the rate of readmission to the hospital, the incidence of acute heart disease,declines in morbidity, life span, and reduction of costs, and improved efficiency delivering health care. Much of this involves wellness and modifying factors that decrease immunity, decreasing stress, avoidance of improper nutrition and encouraging physical fitness..

We need to start on all of this early in life…in early childhood.

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