Today's 'ever-changing' physician

As disruptors have entered the healthcare market and technology has advanced, the role of the physician is not so easily defined. Physicians at the core are healers, but their role in the industry has changed in many ways over the past five years.

Five physicians shared with Becker's how their role as a physician has shifted or expanded in recent years. 

Editor's note: These responses were lightly edited for length and clarity.

Question: How has the role of physician changed in the last five years?

Rima Abdel Massih, MD. President, CEO and Co-founder of Infectious Disease Connect and Associate Chief of Telemedicine and Education in the Division of Infectious Diseases at UPMC (Pittsburgh). The role of the physician has evolved from being mainly a patient-healer to becoming a healthcare leader. While physicians' priority has remained providing top-quality patient care, physicians are now taking an active role in healthcare and hospital leadership. In different specialties, many physicians have stepped up into these leadership positions, leveraging their interpersonal and analytical skills, as well as their relationships with patients. Physician leaders have been involved in optimizing operational workflows, developing processes to increase access to care, and strategizing to reduce length of stay, while maintaining high quality care. 

innovative physician leaders have developed unique models of care, such as virtual telemedicine and AI solutions to allow access to subspecialty expertise in a timely and more efficient manner. Other physicians have engaged in population health initiatives and value-based arrangements to improve patient health while reducing hospital admissions and costs of care. This is an exciting shift for physicians who are naturally equipped with a change mindset and patient-centered focus, which are key to reimagining the optimal health care model of the future.

Michael Davis, MD. Chief of Urology and Surgical Director of the renal transplant program at UNM Health Sciences Center (Albuquerque). The traditional role of a physician has been to administer clinical care. The role has changed and expanded over time. Especially in the last five years, as the environment of healthcare has been impacted by multiple factors.  

The most impactful event to change the role of the physician has been the COVID-19 pandemic. COVID disrupted healthcare with accelerated innovation in technology-based healthcare, and increased the ability of physicians and other providers to offer healthcare in a fashion that did not involve brick and mortar facilities. Thus, physicians had to embrace technology and have technologic knowledge like no other time in the history of healthcare. 

As technology continues to evolve, so does the expansion of the physician role, using this technology as an adjunct to provide care. Artificial intelligence is the most modern example of technology that may help to disrupt some of the traditional roles in healthcare. Examples included image analysis, administrative duties, scheduling and messaging. Physicians will learn to use this technology to increase efficiency and patient satisfaction. Hopefully, this technology can also be used to increase physician satisfaction and decrease burnout. Once again, the role of physicians integrating IT into practice will only expand.

The role of the physician in cost containment and value-based initiatives has continued to expand in the past five years as COVID negatively impacted hospital margins and had a large impact on the healthcare workforce. The days of fee-for-service continue to decrease as more physicians are employed and have to be cognizant of the cost while still delivering the highest quality care. The burden of the aging population will only increase the need to rein in costs while also meeting the goals of patient-centered care and preventative population-based care.

Finally, with all of the above changes in healthcare, the role of the physician leader is likely to be more important than ever before and another example of the expanded role of the physician. Physicians, like those in other industries, need to be able to navigate the policy and regulatory environments, negotiate with payers and pursue the relevant resources that contribute to high-quality care and safety. Physician leadership needs to pursue fair remuneration for services while also mitigating the risks of burnout in a decreasing workforce and increased demand for service. Physician representation in policy and regulatory decisions is more important than ever.

As physicians, we all feel that we take on multiple roles including physician, clerk, transcriptionist, IT professional, among other things. The last five years have emphasized the diversity of the physician role that will only continue to evolve.

Michael Gomez, MD. NICU Medical Director at Orlando (Fla.) Health Winnie Palmer Hospital, Pediatrix Medical Group. Most physicians have historically been able to maintain some sort of boundaries between their practice of medicine and the healthcare environment they are in.

In the last five years, it has become clearer that they must create a way to relax those boundaries while still maintaining enough authority and autonomy to advocate and act on behalf of their patients.

It is a fine line wrought with complex issues that can create moral distress from the "ideal" of when many chose a career in medicine, but it is now clear that very few physicians can operate without effective collaboration or even partnerships with healthcare organizations and even payers to create an environment where they can effectively deliver value-based care. I advise younger physicians to face this challenge head on or risk the regret of compromising principles by learning as much as possible about those they work with and creating collaborative relationships with them.  If you remain passive, you lose your voice in the process.

Agnes Hurtuk, MD. Assistant professor and ambulatory medical director of ENT at Loyola Medicine (Chicago). Changes in healthcare over the last five years have forced role changes a physician may need to accept as a means of adapting to the ever-changing healthcare environment. For instance, many physicians feel new pressures to see more patients, have more responsibilities in the clinical setting due to staffing challenges and need for efficiency, all of which may also be accompanied by decreased compensation. 

In addition to this, regulatory and third-party payer quality and incentive programs have changed and continue to evolve, while taking away clinical decisions and autonomy from physicians and their practices. In the last five years physicians are increasingly required to obtain pre-authorizations for imaging tests, medications or procedures that were not previously needed. This has brought on additional stress to physicians, a feeling of loss of control, dissatisfaction with their careers, all of which may contribute to physician stress and burnout.

As a result, many physicians are looking for non-clinical opportunities within and outside of healthcare to fulfill a passion or purpose in their current career pathway, earn additional income, or to escape the current burdens of their practice. Nonclinical physician opportunities within pharmaceutical, expert witness work, and healthcare insurance or administration are highly sought after roles for physicians. In addition to these roles, some physicians may take on additional clinical responsibilities by pursuing locums or moonlighting opportunities to supplement their incomes.

Lastly, many physicians are pursuing concierge type practices to avoid some of the current health insurance and other administrative burdens experienced by the vast majority of traditional clinical physician practices. The concierge practices allow physicians to practice the type of medicine they desire, without some of the issues that drove them out of the traditional medical practice type. In all these scenarios and varying career pathways, physicians show resilience and use their training and talents to adapt to current changes in healthcare and to overcome the evolving challenges.

Robert Uzzo, MD. President and CEO of Fox Chase Cancer Center (Philadelphia). The past five years covers a historical arch both pre- and post-pandemic, and while it's a trope to say the pandemic changed everything that doesn't make it any less true. The necessity of telemedicine created an expectation among patients that they did not have to travel to a hospital to get care. 

Although not all visits can be handled through telemedicine, patient expectation that cutting edge, compassionate care will be offered closer to them remains, and Fox Chase Cancer Center has adapted by expanding our Pennsylvania-based regional campuses in Buckingham, East Norriton, and Rockledge and opening a new campus in Voorhees, N.J. Additionally, hospital financing with declining reimbursements and premium staffing costs continues to be challenging, and far too many hospitals have closed or are in danger of closing. At Fox Chase, however, we've remained financially strong due to forward thinking management decisions.

Ultimately, what has not changed is physician commitment to patients, even among those who take leadership positions. When I became president and CEO of Fox Chase, I committed to maintaining an active clinical practice so I could remain in touch with what patients were dealing with through real interactions. I know many of my leadership colleagues have made similar commitments. This decision has kept me focused as a physician on what is important, regardless of what around me changes.

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