Page 9 - Delaware Medical Journal July 2015

PRESIDENT’S PAGE
NANCY FAN, MD
MSD President Nancy Fan, MD is an Obstetrician/Gynecologist who practices with Women to Women OB/GYN in Wilmington and is on the staff of Saint Francis Healthcare.
“Every generation needs a new revolution.”
– THOMAS JEFFERSON
A New Revolution?
In 2012, Accenture published a survey indicating the decline of independent physicians from 57 percent in 2000
to 39 percent in 2012.1 In the Accenture Physician Alignment Survey, the top three reasons physicians moved away from independent practice were costs and expenses, prevalence of managed care, and EMR requirements. These results were echoed in a 2013 AMA Rand study2 which also noted that the primary factor in greater physician satisfaction was providing quality patient care. I have commented on both the 2013 Rand study as well as a more recent AMA Rand study from March 20153, which looked at different payment models as a pathway for physician sustainability, including capitation, bundled payments, shared savings, pay for performance, and retainer-based models. How these national trends
apply to Delaware is the topic for this President’s Page.
I doubt the top three reasons cited in
the Accenture survey are a surprise to any physician in Delaware. As I speak with physicians throughout the state, either at Medical staff meetings or there is always the concern regarding the administrative burden of maintaining
a practice. Whether this is in the form
of the need for prior authorization with payers, the learning curve and upkeep of electronic health records, or the claims billing process, the amount of time
and effort for independent physicians
to successfully maintain their practice can be daunting. As is true of most physicians who have been in practice for ten years or more, in the “mid-life” of their career, I believe that my education and training did not adequately prepare me for these top three concerns. While hospital-based graduate medical education is crucial to learning disease processes and treatment options, traditionally it has not incorporated the importance of outpatient practice care and management into that training. However, the trend in the 21st century for the American health care delivery system is focused around outpatient care and the utilization of rapidly changing health information technology. Whether this trend is driven by the rising costs of acute care or the fact that better primary and preventive care provides better outcomes or both, the challenge is that to maintain a practice, independent or not, requires one to evolve and adapt from what our training provided to what the “new revolution” in the delivery of health care will be.
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