Through crafty lobbying, focused public relations and a scare tactic or two, physicians have repositioned themselves as the drivers of the healthcare system.
But a word to the wise: This regained power can quickly slip away if organized medicine continues to exercise stubbornness and individual physicians turn away from the brighter sides of managed care, outcomes management and integrated delivery.
A few years ago, physicians were viewed as the culprits behind skyrocketing healthcare costs. With their inherent ability to control most medical transactions, physicians were painted as the oversubscribing, overtesting, overcharging gluttons of the bloated $1 trillion healthcare industry.
After this painful period of rejection, the public opinion pendulum has swung back of late toward physicians, while managed-care plans have become the targets of politicians, the media and consumer activists.
The managed-care revolution has helped tame runaway healthcare spending, but it also has resulted in physician income stagnation, a decline in doctors' freedom to operate independently and an upswing in third-party meddling.
It's well and good for physicians to have fought back to regain their rightful spot as the premier patient advocates. And after a temporary income dip, physician pay has again headed upward. Moreover, many trained clinicians have discovered the benefits of participating in management, administration and outcomes assessment.
Such physician leadership is commendable and invaluable to the healthcare organizations battling to survive a chaotic marketplace. But this participatory philosophy will only work if physicians and their lobbyists become less selfish and more realistic in their demands and dreams.
For instance, the American Medical Association continues to cling to its shamelessly one-sided Medicare reform package. Among other things, the proposal calls for deep payment cuts for hospitals but not for physicians. It would allow physicians to set their own fees for Medicare patients, reduce malpractice exposure, relax antitrust rules and form their own provider-sponsored networks. The AMA plan calls for ending Medigap policies by creating a $750 deductible with no copayments. It would raise the eligibility age for Medicare along with the current schedule for raising Social Security eligibility and add means-testing for beneficiaries. Physicians can't get no satisfaction.
To its credit, the AMA has cautiously embraced some of the more palatable aspects of managed care and the need for physicians to become more accountable to payers and patients.
Now it's up to individual physicians and their medical organizations to actively pursue evaluation, efficiency and patient-focused care. Physicians in leadership positions-be they healthcare system executives, medical staff chiefs, physician-hospital organization officers or medical group administrators-must blaze the trail.