Sunday, September 06, 2015

The Silent Evolution

Rich Umbdenstock having retired, the American Hospital Association has a new CEO, Rick Pollack.  The August issue of H&HN, the Associations journal, included an interview with him in which he summarized his plans, the issues facing hospitals, and so on.

The issues and strategies covered by Mr. Pollack were as might be expected.  I looked in vain, however, for mention of what seems to me to be a momentous development – the transfer of primacy in the delivery of health care from the medical profession to hospitals.

For all of history up until recently, medical doctors occupied the central role in the provision of health care services.  When my career in hospital administration began in the 1950’s, hospital medical staffs were “self-governing.”  County health departments were the creatures of county medical societies and state health departments and medical licensing boards were controlled by state medical associations.  The AMA accredited medical schools.  No legislature could adopt a law on a health care matter that was opposed by organized medicine.

The gradual change that has been going on in that for some time has been accelerated in recent years by a number of factors.  Except for a few large group practices like Mayo and Cleveland Clinic, the medical profession has not been organized in a way that would allow it to deal effectively with the emerging issues of cost and quality.  The complexity of the payment system has grown beyond the ability of individual practitioners or small groups to cope with it.  Doctors have become more interested in the quality of their lives and are avoiding the stresses and demands of individual and small group practices.

A result of all this is that the mantle of leadership in the provision of health care services has fallen on hospitals – the only entity with the culture, experience, resources, and organizational infrastructure to take it on.  Hospitals have not sought out that role but it has devolved upon them.

The culture of health care has conferred great respect – even adulation – on the medical profession and there is great reluctance even to talk about the demise of its primacy.

It is a silent evolution.

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