Where have you been?
It's alright we know where you've been.
You've been in the pipeline, filling in time
That passage from one of Pink Floyd's signature songs is a segue into this month's cover story (page 24) focuses on the current sprint by physicians toward hospital employment, which comes as no big surprise.
A spate of compensation surveys finds physicians across the board, but especially primary care docs, rapidly losing their financial footing as ever-less money is coming in and ever more is going out to shore up their information technology and billing infrastructures, pay higher malpractice premiums and keep pace with increased demands from insurers and patients.
It's reflexive nowadays to lament the passing of the little guy in our economy, be it the Mom and Pop stories being put out of business by Wal-Mart, or the solo practitioner who wants to practice medicine his or her way without bending to the will of the corporate suits at expanding multi-hospital super health systems.
So independence is being traded for a steady paycheck, an old story in this economy. It may taste bittersweet to many physicians, but I've yet to hear exactly what the health care industry stands to lose.
Right now the consolidation is creating tension in some small markets, where regulators are worried about health systems controlling too much of the market and dictating higher prices, as well as decreasing consumer choice. Physicians for their part grumble about having less freedom in their practice of medicine and having to follow the rigid guidelines of their new employers.
But an issue that consistently crops up in our reporting is fragmentation-a lack of coordination among practices, hospitals, clinics, home health agencies, insurers and anyone else who knows something about the patient that everyone else needs to know. It all boils down to transitions between caregivers and facilities, and I've yet to talk to a medical or information professional who thinks those transitions are being managed well, by their own organizations or their partners.
While it's going to hit some rough patches, the transition to The Machine has the potential to do a much better job coordinating that care, to the big benefit of patients. Medical freedom will give way to consistency, certainly, but I'm not sure how much anyone should worry about that payoff.
Pink Floyd used The Machine in the pejorative to wail about how society was grinding away at individualism. But what does health care have to gain from maintaining physician independence at this juncture?