Play

Summary

Over the past 3 decades physicians shift from self employed to employed, leading to a declining in engagement in societies representing physicians.

There has also been a decline in physician leadership during this period.

There is hope that physician lead organizations, similar to Mayo, will grow as a solution in the current transition.

Medical Associations should function to enable physicians to be the best they can be. Chic hopes physicians will continue to recognize the value of these associations.

Today on Healthcare Pittstop I’d like to welcome Chic Older. Chic and I’ve been friends for many years and after 30 years with the Arizona Medical Association (ArMA) as their Chief Executive Officer Chic is retiring. I thought today we might take a moment to talk about his role at the Medical Association and changes that he’s seen in the community over the last 30 years. Chuck thanks very much for joining.

CO- Absolutely my pleasure.

AP-I wanted to start with why did you join ArMA when you did way back when and why are you leaving now.

CO-I joined ArMA 34 years ago. And I’ll give you a little bit of the background. I’ve been an executive here for the last 30 years or soon to be 30 years. Prior to that for 10 years I worked for the Arizona hospital association. I came over to ArMA because there was an opportunity at that point to transition into what would be my current role as executive director. And I thought the change was appropriate for the way I felt my interest lay and my skill set. I was truly interested in moving from the hospital institutional view into the direct physician view. And so when the opportunity came came my way. I moved over and and truly I’ve never looked back.

AP- I would assume you took that role because you saw the physician performing some unique service in the community. Why was there interest in migrating from hospitals to physicians.

CO- I think it goes back to just my inner passion. Everybody’s got their own. And my was that I felt like I intellectually related with the role of physicians. Having worked in the hospital world for 10 years I felt like where my passion lay was with the actually the providing of health care as opposed to the institutional role that hospitals play. So the transition for me was was not a big one. It was a big one job wise but it was not a big one emotionally. I failed to answer the last part of your question before about why leave now. It’s a complex set of reasons. There is not any one any one. What’s ahead for me for example- my age and also partially that I think it’s appropriate and time for fresh eyes and a new approach and someone whose default system is more on the electronic side of things. And and that’s where their comfort zone is. And so I feel like it’s a good time for both this organization and me as well.

AP-I can appreciate that but you’ve made some observations to me in that physicians have changed over the last three decades while you’ve been in ArMA. Can you tell me about your observations regarding the role of physicians.

CO-When I first came to ArMA I would say that probably more the greater than 95 percent of physicians were either an independent practice or in very small groups. And I felt that there was a very, very, strong commitment to wanting to take care of the profession through a state association. The majority of physicians in the state were also AMA members. They all belonged to their specialties society. Organized medicine was was dealt with as an essential partner and a key component of practicing medicine. Over the years what I’ve seen is I’ve definitely seen some changes. I link the majority of those changes to employment. I’m being careful not to say there are bad changes, they’re just reality, they’re evolutionary. What I found and what I have found is that as physicians are taking jobs where they’re actually becoming employees their priorities have changed. I don’t believe they individually any longer see how essential it is to have a vibrant State Medical Association or County Medical Society or organizational aspect. I don’t think they they feel the direct connect. A good example if you asked me for one would be employed physicians rarely if ever are responsible for their own liability insurance for example. Problems that we have with liability or changes in the premiums, either up or down, the individual physician right now when they’re employed they don’t see the need for change.

They become well acquainted with the need for change if they get dragged into that system unfortunately and are sued then. Then they’re hopeful that we’ve been effective. That’s just one example. Another one would be for example the role of that organized medicine is played with the AHCCCS program or state Medicaid program. If you’re in a salaried position it’s not as much concern to you about who’s included who’s covered and who’s not. And so those are just two examples of how I feel the employment model has taken away the focus for the need for advocacy groups like the Arizona Medical Association.

AP-You mentioned something more fundamental. You told me a story of how what was it- if two doctors went out with a third person 30 years ago the third person might be left out.

CO-My story to you was that the most boring thing a non-physician could do 30 years ago was go out to dinner with two doctors because they were going to be talking patients and medical terminology and procedures and what worked and what didn’t work and what kind of results were they getting for patient care and so on. And you were definitively excluded even when you could understand what was being said. When I go out to dinner with physicians the focus is on me what’s going on what’s happening. Are we going to survive. How can we affect how can we affect change on the business side of things. I’m overburdened with regulation and with the need to meet compliance regulations and performance regulations and what are you going to do to help me. That in my mind is somewhat unfortunate because I think the focus has come off of the quality of care and more towards how do we survive.

AP-Maybe even a little less interested in the actual thrill of the science of health care? 

CO-I really don’t know the answer to that one Alan. That’s something that that you as a clinician are in a way better position to answer. I wish it were that way though. I wish we were back towards the number one focus is how do we take care of the patients the best way. Not how do we survive long enough to be able to take care of them.

AP-I’ve got a sense from you in the past when we talked that you feel physicians are somewhat abdicating their historical leadership role in health care. Who do you think is going to fill that gap and withdrawn and become unemployed?

CO-Well I want to clarify first the word abdicating because that to me at least the way I think about it it implies voluntarily giving it up. I would go to the point of saying I don’t think they’re voluntarily giving it up. I believe in many instances it’s being taken from them. I think that that’s an essential element because that’s the place where I’ve always felt like as an organization like like the Arizona Medical Association can play an essential role. I don’t think the physicians are happy about it giving it up. I think it’s being taken from them as I said. I think that’s an unfortunate element of simply today’s society and the way we function and the way the system has evolved. I think that where we have the highest degree, the highest effectiveness of health care are in those situations where physicians are absolutely the leaders and are in the position to determine how the health care is going to be delivered and how you keep the patient at the focal center of everything that’s going on. In the situations in the systems where the physicians are not the leaders I don’t think they adhere to that that mandate.

AP-It’s a little bit tough. I don’t see someone stepping up to do what’s right in today’s day and age. It seems like it’s run by big government, big insurers, different things like that, as opposed to physician leaders.

CO-What gives me hope is that there are still elements of it out there. The model for example exemplified by the Mayo Clinic which is a 100 percent physician led and run. And you know it means it can survive and it can thrive. And I think that there are other key elements around the state of Arizona- I can’t say I’m ultimately familiar with all systems- but there are situations where I think the physicians are in the critical leadership roles. My hope, especially for myself as I become more of a patient than than a leader myself, is that those systems will thrive and that ultimately they will be the ones that surfaces as the best way to do it it may be over a long period of time. It may not happen on my watch but I’m optimistic. Generally if you if you get to only pick one between cheaper, faster, or right- you only get to do one, what I’m hoping for is that the physician led systems will be the ones we’re doing it right is the number one thing to do. Then doing it cheaper and faster will follow as opposed to the other way around.

AP- That gets to my final question. Your daughter just graduated medical school. My daughter is about to graduate medical school. For the person who wants to apply science to take care of the sick and be a teacher, get back to basics, your suggestion would be that the best possible alternatives would be physician lead organizations? Would that be any other changes in terms of the current climate in America that you try to put forth?

CO- You and I have talked about this. We kind of we kind of batted it back and forth the other day. They’re growing up in the current system. They’re going to be way more comfortable with electronic medical records and the electronic nature of medicine than physicians your age and older. That’s not even their default position. That’s what they were raised on. So they’re going to have a different perspective on some of the things I think physicians in the middle and twilight of their careers are confounded with and very frustrated with. So that’s number one I gotta acknowledge there is there’s going to be a difference that way. Second, they are going to come into a situation where it’ll actually be commonplace to say how many days of vacation do I get? Who’s going to pay my liability insurance? You’ll do my billing, because that’s that’s the system that they went to medical school under and that they’re going to do their residency training under and that they’ll come out into. Some of the things that somebody like myself age related- I’m 70 that I’ve seen- they’re not going to be confronted with, they’re just going to fit into the system the way it’s formulated right now. I don’t think it’ll be as problematic to them. What is problematic will be whether or not this invites the highest possible quality care for patients, the most independent thinking for physicians. Are they going to be able to operate? I don’t mean that literally and figuratively. Are they going to be able to function and the absolute best interest of the patient. Or are they going to be functioning in a system where they’re being told here’s the parameters of what you can do and what you can do and you can’t go outside of those parameters. I don’t think they’re going to be as upset as maybe a substantial portion of the (current) physician community is. But that having been said, the answer to your question is I personally would urge my daughter to go into a situation that is physician lead, that is physician director. That would be that would be my advice to her. Whether or not she’s even able to do that is a problematic question. But that would be what I would advise your daughter as well. What about you what would you advise your daughter?

AP-I think some how we have to separate care from a payment of care. I’m coming to the opinion we need to probably get around insurance because fundamentally that is an obstacle for quality care when people are paid to do things I don’t think that makes sense. Ironically I’m looking for a way to get back to the future. People used to pay their doctor with a chicken or something. And doctors were pretty happy providing care and got a lot of gratification. With big business in medicine I think it’s really been a ying and yang and distracted from the doctor-patient relationship. Chic, any parting words for the medical community with your retirement? 

CO-Well remember Alan I have never had what I consider to be the honor of taking care of a patient. I’ve thought about this. It’s not just something I just spout off about. I’ve thought about it and in my world the most honorable thing a person can possibly do as a profession I can think of is to be a physician. I’ve thought about it. I’ve considered other things. I can’t think of anything that’s greater or maybe that’s why I’ve stayed here, in my mind, truly as a calling because that’s how I view it. I see so many physicians who make it clear they are not happy. My parting words would be- I hope that that above all physicians can remember that what they get to do every single day is such an honorable wonderful thing. These are the things that tend to to put a shroud over it aren’t so much that they blot out the light. And that physicians still remember that you get to change lives every single day all for the better, regardless of they appreciate it, regardless if they can afford it. And that’s been one of my frustrations that I think I think some of that is being boiled out of the medical profession. And I think that’s very unfortunate. I hope that as as the profession grows and what I hope my predecessor will do is to focus on saying we stand here to allow you to be the absolute best you can be. That’s what the Arizona Medical Association stands for and that’s what we hope you’re able to stand for as a physician. And not let and not let the negatives always seem to outweigh the positives.

AP- Chic I really appreciate the time and thanks for your service to the community over the last three decades.

CO- I hope it’s clear it’s been my honor. Thanks very much.