Younger Physicians Must Become Game Changers

All health care is local, as the late Speaker of the House Tip O’Neill so famously noted about politics. And politics is at least part of the reason why we physicians face the challenges we do in health care reform.

The Affordable Care Act takes a broad approach to health care reform, rather than a local one. Its focus on Accountable Care Organizations (ACOs) demonstrates that national health policy makers want to pay health systems a fixed dollar amount to provide care to a population of people. This approach stands in stark contrast to the free-spending, no-one-looks-at-the-price-tag-approach the federal government fostered with the laws that launched Medicare and, to a lesser extent Medicaid, in the 1960s.

Reform became inevitable when General Motors spent more on health care in 1 year than it did on steel. Something had to give.

And physicians are responsible for part of the problem. A significant health care spending variance has been documented. Differences in what physicians order vary by region, with rates for a specific procedure being 10 times higher in some parts of the country than others.

While hip fracture rates are stable across the country, the rate of hip replacement surgeries done for arthritis varies widely. In truth, the unexplained variance is due to provider-induced demand, as has been documented by Dartmouth College researchers.

If physicians do not tackle this problem, others will.

The law’s emphasis on ACOs may have rheumatologists, as specialists who fall outside the primary care umbrella, feeling disenfranchised. As health care reform becomes more mature, private payers are going to move fast to cap spending.

Physicians must resist the urge to ignore the events going on around them; they must get involved with an eye to improving the outcome of health care reform for their specialty.

An aptitude for problem solving is why many physicians chose medical school in the first place, but how to fit into the new world order is not the problem that we signed up for when choosing medical school.

This problem is societal, economic, ethical, clinical, and personal. Physicians hate being told what to do. It annoys us. Having to get prior consent annoys us. But things are going to change whether we are part of the process or not, whether we like it or not.

To be part of the solution, physicians need to get informed. There is a lot being written. Discuss issues with local thought leaders.

The challenge of shaping medicine in the midst of health care reform belongs most to physicians who have at least 10 more years to practice. Tag, you’re it, the leaders of the change. Start acting the part.

The first steps may include joining the county medical society to get to know the other physicians in the area. Find out who the key opinion leaders are in your region and meet them. And read many perspective pieces on health care reform, Medicare, and other cost and political issues of importance, and become informed about the subjects and the arguments for and against them.

Dr. Karen S. Kolba, chair of the American College of Rheumatology Committee on Rheumatologic Care, is in private practice in Santa Maria, Calif. She reported having no relevant financial disclosures.

All health care is local, as the late Speaker of the House Tip O’Neill so famously noted about politics. And politics is at least part of the reason why we physicians face the challenges we do in health care reform.

The Affordable Care Act takes a broad approach to health care reform, rather than a local one. Its focus on Accountable Care Organizations (ACOs) demonstrates that national health policy makers want to pay health systems a fixed dollar amount to provide care to a population of people. This approach stands in stark contrast to the free-spending, no-one-looks-at-the-price-tag-approach the federal government fostered with the laws that launched Medicare and, to a lesser extent Medicaid, in the 1960s.

Reform became inevitable when General Motors spent more on health care in 1 year than it did on steel. Something had to give.

And physicians are responsible for part of the problem. A significant health care spending variance has been documented. Differences in what physicians order vary by region, with rates for a specific procedure being 10 times higher in some parts of the country than others.

While hip fracture rates are stable across the country, the rate of hip replacement surgeries done for arthritis varies widely. In truth, the unexplained variance is due to provider-induced demand, as has been documented by Dartmouth College researchers.

If physicians do not tackle this problem, others will.

The law’s emphasis on ACOs may have rheumatologists, as specialists who fall outside the primary care umbrella, feeling disenfranchised. As health care reform becomes more mature, private payers are going to move fast to cap spending.

Physicians must resist the urge to ignore the events going on around them; they must get involved with an eye to improving the outcome of health care reform for their specialty.

An aptitude for problem solving is why many physicians chose medical school in the first place, but how to fit into the new world order is not the problem that we signed up for when choosing medical school.

This problem is societal, economic, ethical, clinical, and personal. Physicians hate being told what to do. It annoys us. Having to get prior consent annoys us. But things are going to change whether we are part of the process or not, whether we like it or not.

To be part of the solution, physicians need to get informed. There is a lot being written. Discuss issues with local thought leaders.

The challenge of shaping medicine in the midst of health care reform belongs most to physicians who have at least 10 more years to practice. Tag, you’re it, the leaders of the change. Start acting the part.

The first steps may include joining the county medical society to get to know the other physicians in the area. Find out who the key opinion leaders are in your region and meet them. And read many perspective pieces on health care reform, Medicare, and other cost and political issues of importance, and become informed about the subjects and the arguments for and against them.

Dr. Karen S. Kolba, chair of the American College of Rheumatology Committee on Rheumatologic Care, is in private practice in Santa Maria, Calif. She reported having no relevant financial disclosures.

All health care is local, as the late Speaker of the House Tip O’Neill so famously noted about politics. And politics is at least part of the reason why we physicians face the challenges we do in health care reform.

The Affordable Care Act takes a broad approach to health care reform, rather than a local one. Its focus on Accountable Care Organizations (ACOs) demonstrates that national health policy makers want to pay health systems a fixed dollar amount to provide care to a population of people. This approach stands in stark contrast to the free-spending, no-one-looks-at-the-price-tag-approach the federal government fostered with the laws that launched Medicare and, to a lesser extent Medicaid, in the 1960s.

Reform became inevitable when General Motors spent more on health care in 1 year than it did on steel. Something had to give.

And physicians are responsible for part of the problem. A significant health care spending variance has been documented. Differences in what physicians order vary by region, with rates for a specific procedure being 10 times higher in some parts of the country than others.

While hip fracture rates are stable across the country, the rate of hip replacement surgeries done for arthritis varies widely. In truth, the unexplained variance is due to provider-induced demand, as has been documented by Dartmouth College researchers.

If physicians do not tackle this problem, others will.

The law’s emphasis on ACOs may have rheumatologists, as specialists who fall outside the primary care umbrella, feeling disenfranchised. As health care reform becomes more mature, private payers are going to move fast to cap spending.

Physicians must resist the urge to ignore the events going on around them; they must get involved with an eye to improving the outcome of health care reform for their specialty.

An aptitude for problem solving is why many physicians chose medical school in the first place, but how to fit into the new world order is not the problem that we signed up for when choosing medical school.

This problem is societal, economic, ethical, clinical, and personal. Physicians hate being told what to do. It annoys us. Having to get prior consent annoys us. But things are going to change whether we are part of the process or not, whether we like it or not.

To be part of the solution, physicians need to get informed. There is a lot being written. Discuss issues with local thought leaders.

The challenge of shaping medicine in the midst of health care reform belongs most to physicians who have at least 10 more years to practice. Tag, you’re it, the leaders of the change. Start acting the part.

The first steps may include joining the county medical society to get to know the other physicians in the area. Find out who the key opinion leaders are in your region and meet them. And read many perspective pieces on health care reform, Medicare, and other cost and political issues of importance, and become informed about the subjects and the arguments for and against them.

Dr. Karen S. Kolba, chair of the American College of Rheumatology Committee on Rheumatologic Care, is in private practice in Santa Maria, Calif. She reported having no relevant financial disclosures.