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The Keckley Report

The Voice of Physician Leadership: ‘The Shift from Volume to Value is OK, but Do it with Us, not Around Us’

By August 10, 2015March 1st, 2023No Comments

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week’s article. 

Last week, in collaboration with the American Association for Physician Leadership (AAPL), the Navigant Center for Healthcare Research and Policy Analysis released findings of a new survey of more than 2,300 physicians who serve in leadership roles in hospitals, medical groups, post-acute facilities, health plans and employer settings. The results were surprising:

  • Physicians in leadership roles believe the shift from volume to value based payments will not compromise quality of care for patients. They believe the transition is here to stay.
  • Physician leaders cite health costs as the most significant issue facing healthcare (4.6 on a 5 point scale), followed by physician career satisfaction (4.5), and ahead of shortages in primary care (4.4), addressing unnecessary care (4.4), and patient adherence issues (4.4).
  • They have mixed feelings about the Affordable Care Act, but 55% believe that the law has more good in it than bad.
  • And they believe insurer profiles of physician performance are inaccurate, medical malpractice reform is necessary to lower health costs resulting from unnecessary care, and shared savings programs with hospitals often leave physicians on the short end of these deals.

It’s clear these leaders see a “new normal” for themselves and their peers that’s in stark contrast to views held by the ranks of practicing physicians. In meetings with physicians in Florida, Colorado and Tennessee last week, I listened to the views of the frontline in medicine: physicians who see patients every day.  I found their perspectives instructive as I processed findings of the survey…

  • They’re concerned about the profession. They think it’s being hurt by intrusion from policymakers and harmful cuts in their compensation by insurers.
  • They’re concerned about costs, but see little they can do to address it.
  • They’re concerned about their patients. They don’t buy that healthcare can or ever will be “consumer-driven.”
  • They don’t like health reform and the ACA (though they haven’t studied it thoroughly).
  • And they don’t like the notion of being employed. They see the growing ranks of their peers signing employment agreements with hospitals as a slippery slope to perdition in the profession.

The contrasts between the views of the two groups are sobering. One might deduce, these are the best and the worst of times for the profession, and the most challenging for its leaders.

The Best of Times

Physicians continue to enjoy the trust of patients, income 4-10 times the household median in their communities, and a sense of purpose about the profession itself. Most (64%) would choose medicine again as their career because it is meaningful, worthwhile work. Like priests, no one questions the higher calling in medicine, serving patients, though a handful in their ranks have garnered unwanted attention that’s tarnished the reputation of these professions.

The Worst of Times

The spotlight of public attention to medicine is brighter than ever. Practice patterns and inclinations toward inappropriate/unnecessary care is now public record. Business relationships that might pose conflicts of interest are disclosable. And the expanding regulatory environment in which physicians now practice is daunting. (See Issue Brief)

So physician leaders face a huge challenge: they know the train to value-based healthcare that rewards coordinated, transparent efficient and effective care delivery has left the station. Fee for service medicine and unchallenged clinical autonomy are relics of the past. However nostalgic these memories, it is history. Many physicians refuse to board. Some are on-board but hoping to apply the brakes. And all are concerned.

For physician leaders, the practice of medicine will be a team sport. More like football with playbooks and roles than golf where elite superstars take on the course. It’s complicated. And the journey poses a huge challenge for physician leaders as they drive the train.


For a summary of the AAPL survey, go to The Value of Physician Leadership

Sources: Medscape Physician Compensation Report 2015

The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

©2015 Navigant Consulting, Inc.