Bruce Bowers,MD's Profile
I spend my clinical time specializing in the care of patients that are high-risk. In fact, the vast majority of my patients have been turned down for conventional heart valve surgery and are referred for a less invasive option. They are high risk from a multitude of perspectives. Certainly they are of advanced age, frail, debilitated, and have multiple medical co-morbidities, in addition to the heart issue they present with. Our standard of care for these patients is to have them seen in a multidisciplinary clinic where myself(cardiologist), a cardiac surgeon, and a geriatric specialist see the patient and review the case in real-time together. The discussion of risk-benefit is significantly improved when physicians are working together to treat these high-risk individuals. And sometimes, the decision is we can’t help everyone.
There is more data…Big Data…as they say. The issue I currently see is that we are generating so much data that has little to no bearing on patients, practice growth, or quality. Taking a look at the typical EMR in the US, data is shared electronically between physicians 15% of the time. Data is still being exchanged verbally and even “faxed” between Drs. most often. The reason I believe, is that the systems are data capture machines and not useful for communication. Until that changes, we will be generating “big data” that is not particularly useful to is or our patients.
Until our country decides that we are going to subsidize a large portion of the care for these patients, I fear they problem is likely only going to get worse. These patients often do not have the means by which to pay for their own care. As per usual in the US system, we treat illness as an episode, and do a poor job at early education, prevention, and detection.
I would argue that the solution lies in a multi-faceted approach which would start with education. We need to remove the stigmata that is attached to mental illness. We need our adolescence and young adults to be educated about these diseases as much as they learn about the other politically charged health education curriculum.
A more educated public will help in creating the momentum to get programs established for these patients, and help establish new hospital solutions, both private and public, to serve the need. Until the public gets engaged through education, I fear we are going to continue with the screaming “crazy” person in the corner of the ER department.
You have identified the ultimate paradox in the hospital administration-physician relationship. There are usually only two things that the two sides can typically agree on: growth and quality. Both physicians and administrative leaders can rally around these two goals. However, the path they each would take to get there, is often remarkably different and highlights the culture clash that is inherent to non-clinicians holding the roadmap to goal achievement.
This same discordance of how to reach a certain goal between physicians and non-clinical administrators, is the same one that makes compensation models so problematic. The corporate suite tends to evaluate things from a binary perspective. They create the org charts and groups in order to have a consensus. Is it a leader or a loser? Is it growing or is it shrinking? Is it good quality or bad? Is it profitable or not?
Physicians live in both a binary world: sick or healthy? Improving or worsening? Alive or dead? However, more so than our administrative counterparts, we have a significant arbitrary aspect of our profession. Teaching, research, speaking, publishing, local and national reputation, mentoring, new skill adoption, and constant educational requirements, to name a few.
The “value” of these can not be measured by employers. I suggest that until a clear value is assigned to each and every currently unmeasurable thing a physician does, it will be very difficult to have a compensation model that rewards physicians fairly for the many roles they play. Perhaps creating such a value system is a first step to the solution.