How can physicians leverage their power? 

Five healthcare leaders recently joined Becker's to discuss how physicians can leverage their power in the industry.

Question: How can physicians leverage their power? 

Editor's note: These responses were edited lightly for brevity and clarity.

Luis Argueso. Partner at InHealth Advisors: Despite the burnout epidemic, workforce shortages often lead to greater bargaining power among physicians. This presents physicians with the opportunity to push for change in the way medicine is practiced and paid for, especially as they increasingly leave private practice to be employed by large healthcare organizations. I have observed how fee-for-service medicine often leads to a vicious cycle of less time with patients and more administrative burden, as physicians seek to maximize revenue through more patient visits that require significant time both to document in the EHR and to adjudicate claims.  Physicians can use this unique increase in bargaining power to emphasize provider-led innovation in value-based care, particularly around care delivery and reimbursement models.  This represents a potential long-term improvement to their quality of life over time-worn battles like increases in the Medicare conversion factor.

Brian Curtin, MD. Orthopedic Surgeon at OrthoCarolina (Charlotte, N.C.): First and foremost, physicians have to take on leadership roles within healthcare systems such that there is a voice advocating for patients and patient care. Many systemwide healthcare and policy decisions are made in meeting rooms full of hospital administrators or politicians with little clinical background and little understanding of repercussions on patient care. Our professional organizations also have to remain engaged in advocacy efforts to ensure healthcare regulation and policy development is physician-led. This requires time and commitment from physicians to these organizations and the collective voice is far more powerful than any one physician alone. 

Matt Mazurek, MD. Assistant Clinical Professor of Anesthesiology at St. Raphael's Campus of Yale New Haven (Conn.) Hospital: Physicians need to continue to obtain advanced degrees in business, information technology and public health. Physicians are in a unique position to quickly learn and understand the business and operational climate of healthcare — both locally, regionally and nationally. More importantly, as physicians are increasingly employed, the value of unionization will increase. Unions restore collective power and influence. I realize the idea of forming unions is very controversial and contentious, but other methods to raise collective concerns about patient care or the work environment remain ineffective. For example, physician burnout remains high, and the systemic contributors remain largely unaddressed. It is impossible for physicians to agree on everything, but there are issues affecting all physicians that can best be addressed through unions. 

Smita Rouillard, MD. Associate Medical Director of The Permanente Medical Group (Oakland, Calif.): As part of a physician-led, integrated and value-based organization, the Permanente Medical Groups have always operated differently. Our model demonstrates how physicians can partner with hospitals and health plans to deliver 21st century medicine. We believe physician leadership drives exceptional care for our patients. Physician leadership guides every action, and every decision is made with the patients' best interests at heart.

We know, through our nearly 80-year history at Kaiser Permanente, that value-based care drives better quality. We see that in our NCQA results, we see that in our CMS results. Better quality equals better cost outcomes. Physician leadership enables us to derive this through quality efforts versus costs alone. For example, as a gastroenterologist, I thought it was interesting to see how a large fee-for-service organization approaches colonoscopy surveillance and diagnostic care. This now requires pre-authorization while a screening colonoscopy does not. Why? To prompt physicians to use guidelines in decision-making.

We operate differently with guidelines at the front of physician decision-making and due to our prepaid model, the patient, physician and health plan interests are all in alignment. As a first-line test for screening the average-risk individuals, we want to use fecal immunochemical tests, which patients can use at home and then send to a lab for analysis. Depending on the outcome of those tests, a physician may order a colonoscopy with no pre-authorization and no out-of-pocket co-payment for the patient. We use gastroenterology society guidelines (for example, those provided by ACG, AGA, ASGE, etc.) to determine the interval for colonoscopy surveillance — without the need for pre-authorization. It is a perfect example of the difference of true integration and physician leadership with patients at the center of the decision-making, not in the middle.

Shlomit Schaal, MD, PhD. Executive Vice President and Chief Physician Executive at Houston Methodist: Physicians have a critical role in the healthcare industry and can leverage their power in several ways:

  • Advocacy: Physicians can use their expertise and influence to advocate for policy changes that improve patient care and the healthcare system. They can play a vital role in shaping healthcare policies, not only within their own practices or hospitals, but at the regional, national and even international levels.
  • Education and mentorship: As a clinician-scientist and an academician, I wholeheartedly believe that mentoring the next generation of healthcare professionals, physicians will ensure the future of healthcare is built on strong foundations of knowledge and ethics. Mentors can provide guidance on enhancing clinical skills and navigating complex patient cases. They can share their expertise and practical knowledge, thereby helping less experienced physicians improve their clinical acumen. Mentors play a key role in instilling the values of professionalism and ethical practice. They can guide mentees in dealing with challenging ethical dilemmas and in cultivating professional behavior; this is particularly important as non-physician industry leaders don't have the same perspective.
  • Innovation: Physicians are often at the forefront of medical innovation. They can leverage their unique insights into patient needs and care processes to develop or collaborate on new technologies, treatments and models of care. The balance of power in the healthcare industry is delicate, and physicians tend to prioritize the well-being and best interests of their patients above all.

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