We hear a lot about the death of the independent physician practice. But perhaps the more important discussion is about the death of practicing medicine independently. That is, the days when individual physician groups could operate their businesses and treat patients independently and without regard to the surrounding network of other physicians, nursing facilities, health networks, social workers, case managers, and other support is over.
It doesn’t matter whether the physician works for a large hospital system or a physician-owned practice: no longer should that physician view their patients within a narrow spectrum of a focused problem. That way of practicing medicine should go the way of the rotary telephone and the outhouse.
Today, as many physicians know, we have much better ways to practice medicine, in all specialties. The new way must be interdependent and encompass a more complete picture of the patient, including social, psychological, and other issues which may need to be addressed.
This may be surprising to hear coming from an emergency physician. ER docs have, historically, been considered the epitome of isolated care. ER docs don’t typically care longitudinally for patients and when we do it is usually because of some gap in our system of care. Additionally, all physician groups historically have operated as a wholly independent silo within the hospital they serve.
That’s wrong and needs to change. We see the beginnings of this with care coordination and case management. Today, the physician group that doesn’t work as a partner to their hospital is a group which is in danger of losing its contract.
Not only must physician groups recognize their interdependence with the hospitals and hospital systems they serve, they must build bridges with the surrounding support community. In my last several shifts, for example, I arranged for home oxygen for a patient with end-stage COPD to prevent a hospital admission, had half-a-dozen conversation on palliative and end-of-life care with patients and families, and arranged for outpatient follow-up on a patient with a new onset seizure disorder. Ten years ago, those palliative care discussions wouldn’t have happened, and the patients with COPD of seizures simply would have been admitted.
The point is, I was not practicing independently. I had case management searching for home health agencies, involvement of palliative resources and willing specialists to assist in follow-up. That is the life of an emergency physician in 2014. It should also be the life of all medical providers.
Imperfect as they may be, new structures like patient-centered medical homes and integrated care systems are vehicles that will allow medicine to transition from physician practices practicing independently, to the interdependent practice of healthcare.
It’s impossible for a single specialty, even primary care, to provide all a patient’s needs so that patient achieves optimal health. In fact, the healthcare community as a whole can’t even do it. It must be done through coordination of care teams including case managers, social workers, coaches and outreach often focused on nonmedical issues. The groups that understand this the best and work for those outcomes will not only improve the health of the community they serve but their own economic future as well.