Win the battle, lose the war?

If you believe the critical battles over implementation of the Patient Protection and Affordable Care Act (aka Obamacare) are being fought among politicians, you're wrong. The real fight is taking place in doctors' lounges at hospitals across the country. The outcome will determine the future quality of healthcare in the U.S. because it will define for the next generation the very essence of what it means to be a physician.

That Obamacare is causing turmoil among physicians is not news. Late last year, it was widely reported that doctors and hospitals are at war with one another all over the country. The reform law is changing the economic model in healthcare, and soon the vast majority of doctors are expected to become hospital employees—a seismic shift from the long-standing tradition of doctors owning or working at independent practices.

What's new is that while the outward conflict appears to be between doctors and hospital administrators, the actual battle is among the physicians themselves. The fight isn't about status or money. It's about patient care and a real threat to the long-held belief that medicine isn't like other businesses because people's lives are on the line.

During the past year, I was a party to a major university academic study of physicians in a large metropolitan setting to determine the human impact of healthcare reform on their psyches. According to the study findings, doctors are being threatened at a deep, emotional level, and it's beginning to affect their performance because they are worried about the future of patient care.

The physicians in the study were openly divided into two warring factions—independent and employed doctors—and visibly split along generational lines. The baby boomer doctors are rebelling against the coming new order. They value the personal relationships they have with their patients and the independence of their medical decisions.

By contrast, the younger physicians like the new paradigm of hospital employment because it provides a balanced life—a predictable workday schedule where the patient sees the next available doctor if their regular doctor isn't working that day or that shift.

The presumption is that the routine transfer of patient care from one physician to another shouldn't be a problem because the mandated electronic medical-record system will have the necessary information for any doctor to make sound medical decisions.

And this is the rub: The baby boomer doctors say this isn't the way medicine should be practiced, and they aren't going down without a fight. To them, being a doctor means a 24/7 commitment to patients and sustaining personal relationships.

No electronic medical record could ever contain enough nuance for a physician to really know their patient. The older doctors look to their younger counterparts with disdain because, as employed physicians, they are willing to accept a hospital administrator as their master in exchange for a few perks and the leeway to treat patients as transients.

In the eyes of the baby boomer doctors, the younger physicians simply aren't paying their dues, and the new practice of medicine will forever change the profession and the nature of patient care. They see a day coming where doctors will simply become fungible technicians—highly educated assembly-line workers who can be easily replaced by the next technician with similar training. And the patients will stand in line to see whichever doctor is available, with the quality of care based on the luck of the draw and the last entry in their electronic medical record.

In rebuttal, younger physicians say they are committed to their patients, and the hospital's vast resources allow for the best practice of medicine. They also believe a balanced lifestyle makes them more complete human beings, therefore better doctors. Yet they also fear the influence of hospital administrators in medical decisions and the loss of marketability that comes with commoditizing an entire profession and having a hospital employment contract with a noncompete clause.

Although divided by their response to Obamacare, the physicians are united in their sense of fear about the future. Is that how you want your physician to show up for work every day?

With the inevitability of the ACA, the baby boomer doctors may be fighting a losing battle. The reform law has transferred the bulk of power in healthcare to the institutions.

Hospitals, insurers and pharmaceutical companies are all set to gain from the implementation of our new healthcare policies.

The insurers will have more customers, the pharma companies will be able to sell to a manageable number of hospitals rather than a plethora of independent physician practices, and the hospitals will entrap patients and have control over physician costs. That leaves the doctors—arguably the most important people in healthcare delivery—as the sacrificial lambs.

In the end, as the ACA is fully implemented, and depending on the outcome of the internecine struggle raging among physicians, America may have won the battle of universal coverage, but lost the war over the quality of the healthcare we receive.

Sean K. Murphy, an independent consultant, has been a strategic adviser to numerous hospitals and healthcare systems across the U.S.