A recent survey of more than 1,500 front-line staffers from nine New York hospitals showed that hospital work environments that value and support a broad range of front-line workers had higher rates of patient satisfaction and lower likelihood of adverse events according to Health Behavior News Service. While this may seem to be common sense to most practitioners, it appears to come as a surprise to hospital administrators.

"How we treat hospital workers--whether we support them, give them a say in decisions about their work, and treat them not as interchangeable or dispensable cogs in a wheel but as a valued resource--affects their ability to work together to provide care that patients want and need," stated lead author Dana Beth Weinberg, associate professor at Queens College and the department of sociology at the Graduate Center-CUNY.

As a physician, your medical practice is your identity – and it is the only branding opportunity you have with your patients.  Like it or not, they associate your face with your practice and will make treatment decisions and recommendations accordingly.  Having accepted that, how do you develop a medical practice marketing strategy as a physician?

The first decision you must make is what niche you want to occupy within your specialty.  If you’re a dermatologist, do you want to be seen as the life-saver who identifies and treats skin cancer or as the Botox specialist for the masses?  If you’re a cardiologist, are you the preventative-maintenance authority who advocates lifestyle changes or the brilliant diagnostician who recommends all the right medical tests?  There is no right or wrong answer here, and every niche has value – but you need to decide how you want to brand yourself and ultimately, your practice.  A scattered marketing strategy will be ineffective because potential patients won’t be able to figure out what you have to offer them.

As a physician, you have probably noticed that your patient load – and the accompanying revenues – tends to ebb and flow. Doctors’ incomes are not subject to the same cyclical nature as, for example, owners of retail stores, who rely on holiday shopping to make up for the slow times. However, your practice may well experience slowdowns during summer, when people take vacations, and around the holidays, when they visit family and spend all their available money and time shopping for gifts. Slowdowns do vary by specialty and geographic area; cosmetic dermatologists, for example, may see an increase in appointments as patients prepare themselves for holiday parties, and gastroenterologists may also see more patients after holiday over-indulgences.  

In these busy times, it’s no surprise that the patient-doctor relationship has eroded. Increased productivity requirements have shortened the amount of time you have to spend with each patient so many physicians are opting to communicate with patients via email.

Why would doctors leave the profession because of the passage of the bill? Despite what the proponents of the bill are saying, specifically: “If you like your doctor, there is nothing in the bill that will change that, or make you lose your ability to choose”; the reality may be completely different. While it is true there is nothing in the bill that forces doctors and patients to change their relationship, the eventual outcome of the bill will be that doctors may not be able to afford to treat patients as they would like. Some doctors will not let the government (or insurance companies following government mandates) tell them how to treat their patients and will retire from medicine.

What will this mean to doctors who remain in the medical field? If only 10% of the doctors leave the profession, that will mean a heavier patient load for those doctors remaining in medicine. Heavier patient loads may be welcomed by some practitioners and will increase their income, but lower Medicare and Medicaid reimbursement will make the income increase minimal at best. More work for the same pay is not a good long term arrangement.

The more onerous implication of the bill is how many future doctors will choose another career path. It is entirely possible that many young adults will see the writing on the wall (or in the bill) and reasonably decide that their talents will be better rewarded in another profession. It will only take a few years before this decrease in students applying for medical school and ultimately graduating to become medical doctors, will be felt by patients as a doctor shortage.

The authors of the healthcare reform bill have anticipated this impending doctor shortage and have written several provisions into the bill to address this situation.

1) The only area of medical reimbursement through Medicare that is slated to increase is payments to primary care doctors in areas that are currently being medically underserved.

2) Student loans will be forgiven for doctors, nurses, and other medical professionals who work in primary care in areas of doctor shortages.

3) Student loans will come directly from the government, not just private loans guaranteed by the government. In the future students may only be available in areas of study that the government approves of, or to students the government deems in financial need.

So, even though the healthcare reform bill does not directly tell doctors where or what to practice, it clearly will define what type of practice and location of practice will be financially viable. The implications of the healthcare reform bill will not affect older doctors much, but for younger doctors or future doctors it will have a great impact. Patients will eventually see a shortage of doctors, especially in some specialty fields, and clamor for the government to do something about it. That may be the trigger point for the government to make their move toward socialized medicine.

 

COMMENTS:

Excuse me, but I lived in Europe for 30 years, working in hospitals, and there are plenty of very dedicated, happy doctors there. And they do fine financially as well. I think what you have written is nonsense.
Andrea
05/25/2010

 
“Some doctors will not let the government (or insurance companies following government mandates) tell them how to treat their patients and will retire from medicine.”

I had to comment when I read the above statement. I find that this statement pokes holes in the entire argument being presented. This is why: All doctors currently practice medicine and treat patients according to the laws and mandates of the government. There are literally hundreds of requirements and system checks in place that make it impossible to practice medicine without government involvement.

If we want to discuss the fact that doctors (particularly specialists) will not be as prevelant due to budget cuts and therefore payment reductions (SGR fix) then that’s a different story. It has nothing to do with not wanting to practice medicine under the watchful eye of “Big Brother”.
Jane Loxley
05/25/2010

 
Insurance reimbursements are so bad now I can’t imagine it getting any worse. If it does I think it will definitely affect the quality of healthcare in the future. Why would you go into a career where you have no control of your income and very little control over how you treat your patients!
To make matters worse insurance companies are now coming after money they have already paid the doctor.
This healthcare scene is not pretty. It’s actually very sad…
Ray
05/25/2010

Everything in the article is correct, unfortunately, and I will be among those who will decide to stop practicing. I feel sorry for my children and grandchildren. I and my generation have paid into the system for our entire career,and because of bad politicians and poor management, our money has been dribbled away, and now there is not enough. Even the providers are responsible, as they have committed fraudulent acts out of greed. the other issue is the lack of tort reform, which is totally out of control. Thank the lawyers for that.
Arthur N. Vecchiotti, MD
05/26/2010

It is getting harder and harder to get paid by insurance and medicare is a joke. Its all falling on the Dr’s more service demanded for less money, more documentation, with more risk with all of the new HIPPA laws. The Gov. will want less services and studies done but the Dr’s are being exposed to increasing risk of failure to diagnose, and poor treatment out come. Due to failure to enact adequate tort reform. More medical dollars going to the attorneys. Many law suits over medical conditions not treatable 20 years ago. Medicare threatening to sue every one, who wants to take the risk.
Douglas Peffer D.C.
05/26/2010

 
We have a podiatric medical office in Houston. A patient of ours actually lives in Scotland. He works as a professional soccer player. He got an ingrown toenail and was put on a six month waiting list to get it treated. In order to continue working, he flew here to Houston to get his ingrown toenail removed. He has done it multiple times. Is that the kind of situation we want for people here in the US? Where will people go for treatment when it can’t be obtained here? We will leave the business because we cannot survive under the new healthcare system. That is the bottom line. It is a sad statement in a country where we have always been proud of our free market system.
Rae
05/26/2010

All your statement here about how all these docs will quit is a good thing. We don’t need them that are only there for the money anyway. Second, the health care system with the HMO’S and PPO’s is very bad and very ccontrolling. Many doctors now that want to treat cannot get on the lists. ONLY the sacred few are allowed on FOREVER! This whole system needs to fall. So, be it about those 10% that will leave there will be thosand more that will be willing to have a good paying job when they are no longer force off the lists and can see the patients they want to see. WHY don’t you print my statement here. I have been in practice for 25 years and it became hell with these controling big corporate managage care organizations making their own laws. Government may show to prove it self to be also bad, but I am willing to take the chance from what we have now.
Dr. Wiese
06/02/2010

 
All statements to the fact that: waiting lists, patient increase, riembursment decreases, doctor fallout, loss of autonomy, regulation fines and the list goes on and on are all true. the question I have to all my doctors that are going to stay in PRIVATE PRACTICE is what are you doing in your practice to position yourself for this?

Sherry L. Krueger
06/07/2010

This was a very informative article. It just tells us about how the Bill is going to affect physicians in a quick, simple, concise manner. No hogwash. I’m a physician planning to attend med school in Spring 2012. I wanted to ask two questions, how is a private practice affected, and how will the departure of medical school students change the demand for doctors, or more specifically, how much less difficult will it be to attend medical school.

Thanks,
John
Oshii Knight
06/14/2010

Everything seems to be going against physicians these days. Reimbursements are declining, most expect healthcare reform to hurt doctors more than help them. Doctors lives are increasingly controlled by managed care “specialists”; even worse, the public perception of the integrity of physicians is declining. What should you do, roll over and cash it in. Not so fast….change can be your friend, your best opportunity to move in a new direction.

Think of this. The world is in chaos (I think we all agree on this one!), chaos creates need; need spurs the need for solution. That’s where doctors can come in. You are on the forefront of the healthcare system. The public is clamoring for solutions to the healthcare system. Studies show that patients are looking for a new set of services from their doctors, especially the baby boomers who are coming into the high utilization period of their life. They want convenience, better access, internet based healthcare and wellness. These expectations present all kinds of revenue generating opportunities for proactive doctors. Begin to listen to what your patients want and start looking around for what proactive doctors are providing to meet those needs.

Everyone’s looking for someone to blame for the ills of our healthcare problems. Is it the insurance companies who pay their executives too much, or the patients who overuse the system, or is it the doctors’ themselves? Regardless of who is to blame, it is a certainty that doctors can play a major role in bringing positive changes to the problem. However, it can’t be business as usual. Doctors need to challenge some of their most fundamental beliefs and ways of doing business. Here are some questions to ask:

Do I have a sour outlook about the future of healthcare or do I believe there is a way to make my practice more satisfying than ever?

1. Am I thinking out-of-the-box or am I locked into the old, outdated healthcare system?
2. Am I looking for ways that I, as provider, can save healthcare costs or do I spend my day resenting/fighting the insurance companies?
3. Have I looked at how I might be able to help my patients PREVENT their health problems or do I just fix/manage problems?
4. Am I looking at how I can work in conjunction with alternative modalities that most of my patients are using?

Doctors will soon be presented with two choices; either be absorbed by the system (that healthcare reform will create) or proactively reconsider and reshape how you practice.

“When doctors sit in the lounge all they do is complain about how miserable their lives are. I can’t stand to go in there anymore”, stated a thirty year veteran surgeon. Why are doctors so dissatisfied? And more importantly, why don’t they do anything about it?

In August the Department of Health and Human Services (HHS) proposed new regulations for defining and reporting security breaches of patient information under the Health Insurance Portability and Accountability Act (HIPAA). The new regulations are specifically tied to requirements in the section of the Stimulus Bill known as the HITECH Act, that provide for the adoption of Electronic Health Records (EHRs). The new HIPAA regulations went into effect on September 23rd.