MEDICAL PRACTICE
The changes in the overall health care scene
that are taking place will have a profound
impact on prospective medical students who will
be the practitioners of the twenty-first
century. These changes will be reflected in the
three areas discussed separately below.
Physician Status
· In the twenty-first century most
physicians will be salaried employees rather than
fee-for-service practitioners. They will work in
or for group practices, hospitals, insur-
ance companies, medical schools, or health
maintenance organizations (HMOs).
Medical care will be provided to patients as a
result of contractual agreements between
business and governmental units and medical
providing groups, with solo practitioners
usually not having access to enrollees of such
plans. As a result of this restructuring,
competition will increase among individual
health care providers.
· It is anticipated that there will be
fewer specialists and a greater number of pri-
mary care physicians. Some subspecialists may
have to retrain in order to also serve as
primary care physicians.
· Practicing physicians will be held
more accountable for their performance.
· Business managers will have more input
into how medical services will be pro-
vided.
· On the positive side, there will be
less paper work imposed on physicians and thus
they will have more time to see patients. It is
anticipated that primary care physicians
will be reimbursed at a higher level while
specialist remuneration will decrease. The
working schedule of physicians will be more
predictable. This will provide them with
greater leisure time.
· Medical care in the next century will
focus much more on prevention and patient
education in order to both extend life and also
reduce long-term medical costs.
Physicians will experience reduced per-patient
revenue, but with an increased number
of patients having access to medical care, they
will be forced to see more patients in
order to maintain their income.
Physician-Patient Relationships
Today, the depersonalization of medical care
due to the interference of administrative
personnel has had a dehumanizing effect upon
patients. The disease, rather than the
patient, is being treated. A positive
doctor-patient relationship can be restored by provid-
ing a more sympathetic and attentive attitude.
Medical treatment is not always essential
or even necessary, but the patient's
psychological and emotional needs should always be
addressed.
Physician Reimbursement
The focus in health care over the past several
decades has changed from one aimed at
increasing access to medical care to an
emphasis on decreasing costs. Both public
and private insurers have been seeking ways to
significantly lower expenditures.
Most current health care proposals have the
following features in common. They
would (1) insure access to health care of most,
if not all, citizens, especially those in
the central cities and rural areas (who are
frequently uninsured); (2) establish cost
controls; (3) establish defined criteria for
quality; (4) require preventive care (such as
immunizations, mammograms, etc.); and (5)
introduce medical malpractice reform
(see below).
Managed Care
Proposals for managed care fall into three
major categories. The first is a national system
(modeled on that in Canada) that is completely
under government control. The second is
diametrically opposite and is a "free market"
approach, which allows the principle of
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