I am a veteran of several hospital system consolidations and, not least, efforts to integrate different physician groups into a newly consolidated organization.
Some of these physicians were employed, some were independent and some were academic affiliates.
I am grayer, but still alive.
The goals of all the consolidation efforts can be exemplary. For the patients: better access, integrated clinical programs that provide help along a broad continuum of care, helpful electronic medical records. For physicians: relief from some business responsibilities and malpractice tolls, legal protection, access to more specialists and technology, the ability to charge at hospital rates, maybe even more or better volume. For the hospitals: better bargaining leverage with payers, the opportunity to get into the payer business themselves.
There are, of course, instances when this has actually worked out.
In the cases I am most familiar with, however, at a minimum the going is tough. Even where there's been progress in moving toward value-based purchasing, stubborn cultural differences and competition between providers have continued to impede strategy, frustrate physicians and simply mystify consumers and payers.
Physician communication, engagement, outreach and network management thus remain escalating concerns.
The normal cures. The typical recommended therapy for physician engagement is involving them more in decision-making. This, it's true, is always a good practice.
In early June, in fact, the American Hospital Association and the American Medical Association released a blueprint for halting the long hostilities between physicians and hospitals. In diplomacy, this would be spun as a "framework for peace." It is in fact a list of six fine ideas (clinical independence, operational collaboration, an expensive IT system) that, like the Golden Rule or even Woodrow Wilson's Fourteen Points, could help usher in an era of peace, love and reasonable dispute resolution.
Another oft-recommended strategy is "better communications." It is similarly hard to argue with that.
The administrators and chief medical officers who typically control communication strategy also frequently focus on reducing – or at least accommodating – physician "information overload." That's another worthy pursuit.
Solving emotional as well as functional needs. But both good communication and effective physician engagement require more sensitive and more expert communications than nostrums, committee meetings and tactics to restrain the volume of emails.
I'd argue that meaningful physician communication includes a better understanding of how physicians and physician professional identity are changing. Providers are not unlike everyone else. When their circumstances change, so do their relationships to their employers, payers, suppliers, patients and each other. With changes often come uncertainty, declining expectations and discontent. It's a topic that is rarely even discussed or included in communication strategy or messaging.
But numerous studies at various locales emphatically suggest that professional identity is a key issue in communication and in physician relations. You don't have to read between the studies' lines to understand these physicians have been a notoriously dispirited lot in recent decades. Their professional uncertainties are ignored at considerable risk.
The reasons for their discontent are not that hard to divine.
Physicians and their discontents. There are threats to their earnings, their clinical independence, even their place at the top of the care hierarchy for their patients. There are existential competitive threats from retail-based clinics, from powerful payers and closed networks, from skilled nurses and from mid-levels. Quite frequently, an employed or affiliated physician finds him- or herself competing for patients against a physician employed by or affiliated within his or her own system. Depending on the doctor's age, electronic medical records may be less a boon than a grievous, time-consuming interruption to their productivity or their already rushed face-to-face interactions with their patients. Many remain overwhelmed by current volumes, resentful of standardization, frustrated by attempts to keep up with metastasizing medical knowledge about their own specialties, by coding changes, insurance denials and, not least, inconsistent payer standards of quality of care.
On the flip side, other studies about what physicians do care most about include their office mates, their specialty and clinical expertise, providing high-quality care, leadership that supports quality-improvement ideas, income stability, the quality of nurses and anesthesiologists, the financial burdens on their patients and the continuing need (and inability) to influence – some how and some way – the social determinants of their patients' health.
These are prominent among the opportunities and threats cited in numerous studies. (A few of the studies are listed below).
The order in which providers list these and other components of their importance change by locale, competitive environment and employment circumstances. The content also changes. Once they are identified, ranking them by market in order of how they influence docs, clinical care and system integration requires some research and then some disciplined communication strategy to deploy them.
So far, however, it's a rare provider organization, hospital or health plan that actually speaks (publicly or at all) about the non-clinical issues physicians either care most about or that create the greatest uncertainties for them. But adjusting strategy to discuss what influences any audience – including this one – is also a very good idea.
Bill Sonn is principal at The Sonn Group. His email: wsonn@comcast.net.
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