Moving Reform to the Bedside

Involvement of Individual Physicians

The health care reform debate was dominated by seasoned special interest groups and politicians in nearly every public forum. As Cary Gross, M. D., co-director of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at Yale and Erica Spatz, M. D., RWJF Clinical Scholar (2008–2010), an internist, followed the opinions rising from all sides, they became aware that one critical group was largely missing—the nation’s physicians.

“A lot of professional societies had spoken, but not much had been said about what individual doctors thought or could do as reform took shape,” Gross explained. “We found that our concerns were shared by other RWJF scholars,” Spatz added. “That kick-started our effort to develop concrete, tangible things that doctors could do to assist with health care reform.”

In an effort to be as objective and effective as possible, Gross, who was also an RWJF Clinical Scholar (1997–1999), and Spatz made it clear from the outset that they had little interest in the politics of choosing sides. We drew on the quote, “...we are not Republicans or Democrats, we are physicians seeking better ways to take care of patients and communities…we are ready to help,” they said.

With that motto as a guide, Gross, along with a group of 50 physicians led by former Clinical Scholar (2000-2002) Stacy Tessler Lindau, M. D., an obstetrician and professor at the University of Chicago, took a trip to Washington, D. C., this past December.

“We met with multiple senators—we had primary care physicians and doctors from every specialty,” Gross said. As a result of the trip (which was not initiated or sponsored by RWJF), Spatz and Gross crystallized the advice that grew out of the many hours of discussion the physician group engaged in while in D. C. and afterward. “We knew from our own work and talking with our colleagues, that physicians are often stymied by how overwhelming the current health care system can be. So we wrote recommendations that we thought could provide solid guidance.”

In “Moving Reform to the Bedside: Involvement of Individual Physicians,” published in the April 2010 issue of the Journal of the American Medical Association, Gross and Spatz offered perspective, as well as workable steps for physicians willing to engage in successful health care reform.

“We explored seven topic areas,” Gross said, but most touched on what Spatz and Gross saw as the three most important topics for doctors: 1.) Raising physician awareness about the need for them to participate in reform. 2.) Controlling health care costs. 3.) Improving the quality of care provided in the daily practice of medicine and enhancing communication with patients.

Every Physician Can Make a Difference

Gross and Spatz’s global goal is to help individual physicians to see that “they play a role in health care,” Gross said, “and if we don’t start to work to improve things, reform efforts will not be successful. Our hope is that individually, and as a profession, physicians will assume a leadership role in reform efforts.” “We want doctors to ask themselves: ‘What can I do, beyond just working in my practice?’ “Spatz said.

“As reform rolls out and access to care is increased, doctors also need to understand how they can control costs in their own practice, while increasing the quality of care they provide,” Gross said. “To some degree, that means examining the culture of medicine, as well as what patients have come to expect,” Spatz added. “Most physicians realize that many of the tests we order are unnecessary or do not lead to better care, but if a patient has a pain in the knee, they’re going to get an MRI, whether or not it would improve care. The fact that reimbursement is aligned with services is another issue,” she said, while acknowledging that many doctors are deeply concerned about how shifting cost structures will affect them.

“I think doctor’s fear the unknown right now, they worry that if hospitals and insurance companies have to pay more, those costs will be transferred to physicians and their patients,” Spatz said. To alleviate those concerns, the best approach is to become part of the solution, Spatz advises, adding, “physicians can be drivers in eliminating wasteful medical spending.”

As physicians recognize the value of participating in reform and cost cutting measures, Spatz and Gross also encourage them to make better use of their unique, personal relationship with their patients. “Optimizing electronic medical record systems and other methods of information exchange can help patients keep track of their medical conditions and treatments,” and possibly make more informed choices about care, Spatz said. “We also have to be willing to talk to our patients about reform,” Gross added, “and help them understand why the system is broken and why we need change.”

Scholars Taking the Lead

Gross and Spatz credit their working relationship and expansive view of the physician’s ability to aid in successful health care reform, in part, to their participation in the RWJF Clinical Scholars program. As a young Clinical Scholar, Spatz worked with Gross, her mentor, to bring together other scholars and physicians to explore ways that doctors could contribute to national reform through the practice of medicine.

“A valuable part of the Clinical Scholars program is the time we spend learning about the health care system and how policy affects care,” Spatz said. “My experiences with the Foundation, first as a scholar, then as program faculty, confirmed, for me, that there is a large and growing group of Americans who have no access to care and that interventions must work at the policy, patient and provider level if they are going to be successful,” Gross said. “So I was delighted to work with Erica to engage her in a different type of writing to help disseminate ideas and recommendations that could reach a broad audience.”

To their fellow physicians, Gross and Spatz offer this advice, “if we do not start to take the initiative in quality, costs and other areas, others are going to do it for us. We should be involved, and ask: ‘How can we help to successfully reshape the health care system?”

The Robert Wood Johnson Foundation Clinical Scholars Program advances the development of physicians who are leaders in transforming health care through positions in academic medicine, public health and other roles.