Every so often the Journal of the American Medical Association (JAMA) is devoted to a single topic. The May 12 edition was devoted to “professionalism and governance” and the articles addressed a range of related subjects from medical education to board certification. I was particularly drawn, for obvious reasons, to the section on “professionalism and employment.”
I think it is fair to say that physicians have often cited their commitment to professionalism as a justification for the high value placed on independent private practice. That is, independence – of insurance companies, corporate overlords or pretty much anybody telling them how to practice – is the only way to assure that they can consistently act in the best interests of their patients.
This way of thinking is now severely challenged.
As I have argued previously, independence is an anachronism, and should be replaced with a commitment to professional autonomy. We should not be defending an “each man for himself” approach to medical practice, but rather advocating for physician leadership in the design and operation of care delivery. To do otherwise ignores the reality of current medical science and the complexity of contemporary care.
It was with this in mind that I read Francis Crosson’s article on “Physician Professionalism in Employed Practice” in that recent JAMA. In it, he acknowledges the old concern about the need for independence to exercise professionalism, and then outlines four “key elements” of employed practice that should alleviate that concern. Those are:
- Clinical Governance: the “determination of clinical practice patterns recommended to (or in some clinical situations required of) employed physicians” should rest with physicians, regardless of the organizational structure
- Management Capabilities: there must be organizational ability to establish “clinical oversight and improvement” through means such as “quality measurement… personnel management, … [and] data analysis.”
- Clinical Performance Information Transparency: physicians should have access to their own individual performance and to the group’s
- Appropriateness of Financial Incentives: it is important to strike the right balance of goals and size of incentives, and to make the system transparent to physicians and patients
I took away two things from this article. First, it serves as a roadmap for the journey from independence to autonomy, and second, that our Medical Group is on the right path, and headed in the right direction.
What do you think?