Physicians discussed the challenges they're experiencing firsthand with integrating into employed settings—and the potential solutions—during a panel discussion Friday at the 2015 AMA Annual Meeting.
John Flores, MD, an internist at a Texas medical clinic, thought joining a hospital group could help his practice run more smoothly.
“When your cash flow is connected to a payment that might come in the next 30-60 days, and your bills are due today, it becomes very challenging,” Dr. Flores said. “And that's why I decided to talk to hospital groups.”
But his experiences over the 18 months he's been employed haven't been what he expected.
“I was hoping to experience a corporation who knew how to run a practice—electronic health records (EHR) issues, accounts payable issues,” he said. “I found it was very new to them, too.”
For Dr. Flores, an important part of his job is communication with hospital leadership.
“I have to work to get my point across to the hospital administration because they're outside my world,” he said. “They don't deal with the same kinds of problems I do.”
Making physicians’ concerns heard
That type of communication is a key part of successful integration, said Kelly Guglielmi, MD, medical staff president at Advocate Christ Hospital Medical Center in Oak Lawn, Ill. She stressed the importance of a culture that gives physicians opportunities to voice their concerns and suggest solutions.
“My role is to keep the voice at the table for [physicians],” she said. “And that's not always easy. The needs and wants are different … but if you're not part of the solution, you're part of the problem. I ask you to be at the table.”
But it isn't always easy to actually get to the table, a problem some physicians raised. For example, when meetings are held during the day, physicians are taken away from their practices and must forego seeing patients, which can deter participation.
Successful physician-hospital integration can remedy that, Dr. Kelly said. For instance, the hospital system where she works offers stipends to physicians who take time to sit on committees and develop programs.
Challenges to successful integration
The challenges physicians discussed are familiar ones. New guidelines from the AMA and the American Hospital Association (AHA) seek to address many of these issues with principles for building successful integrated leadership. This includes:
- Differing mindsets. Physicians and hospital administrators have different perspectives, and it can be difficult to have an understanding of, and respect for, each other's point of view.
- Lack of clarity on values. If physicians and hospital leaders are misaligned in the organization's values, both groups may be uncertain of what to expect from one another.
- Inadequate leadership and management skills. Physicians don't have business training, which can prevent them from fully participating in the business side of providing care.
See the full list of proposed solutions.
The AMA-AHA guidelines are a positive start to increased communication and better integration, said Hoyt Burdick, MD, vice president and chief medical officer at Cabell Huntington in West Virginia.
“We talk a lot about integrated practice, but nobody's talking about integrated leadership, and this is a breakthrough,” Dr. Burdick said. “You need to be at the table when these decisions are being made.”
