Health law uncertainty creates chaos for some doctors

Gregory Warner Apr 24, 2012

Kai Ryssdal: You know how business always say what they want most from the government is stability, some kind of certainty about things? OK, so think about health care right now. You can’t get much more uncertain than waiting for the Supreme Court to decide what’s going on. Decide which parts of the health care law to let stand, if any, and which parts to strike down, if any.

Doctors who’ve been practicing medicine the same way for decades are facing a whole new way of doing business. They just don’t know what that way is. Marketplace’s Gregory Warner reports from the Health Desk at WHYY in Philadelphia.

Gregory Warner: John Henry Pfifferling knows how stressful it can get. As director of the Center for Professional Well Being in Durham, N.C., Dr. Pfifferling gets called in as a consultant to deal with doctors, nurses and even health care CEOs who have become unhinged.

John Henry Pfifferling: They throw a forceps or they push somebody out of the way. Or they scream at somebody or they curse at somebody.

In his four decades of doing this work, Dr. Pfifferling says he’s never seen as many senior level people acting out.

Pfifferling: We don’t teach people very well how to deal with uncertainty, especially our docs. We don’t give them change mastery tools!

These are times of change. In the industry everyone seems to be trying on new hats. You have generic drugmakers buying brands, nonprofit hospitals starting venture capital firms, even for-profit hospitals launching insurance networks.

David Nash: You’re seeing insurance companies buying hospitals. This is chaos!

David Nash is dean of the School of Population Health at Jefferson University in Philadelphia.

Nash: We’re pouring more money into this system than any country on the planet, we know it can’t continue, and then we have additional uncertainty about the Supreme Court decision.

And for doctors, its not just the yay or nay at the Supreme Court or even the mandates of health care reform. It’s how are they going to do business in the future? Richard Lofgren is chief medical officer at the University Healthsystem Consortium.

Richard Lofgren: The current anxiety that you’re getting is that you have to have a foot on both stools.

One stool is the old way — where doctors fight for their piece of the pie and there’s a fee for every service. The other is trying out new models of coordinated care and lower costs.

Lofgren: But there’s uncertainty about which of those models are going to succeed.

Toby Cosgrove: There is tremendous anxiety, tremendous flux.

Toby Cosgrove is CEO at the Cleveland Clinic.

Cosgrove: This is probably the biggest inflection point that we’ve seen in health care in the past 50 years.

If Cosgrove seems like, well, the last guy who’s going to fling a forceps at anyone, it’s in part he was a surgeon on the front lines of Vietnam — in part because at Cleveland Clinic they already tackled the which way to go issue a long time ago. At the Cleveland Clinic and other hospitals like it, doctors earn a salary and work in teams. The motto is “To Act As A Unit.” Which is exactly the advice that the anti-stress guy, Dr. Pfifferling gives his disruptive doctors. First he tells them to give up the need to control everything.

Pfifferling: It used to be that there was much much less knowledge, less quality assurance, less scrutiny, less accountability.

A doctor could be a lone wolf.

Pfifferling: That goal of mastery is basically impossible given the explosion of everything we know today. And the way to get a handle on it, is teamwork!

Learn to trust your nurses, he says, confide in colleagues, and above all admit what you don’t know. Before long, he says, this time of uncertainty might start seeming like opportunity.

In Philadelphia, I’m Gregory Warner for Marketplace.

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