President’s MessageIs This The World We Want?Health care in the United <strong>State</strong>shas been in a state of evolution overthe past 40 to 50 years. A numberof factors influence these changes,including economic pressures,advances in technology, politicalpressures, and the changingdemographics of our nation.What do we have to look forwardto as physicians? If the opinionsof many experts hold true, thereplacement of the independent,private physician practice modelis inevitable. Many pressures willforce physicians to consolidatewith other physicians, or becomeemployees of a hospital, or healthcare delivery system because theywill lack the money or technicalor administrative resourcesneeded to survive on their own.The emerging practice modelswill vary depending on wherein the country one practices.New terms such as AccountableCare Organizations (ACOs),<strong>Medical</strong> Home, Aligned Groups,Concierge Practice, CommunityHealth Centers, and Small AlignedGroups will be common place.Current and future health carereforms will impact physicians inways not seen in the past. Complyingwith government regulations isgoing to become a minefield; andof course, open up new, potentialareas of liability. Many of you haveheard of the “Whistleblower”. Thegovernment is pouring a great dealof money into this program to recoupfunds possibly obtained by fraud.The government is also discussingsuspension of the need to provethat one intended to defraud. Theaverage doctor is going to be outmatched in this environment.This new medical practice climateis going to cause many physicians toretire early or change careers. Sadly,I would imagine that many youngpeople will not be encouraged bypracticing physicians to seek a careerin medicine. If we think we have aphysician shortage now, what onearth does the future offer? Primarycare shortages especially are goingto be severe. There is no doubt thatfuture primary care doctors willspend less time with patients. Heor she will spend the bulk of theirtime reviewing practice patterns,seeing the most difficult cases, andupdating information technologytemplates on their computer. Thismay appeal to the individual whodoes not enjoy interacting one onone with their patients. I do notpersonally believe that anyonehas been trained for this. Thosephysicians are going to be pressuredto change practice patterns. We willutilize more and more allied healthprofessionals in order to meet publicand government demand for higherquality care at a lower price. Look atall the problems with the SustainableGrowth Rate (SGR) formula and askyourself if increased reimbursementfor your services despite increasingoverhead costs is going to bepart of this NEW WORLD.Surveys of physicians abouthealth care reforms have been widelyunfavorable. Most physicians feelthat the reforms cause them to workharder for less pay in order to carefor their patients in this environment.Physicians wonder if they can affordto practice medicine. The future ofthe full-time, independent physicianaccepting third party payments willdie. New physician classifications willbe Part-Time Physician, EmployedPhysician, and Concierge Physician.Thomas Paine wrote on December23, 1776 “These are the times that trymen’s souls, but he that stands by itnow, deserves the love and thanksof man and woman”. My fellow<strong>West</strong> <strong>Virginia</strong> physicians, these aretroubling times for men and womenof medicine. If you feel you can tacklethe issues on your own, then continueon as if no storm is brewing. If youare concerned, which I feel many ofyou are, then embrace and supportorganized medicine’s efforts to havea voice in the decision process. Ifwe have greater numbers, maybewe can MOVE THE WORLD.MaryAnn N. Cater, DOWVSMA President4 <strong>West</strong> <strong>Virginia</strong> <strong>Medical</strong> Journal
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