From artificial intelligence breakthroughs to mounting insurance and reimbursement pressures, eight physicians joined Becker’s to discuss their biggest concerns, and in some cases, optimism, about the future of medicine.
Question: Looking ahead, what worries you most about the future of being a physician?
Editor’s note: These responses were edited lightly for clarity and flow.
Michael Baria, MD. Director of Orthobiologics at The Ohio State University Sports Medicine Research Institute (Columbus): I am not worried. I am excited to see growing technology on all fronts. I’m encouraged to see medical centers using new compensation models to attract great physicians, while simultaneously increasing profitability, which ensures the stability of the long-term mission. I am excited about the new medical schools being built, providing innovative educational models, training more physicians and getting them into the workforce with less debt. As we grow, physicians must seek out leadership opportunities. Physicians should be at the forefront of these changes to ensure the strength of the profession.
Gregory Brennan, MD. Gastroenterologist at Texas Digestive Disease Consultants (Mansfield): As a group, I think physicians are poorly represented in Washington D.C. and local government. Hospital systems, insurance companies and pharmaceutical industries are very well connected and influential. It seems legislation is always favoring the big players and leaving behind physicians and patients. Year after year reimbursements go down. I can’t think of anyone representing physicians on the national level who is making a meaningful impact right now.
Richard Chazal, MD. Medical Director of Heart Health at the Lee Health Heart Institute (Fort Myers, Fla.): The ongoing conflict between the need for high quality, efficient care in a system that incentivizes volume (and treatment) over value (and prevention) is a complicated issue without an easy/painless fix. Unfortunately, failure to evolve may result in economic and social forces causing an abrupt change that could be worse.
James Constant, MD. General Surgeon at Kaiser Permanente (San Francisco): Actually the opposite. I’m very excited about the promise of AI and other tech to provide real-time clinical decision support and improve quality and safety. Short-term holy grail (not clinical per se): accurate AI coding so I can spend less time on the computer and more with patients. Think of off sides soccer/tennis tech, robot umps for baseball, etc. ‘Documentation’ should return to the old primary function of enhancing communication with other healthcare team members.
Kurt Eichholz, MD. President of St. Louis Minimally Invasive Spine Center: I am worried that the increased pressure from hospitals, insurance companies and CMS will cause small independent private practices to cease to exist in the next five to 10 years. This will be highly market dependent. However, the vast majority of new physicians are going into practice as employed physicians of a hospital system, rather than running their own practice as a small business owner. This makes sense, as new doctors, just finishing residency and burdened with significant medical school debt, are looking for an immediate paycheck, rather than increasing their debt with the costs of joining or starting their own practice. Increasing hospital employment will further lead to the commoditization, or “Wal-Mart-ification” of healthcare. Patients will no longer decide which physician they want to have to take care of them, but will have to decide which hospital system they want to be a patient of. Hospital systems are incentivized to keep patients, and all of their encounters, within the system. So referring primary care doctors will be driven to send to specialists within the system, rather than to the specialist that would best serve the patient.
The continued reduction in reimbursement by CMS puts far more pressure on independent physicians. Reductions in Medicare rates do not affect hospital systems as much as independent physicians, because hospitals make significantly more revenue on the facility fees than they do on physician fees. However, independent physicians typically only have this one revenue stream, unless they have ancillary services such as a surgery center. Most insurance contacts with physicians are based on a percentage of Medicare rates. So when CMS reduces physician reimbursement by 2% to 3%, this can be 4% to 6% reduction on insurance contracts. Small practices have virtually no ability to negotiate rates with insurance companies, and they get “community rates,” which is a fraction of the rates of hospital systems. As virtually all expenses for private practices, such as malpractice rates, personnel costs, rent, utilities and so on continue to rise, physicians consider it a “win” when Washington puts a hold on CMS rate cuts. In the long run, it is not sustainable, and many physicians are making the difficult decision to give up their practice in order to be employed, thus removing the expenses, and obtaining a steady paycheck. However, that comes at a cost to all of us.
Once employed by a system, the practice belongs to the system, not to the physician. As an employed physician, you do not have a practice….you work for the hospital, providing services to their patients. In most cases, if the physician leaves the system, whether under duress or not, the patients belong to the system, and the physician will not be able to solicit patients to a new hospital system or practice. The physician is just an employee of the system. This is when being a physician is no longer a profession or a vocation, and just becomes a job.
The freedom and responsibility of being a small business owner, being responsible for your own patients, your employees, and your own practice is very rewarding. However, that will become a thing of the past as time goes on and more physicians become employed by hospital systems.
Rachel Hitt, MD. Medical Director of Patient Experience, Chief of Breast Imaging and Associate Clinical Professor of Radiology at Tufts University School of Medicine (Boston): I worry about the need to monetize every interaction with our patients, which will detract from the patient-doctor relationship. The pressure to perform constantly (working long hours without breaks, working at a fast pace) produces more opportunity to fail or fall short, for both our patients and ourselves. In academia, which has become more like private practice in terms of volume, there is less time to properly educate the next generation. The next generation will demand a better work-life balance, yet there is already a shortage of physicians being trained and many practicing doctors are leaving the profession early due to burnout. Fortunately, medical schools continue to attract the best and brightest. I just hope the business reality of practicing medicine improves to keep new physicians involved in clinical care and we can continue to attract only the best. That is what our patients deserve. We often forget that at some point in our lives, every one of us will be a patient as well. What kind of healthcare system do we want for ourselves and our loved ones? An unhealthy society is a diminished society, not optimizing its full potential.
Richard Kozarek, MD. Executive Director of the Digestive Disease Institute at Virginia Mason Medical Center (Seattle): From a professional standpoint, I worry about two things: the marginalization of research and science by the current administration as well as the unfettered medical misinformation amplified by TikTok, X, etc.
Stephen Quinnan, MD. Orthopedic Surgeon at the Paley Institute (West Palm Beach, Fla.): The actual practice of caring for patients and performing surgery have always been what makes being a physician great and that fundamental aspect of the work is unlikely to change. However, the increasingly overwhelming financial pressure, regulatory burden and vicious legal environment form a triumvirate of steadily worsening problems that are incredibly anxiety provoking and stressful. These make me concerned about what shape a future medical practice will have to take to be viable.
