Health Care Anew

The current state of the art of managing physicians is illustrated by the March 6 issue of The Boston Globe, which carried a story about how the 360 salaried primary care physicians at Partners HealthCare (the parent company of the Massachusetts General and the Brigham and Women’s Hospitals) are being offered bonuses of about ten per cent of their salaries (now roughly $200,000 per year) if they agree to accept more new patients. 

It seems that Partners is concerned about the inability of new patients to get appointments with its physicians and is trying to expand capacity by offering this inducement. 

In most organizations, if management felt that staff members should be producing more, it would find some direct way to make that known and expect a response.  But apparently that has not been done at Partners or, if it has, the response has been inadequate and management has not felt able to do anything about it.  Thus the alternative of offering the “carrot” of more money and hoping it works. 

Another implication of the story is that individual primary care physicians at Partners are making their own decisions about whether to accept new patients or not.   In other words, each physician is determining his or her workload independently of management.  It would be hard to find salaried staff with that level of freedom anywhere else. 

The story mentioned that Leahy Clinic, also located in the Boston area, had adopted the policy of guaranteeing a new patient an appointment within 48 hours.  There was no mention of any financial inducements associated with that.  Leahy is a long-standing group practice with a great deal of experience in the employment and management of physicians and apparently has a better handle on things.

The clear direction of development in the health care delivery system is the combination of physicians and hospitals into single entities that can be held accountable for the cost and quality of care.  The only way that will work is if all elements of care, including physicians, are effectively managed.  It seems that there is a lot yet to be learned about how to do that.