Leaders have influence and power, Employees do not. So how can physicians get these features of autonomy back as employees?
Maintain restrictions on lay control of the practice of medicine
In a changing and uncertain environment, many physicians will seek employment opportunities as a way to deal with unpredictable and oftentimes inadequate payment models and the increasing — and sometimes overwhelming — administrative burden of running their own practices. At the same time, hospitals and other nonphysician-owned entities will continue to seek to employ physicians.
Quality measures must take into account how sick patients are and what associated diseases they have. Incentives focused primarily on cost per member will reward physicians and providers for treating only the healthiest patients. The poorest and sickest likely will drag down the “efficiency” ratings so that their physicians and providers become ranked as “lower performing.”
Protecting the patient-physician relationship lies at the heart of Texas’ legal doctrine banning the corporate practice of medicine. Patients must be able to trust that the tests and treatments their physicians recommend are tailored to their individual medical needs and are shielded from improper lay influence. Each patient encounter must be governed by the ethics of the medical profession, the integration and application of advancing medical knowledge, and the partnership with the patient in making good decisions for that patient’s health.
Employment without protections is the corporate practice of medicine. Employment with protections is part of the practice of medicine, and that’s what we stand for.
At TMA’s urging, the 2011 Texas Legislature passed ground-breaking new laws that protect patients and their physicians’ ability to exercise independent medical judgment free from interference by a hospital administrator or corporate officer. At the same time, we preserved Texas’ ban on the corporate practice of medicine with several carefully delineated expansions for physician employment. These included strong protections for physicians employed by or associated with hospital-controlled health care corporations, rural county hospital districts, large urban hospital districts, and the newly established Texas health care collaboratives. Texas is the first state in the country to take the critical step of protecting clinical autonomy. The laws place responsibility for monitoring and enforcement with the Texas Medical Board, which is the agency responsible for upholding the standards of medical practice in the state.
Over the course of the coming decade, patients and physicians will see many changes in the organization and delivery of medical services. New payment models likely will drive new practice arrangements. Many physicians will continue to practice independently, some will partner in small to large groups, and others will join larger single or multispecialty groups. Payment models for physicians’ services will continue to be a mix of fee-for-service, global or capitated payments, and salary arrangements for physicians who choose employment.
Regardless of the applicable practice arrangement, TMA and its member physicians remain committed to protecting the clinical autonomy of physicians and the primacy of the patient-physician relationship.