I was recently invited to serve on the panel of a new think-tank about health care comprised of physician leaders from the academic, government, hospital, insurance and private sectors in Hawaii. The 12-member panel bantered about whether the country would be served well by a national system. We also spoke about an evolving model of the patient-centered medical home supported by HMSA in which patients are assigned to facilities that offer a collaborative medical team that looks after not only illness but prevention, lifestyle and psychological health of patients and their families.

One physician who runs an independent private practice launched a lively discussion about the pressures on solo practitioners, particularly, in light of health care reform. Independent physicians have always had to handle the rigors of full-time patient care in addition to practice management including staff recruitment and training; the arduous process of billing multiple payers for services; and compliance with all the laws of the land from OSHA to the IRS.

In recent years, independent physicians have had to ramp up on how to manage information systems including local area networks, internet connectivity and communications. Add to that, electronic health records. To be sure, the challenges and costs of process change in transition from paper charts to electronic records are far greater than when starting a practice with them from the get-go. The system is not simply an easy way to chart patient visits. It is a window into the medical world where colleagues and payers, especially Medicare can now readily peer in. With this new opportunity to easily survey a physician’s work, the expectations placed on what a provider does have increased dramatically.

No wonder CNN Money recently featured a piece about doctors going broke. Reduced insurance reimbursements, increased regulations and growing expenses are causing doctors to run for the door.

Physicians around the country are going bankrupt in the face of bustling practices. It has come to the point where practices that do not have enough providers to enjoy economies of scale are seriously at risk.

There is no question but that many of the systemic changes are salutary for a very sick health care system. Our national collective effort through reform is meant to increase access to quality care at a reasonable cost and it is critical that we get there.

Yet, there are serious casualties.

As we streamline and homogenize the practice of medicine, we will care for more people with fewer dollars but the art of medicine, the very soul of medicine, is at risk. This fledgling think tank has much to consider.

———

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.