Weathering the Current Health Care Climate

Keeping your practice afloat takes knowledge as well as dedication.


To fully understand how to lead your practice, you must realize where you fit in the scheme of things. For physicians, this can be very difficult. We are trained to treat one patient and one illness at a time; we rarely focus on the big picture in our clinical work. In order for any medical practice to survive or even thrive in today’s environment, however, a shift in focus is necessary.

Recent changes in the health care environment have brought a flurry of new concepts and initiatives. The laundry list of today’s technical topics includes integrated delivery systems, capitation, direct contracting, direct provision of care, outcomes research, most desired outcome, consumer choice, consumer cooperation, and physician partnerships. Physician reaction to all of this has varied. Some retire, slow down, give up, cry, or complain. Others have formed IPAs or health plans. Still others choose to sell their practices and become employees. An angry few have suggested that we form unions and fight back.
The plight of physicians is not a popular cause. We have few allies, and the main voting and lobbying constituencies are eager to lower costs to patients, insurers, and the government. We must hold our ground and help ourselves until the funding climate changes.

Understandably, but often to their detriment, many doctors are turning for guidance to the ever-growing ranks of consultants and gurus who profess to have all the answers. These advice experts are generally talkers and not doers.
The major reality is that health care, like politics, remains a local business. You will need to have quality local help including attorneys, accountants, tax advisors, computer support staff, and financial planners. Find local folks to rely on and you’ll see that the help you need isn’t very far away.

The key factors to maintaining a successful practice stem directly from the physician in charge. Consider the following qualities:

Leadership. No one else will come along and solve your problems or lead you to a solution. You or other authority figures in your group will have to take charge and responsibility.

Passion. Muster the passion to care, and your support system will follow suit. Your administrators, managers, nurses, technicians, assistants, and billing staff must feel your commitment to the success of all. Passion is not about just your personal success as a physician.

Partnership. Physicians are individualists by nature. However, we must not fear partnering. Take reasonable risks and associate with colleagues, competitors, hospitals, and other players in the health delivery system.

Innovation. You cannot run a race looking behind you. Physicians must anticipate and welcome change. Embracing change means you are committed to innovation in your medical practice.
Service. Physicians work in a service industry. Forgetting this leads to patient dissatisfaction, complaints, and even lawsuits. Our prime responsibility is to provide service in the form of communication and information.

Motivation. Finally, it is important to stay inspired by calling upon the motivations that first led you to pursue a career in medicine. Doing so will motivate not only yourself, but also those around you.

Joseph N. Macaluso, Jr, MD, FACS, is Managing Director of the Urologic Institute of New Orleans, Chairman of Urology Domain, and President of the Urology Society of America. Dr. Macaluso may be reached at (504) 394-7000;

Material extracted from a presentation by Dr. Macaluso given at the Society of Cardiovascular & Interventional Radiology Annual Meeting on April 7 and 8, 2002, in Baltimore, Maryland.


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Endovascular Today is a publication dedicated to bringing you comprehensive coverage of all the latest technology, techniques, and developments in the endovascular field. Our Editorial Advisory Board is composed of the top endovascular specialists, including interventional cardiologists, interventional radiologists, vascular surgeons, neurologists, and vascular medicine practitioners, and our publication is read by an audience of more than 22,000 members of the endovascular community.