Joseph Anderson, MD, gastroenterologist and professor of medicine at Dartmouth College in Hanover, N.H., joined Becker's to discuss what is driving physicians out of the medical field.
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Question: In a recent survey, only 57.5 percent of physicians said they would choose to become a physician again. What reform would you make to change their minds?
Dr. Joseph Anderson: One of the major events that occurred about 30 years ago was what I call the "death of the internist," which made internists gatekeepers by putting the responsibility to decide if patients should get referrals or not onto them. In the early '90s, the role of internist was changed. The first thing I would do is make the internist more empowered. I would empower internists to not just have primary care, but have true, comprehensive internal medicine. The reason that's important is because the "death of the internist" really kind of changed a lot in medicine. Today, we deal with more complex patients. There are a lot more treatments and it feels like we're treating conditions, not patients, which makes physicians feel they are not doing a good job for their patients.
Internists and family medical physicians changed from the clinicians who was running the show and integrating care to somebody who now are a conduit for referrals. They no longer manage the patient. It's so decentralized, it forces physicians to manage outside their area of expertise. The other thing that happened is the loss of small groups, which equals a loss of autonomy.
Q: What changes would you make to address this?
JA: One thing I would want to do is make the internist or primary care provider the person who's integrating care. Raising the RVU dollar value for cognitive care might help achieve this goal. Let's reimburse for this iterative care. The other thing would be empowering small groups. The important thing about small groups is that they deliver care the best in terms of being able to work efficiently in terms of costs and things like that. In small groups, the accountability in terms of the relationship between the individual physician and those in charge is clear. You don't have middle management. Of course, there's a purpose to large organizations, but the loss of the small group has been very bad for the physician because the small groups gave physicians leverage.
I've always worked in a large health system, but the reason that I have the ability to practice the way I want to do or the salary that I'm happy with is because of the leverage due to the small practices.
The way to cure medicine is "CLOP." That's the way to cure medicine. Clop is "communication" — not through electronic records, but through human beings talking to each other. The "L: is for "longitudinal care": facilitating more long-term relationships with patients to build more trust. The "O" is for "ownership of the patient" — making sure every physician knows their patients and evaluates them individually. The "P" is for "pathophysiology" — making it clear to everyone on the team why what's being done is being done. It just goes back to basics.