It is hard to imagine a more uncertain time for the healthcare industry in the United States.
The recession has brought an increase in charity and unreimbursed care as millions of Americans join the ranks of the unemployed and lose their healthcare benefits. Recruiting in the midst of a severe physician shortage is only going to get tougher as more doctors retire and competition intensifies for the too-small candidate pool to replace them.
And, hanging over everything, is healthcare reform. Just about everyone agrees that President Barack Obama will sign some sort of healthcare reform bill this year. Few, however, would venture to guarantee what those reforms will contain beyond an expected expansion of health insurance coverage to some of the 46 million uninsured people in the United States.
So, physicians and other healthcare professionals are looking at a very distinct possibility that they will soon be asked to work harder for more people and probably not make as much money. A little anxiety and outright crankiness is to be expected.
"It's a very trying time for physicians. There are changes going on in the entire context of the healthcare delivery system, and the fact that the economy is down, and so their practices are down," says Jeff Peters, president and CEO of Surgical Directions, LLC, a physician-led consulting firm.
Peters says unhappy physicians should no longer be looked at as disgruntled prima donnas. "That is probably a dying concept. Clearly, the younger physicians are much more balanced and reasonable," he says. "The biggest issue is that they are working too hard. They have too many nights, too many weekends, too much call, and they aren't making enough money. So, there is a general unhappiness with the level of compensation in comparison to the amount of work they are doing."
Being human, Peters says, physicians will take their anger out on whoever is close to them, or whoever is perceived—whether fairly or not—to be the source of their frustration. And in a physician practice, no one is more of a lightening rod for complaints and dissatisfaction—even in the best of times—than the practice administrator.
Give physicians a say
"A lot of the other unhappiness stems from the doctor not making enough money. While the practice manager can't control the market forces, there is a lot they can do to drive the overall processes to help the practice be more successful," he says.
Peters says there are a number of big issues that can sink a physician practice if not correctly navigated. Probably the biggest single mistake a practice can make, Peters says, would be to change the compensation formula without input from the affected physicians. Billing and collections issues are always hazardous. The advent of electronic medical records (EMR)—which has the potential to profoundly reshape healthcare delivery—is another potential iceberg for physician practices. "There are going to be lots of changes associated with EMR, and it never goes perfectly, and they are going to blame the practice administrator," Peters says.