After working in policy, business, and clinical medicine, I can tell you right now there will be great changes in medicine in the future. In the consulting world, we are seeing a lot of cost shifting being done by large employer groups, which most people are not willing to tolerate. We are thus beginning to see a trend in consumer driven healthcare as a possible option which will require individuals to make more decisions about their own personal healthcare while managing their own expenses
So how does this impact physician?
Many physician groups are dropping out of the major health networks, mainly due to bankruptcy because capitation is simply not enough to cover the cost of claims. Although the idea of managed care does have its positives regarding preventive healthcare and healthcare promotion, with escalating costs especially in the arena of prescription drugs (due to a increasing number of the elderly population), most physicians can anticipate rising claims without the same increase in capitation. Bottom line here is that many are returning to fee for service models (the main reason why managed care came to existence in the first place).
In addition to these dillemmas, you have the issues regarding a population that increasingly suffers from chronic conditions that will require individuals to obtain additional care with limited resources. With the surplus gone, and the economy in a recession, you can expect the uninsured population to climb once again and for entitlement programs such as Medicare and Medicaid to be cut.
We are in a system with limited resources and it can be anticipated that there will by many challenges ahead to address these issues. The biggest problem of which how to deliver quality care in the most cost effective way without actually increasing costs and hitting people where it hurts, in their pocketbooks. This is resulting in the hiring of other healthcare professionals that can deliver similar care such as nurse practitioners at a cheaper cost. Ultimately, this will cause the primary care physician salaries to shift downward as the public demands cheaper healthcare and other health professionals can meet these demands.
I can tell you in the business arena and during my masters degree in public health, I encounter many disgruntled phsyicians, more so the younger professionals that are busting their asses and have to deal with this system of limitations. It is important as we all pursue the medical profession to understand the frustrations and obstacles we have ahead of us. The days of treating patients and being the patients number one advocate are gone unfortunately. I believe many enter this profession with preconceived notions that never come to fruition that ultimately cause them to become frustrated. Just some food for thought.