This article first appeared on the forum Motivate MD on December 28, 2016.
Please go to medical school, finish medical school and become a doctor. This is a personal request from a 47-year-old future patient of yours. By the time I reach my elder years I’m going to need access to some medical professionals with at least a couple of decades’ worth of experience under their belts. Mathematically speaking, that means you. I confess that my advice to you may be self-serving, but at least you know I’m honest…
I’m not going to pretend to understand the intellectual, physical, and emotional challenges that you will have to manage in medical school. Others can comment more informatively about that than I. I’m not a clinician. I’m a career health care consultant. I have been practicing in, observing and writing about our health care system since the mid-1990s. The best doctors I know are more than great practitioners. They have thoughtful perspectives on a variety of issues that impact your profession. You might want to develop some of these opinions too.
With this in mind, I wish to pass on some insights on a few topics that will impact you as your career unfolds. If you start thinking about these issues now, you will begin to develop your own ideas which will help you to proactively manage your professional life.
Who needs sleep when you can think about things like…
1. REIMBURSEMENT: Advocate for direct consumer-to-provider pay models of reimbursement.
In this time of policy flux, lots of ideas about how to transform the health insurance system are being proposed. To many, a European-style, single payer system sounds attractive because of its simplicity and egalitarianism. Unfortunately, it will likely never work in America. I believe our country is too large, too diverse and too unhealthy to be managed centrally by the federal government. We’re also a capitalistic nation. We simply will not tolerate socialized medicine. Instead, we might consider an American-style single payer system where the single payer is the patient. Rather than routing money through the government and/or insurance companies for a service delivered by you, the doctor, the patient would just pay you directly. This is true consumer-driven health care. This model has already gained traction in low-acuity service environments (“minute-clinics”) and has started to gain a foothold in more acute care settings like ambulatory surgery centers. If you need any convincing that this direct pay model is a good idea, I encourage you to visit the business office of your hospital or clinic. Then go have a beer.
This model will not replace the way that all health care is reimbursed for every single patient. But it can start to simplify the payment system and move pricing towards figures that are set by the market – not by the government or an insurance company. Please re-read this section after you get your license and start thinking about employment options. When you’re a partner in a medical practice, you’ll appreciate the phrase “cash is king.”
2. CLINICAL STUDIES: Engage in useful studies that can offer low cost, high quality results.
A few years ago I spoke with an individual who was conducting a study on cancer rates in women in Sub-Saharan Africa. If a study existed that had a flawed data set, this was it. The notion that any woman in Sub-Saharan Africa would live long enough to develop cancer meant that she had already cheated death from a whole host of mortality factors including but not limited to complications during childbirth, dysentery, HIV, and violence. Think long and hard about the usefulness of what you’re studying. In contrast, consider a recent report that recommended a protocol that dramatically improves outcomes for patients that present in the ER with a hip fracture. Expediting surgery within hours rather than waiting several days reduced patient discomfort, rehabilitation time and mortality rates. Costs associated with these issues were reduced or eliminated. Most importantly, lives were saved. Win-win!
3. TECHNOLOGY: Embrace technologies that transform care rather than solutions that automate processes.
A September 2005 Health Affairs article cautiously stated that “The adoption of interoperable EMR systems could produce efficiency and safety savings of $142–$371 billion.” In case any of you were wondering, that didn’t happen. Analysts under-estimated the costs of implementation as well as the challenges of collecting and connecting a comprehensive data set. Many EMRs include scanned PDF files. The data on those files cannot be analyzed through the EMR, although it is considered “electronic.” Here are some departments that love scanned PDFs: legal and compliance. There have also been high hopes that wearables will transform health care. The problem is that most wearables simply capture data. It’s up to the user to do something with the information. The individuals that will be influenced to take action based on wearable data are the people who buy these products in the first place. It’s the individual’s motivation, not the device, which drives change. In other words, just giving people Fit-Bits isn’t going to help them with their obesity problems.
Telemedicine is a different story. Here’s a great low-cost way to broaden access to care, engage with patients on a more regular basis, and reduce costs. To be sure, telemedicine has yet to be fully regulated. As doctors, I encourage you to view telemedicine as an effective care delivery tool rather than a job-killing threat.
4. ETHICS: Read philosophy.
Your generation of doctors will face an unprecedented number of ethical situations where the cost for treatment and the need for care will come into intense conflict. A current concern is how costly hepatitis c drugs, which can run $1,000 per pill, are covered. Depending on patients’ insurance and financial situations, they may or may not be able to afford treatment. And when it comes to certain public health outlets, such as prisons, care is rationed; some inmates don’t get treatment at all. Wrap your brain around that. Advances in genetic studies and precision medicine will generate wonderful treatment options in the coming years. As with any new technology, be it an iPhone or a custom-tailored pharmaceutical, the early adapters of these cutting-edge products will be the wealthy. This inequity in care access is not strictly an American problem. Folks from all around the world come to America to get the treatments they want because they can afford to pay for them. (Some of you doctors are pretty amazing too!)
The American health care system has its issues. But know that many people are working to close the gap in care access and quality so that together, we can improve the health and wellness of all Americans.
Thank you for your commitment to such an important profession. Best of luck!