In Doctors Council’s recent White Paper and other forums we have argued that fundamental change in the health care delivery system can not be achieved without doctor involvement. A recent study in Health Affairs: First National Survey Of ACOs Finds That Physicians Are Playing Strong Leadership And Ownership Roles ,makes the same point in relation to ACO’s. The report concludes “It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for service payment will not be accomplished without strong, effective leadership from physicians.”
For Doctors Council, one important question is what are the necessary conditions that allow for strong doctor leadership. The recent scandal at the VA Administration provides an important negative example of doctor involvement. Increasingly it is clear that doctors and other providers at the VA were threatened and disciplined for raising patient safety issues. The New York Times writes “Staff members at dozens of Department of Veterans Affairs hospitals across the country have objected for years to falsified patient appointment schedules and other improper practices, only to be rebuffed, disciplined or even fired after speaking up, according to interviews with current and former staff members and internal documents.” Providing a safe environment for doctors to raise patient concerns is obviously a pre-condition to real doctor involvement, but one wonders if the intense drive to meet performance metrics could create a culture that silence doctors.