Our article focuses on the specific implications of US health reform for internal medicine GME. We describe the required competencies that will allow tomorrow's comprehensive primary care internist to thrive in a proactive US care system.
Health care providers are encouraged to implement “shared decision making” in which patients and doctors together choose the treatment that is best for each patient. However, doctors need more instruction on how to engage patients and better information systems to make sure patients know their options and receive individualized care.
Before we allow others to implement policies attempting to optimize the use of physician time or reduce the amount of equivocal or inappropriate care, we need to understand what physicians think about these issues and what they are prepared to do about them, writes Robert H. Brook.
Because the budget crisis is really a crisis, it behooves physicians to answer the waste question as rapidly as possible. Without an answer, there is no hope that an appropriate policy process for reining in health care costs will be identified.
A paradigm shift involving acknowledgement of the value of clinicians in the context of community research, establishment of a stable infrastructure to support a cohort of clinicians across time and research studies, and realignment of incentives to encourage participation in clinical research is required.
This commentary argues that it is timely to reengage physicians in the discussion of international comparative data about health care and to ask why the United States is so provincial in designing the systems by which care is delivered.
Pay for performance, transparency, and other innovative ways of compensating physicians will work only if, at the same time, the system for providing care is changed to one that has clear objectives and provides specific tools to help physicians achieve those objectives, writes Robert H. Brook.
Profiles created for physicians based on the cost of the care they provide can vary widely depending upon the methods used by insurance companies to create the profiles in order to encourage patients to visit low-cost physicians.