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When physicians are fresh out of medical school, they are often full of the ideals we would all love them to hold onto throughout their practicing years. Young physicians are working to reach the point where they are in a position to take care of their patients, and to improve the quality of care their patients receive. Typically, young physicians have not been faced with the annoyance of bureaucracies many employers impose, and they have not yet had to deal with the implications of costs, compensation, and overhead. Therefore, their focus remains on the patient, and the provision of the best quality care possible.
Holding onto these ideals will serve physicians well as they enter their practicing years, whether they become employed by a hospital system or join a private group practice. As we all know, health care reimbursement is rapidly changing on many fronts. Not only are physician reimbursement rates going down in many instances, new incentive programs are also springing up that allow for physician payment to be directly tied to quality of care. For instance, physicians can participate in Accountable Care Organizations ("ACOs") which are paid a percentage of the amount of money they save the Medicare program. Additionally, bundled payment programs are becoming more prevalent. Bundled payment programs set a flat rate fee for a particular procedure a patient may undergo. In both types of arrangements, physicians are obviously financially incentivized to save money and provide care more efficiently. In other words, going back to the ideals taught and widely held in medical school, focusing on the quality of care provided to patients is becoming more and more tied to the compensation physicians can expect to see in the future. As I type this sentence it even seems silly in how obvious that statement may seem; however, there is a very strong history in American health care of physicians being paid on the basis of the services they provide, rather than being paid based on how well they provide those services.
Due to the inevitable evolution into pay-for-performance health care reimbursement, it seems to me that young physicians are well-served in holding onto the ideals that drew them into medicine in the first place. Keeping this frame of mind will serve physicians particularly well as they go into their job search process and negotiate their employment contracts. Employers love to work with physicians who acknowledge that this is where health care reimbursement is heading, and that the physician is amenable to participating in the structures that are becoming more prevalent.
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