Change is hard. While I am frequently advising my patients to change something — stop smoking, lose weight, start exercising, or begin a medication — I know that it will be hard for them to do whatever it is I ask of them. Likewise, when I vow to change something — be on time for all meetings, exercise every day, pass on dessert, write the letter, make the call, orbe mindful— I find it hard it myself to make a concerted effort.
Healthcare is changing, no doubt, and it is changing quickly. However, much like in other areas of life, knowing that we need to change and actually changing are two different things. We all recognize that we, as a country, cannot continue to spend as much as we have on healthcare. We know that eventually, we will have to improve our quality and value like most other industries. As doctors, we have to realize that if we don’t start doing a better job accommodating our patients’ demands for convenience, someone else (Walmart?) will.
Yet, we go to work day after day, and a lot remains the same. For the most part, my clinical practice in 2015 is the same as it was in 2002, when I graduated from residency. My appointments are full, I see one patient per appointment, and I get paid for the appointments I see, rather than for value. It is hard to feel the need for change when things feel so much the same.
As difficult as change is on an individual level, it becomes increasingly challenging when it is done as a group. How do a group of physicians unite behind the type of change we hear is coming? Inevitably, there are early adopters who are already planning the change before the details are even clear. There are also traditionalists who see no reason for change and have no plans to change, even when it looms before them. Most of us are in the middle —recognizing that change is coming and doing very little about it.
Healthcare faces unique challenges, but still behaves like many other industries. Money tends to drive behavior. As a country, we primarily still pay for care based on a fee-for-service model. While there may be token payments for quality or value and nods to things like care coordination and asynchronous care, the majority of payment remains fee-for-service.
The challenge to change this feels daunting. In parallel, we need to revamp the way we provide clinical care, while insurers and the government restructure the way they pay for clinical care. Both sides are hoping the other will lead the way. While the debate ensues and may lead to incremental changes, the patient flow continues.
For physicians to truly change the way we provide care, we need something similar to the motivation needed to change other areas of our lives—a burning platform, a big scare or large incentive, or a compelling and immediate reason. Right now, there’s a lot of talk about these incentives with the result being very gradual thus far. So, I wait with my colleagues to see what’s next and when the much hyped healthcare transformation will actually arrive.