Work Smarter, Not Harder: Knowing the Players and Rules to the Game of Healthcare and Understanding Market-Driven Healthcare can be a Game-Changer in your job-search process.

When you first thought of becoming a physician, you were, of course, focused on the obvious:  doing well in school, scoring well on standardized tests, having a portfolio and personal statement that helped you stand out from the very large crowd of applications competing for spots in the medical school of your choice.  After gaining entrance to medical school, your focus shifted to a different type of learning.  The intricacies of anatomy, physiology, and pharmacology, coupled with honing communication skills to extract every bit of clinical information from the trickiest historian, occupied most of your mental and physical time.  By the time you reach residency, you’ve spent endless hours developing those skills and expanding your knowledge base so you can be the most caring, competent, and reliable physician you can be.  You’ve literally spent years of your life learning the art of medicine…..yet it’s very possible a scant amount of that time was spent learning about the business of medicine.  Unfortunately, being efficient at patient care does not necessarily translate into being proficient at understanding the drivers of healthcare today.  It’s time to change that.

Getting the Lay of the Land

Like the practice of medicine, healthcare is an ever-evolving entity that has changed both slowly and at a rapid pace in the last few decades.  It wasn’t unusual for several competing health systems to be running a parallel course on train tracks in the same geographic area; physicians would then provide care at either or both as part of the “medical staff.”  As much as healthcare appears to remain fractionated in the United States, there have been some not-so-subtle shifts in the landscape that are now shaping the healthcare market of the future.  More and more, hospitals and physicians exist as systems made up of clinically integrated networks with the goal of improving outcomes, reducing cost, and making quality of care a priority in patient management.  By stepping out of their silos, these new systems have latched onto the “work smarter, not harder” idea.  Or so it seems…

Keeping Your Eye on the Goal:  Understanding the Focus of the Triple Aim

As I’ve said before, change only happens when the process of going through that change is less painful that the status quo.  Driving change in a business model as complex as the American healthcare system is like moving a barge:  it requires a slow, coordinated, powerful movement to turn a large, seemingly unwieldy machine.  It’s logical to ask yourself what engine is powerful enough to steer this ship in a new direction.  The answer, not surprisingly, is tied to money.  Payers have finally started to realize the potential savings for and value of quality care and are beginning to reimburse as such.  Like most major shifts in business, this did not happen spontaneously or without good reason.  The Institute for Healthcare Improvement (IHI), a not-for-profit organization recognized as a world leader in crafting healthcare reform, created a framework for all healthcare systems called the Triple Aim outlining the data, need for, and importance of this shift.  Under this doctrine, the IHI believes “that new designs must be developed to simultaneously pursue three dimensions:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.”(1)

By placing the focus on quality and population based health, systems that previously existed as competing foes in isolation are now developing mergers and/or working relationships to meet the outcomes of the Triple Aim in a fashion that benefits not only the patient but their reimbursement rate as well.

Knowing your Role:  the Impact of the Triple Aim on Individual Physicians

A movement as large (and respected) as the Triple Aim always has consequences; some of these can be anticipated, while others often only show themselves over time.  As noted above, it’s not surprising that there is a seemingly constant reorganization of healthcare systems in any given geographic area.  Hospitals that were previously “rivals” are suddenly married in a business affiliations; more and more physicians align themselves with one entity or another for a variety of reasons.  As these relationships continue to evolve, the types of employment available to physicians continues to change.  All of these choices have risks and benefits and vary greatly from each other.  Take the time to ask yourself which of these seems like a good “fit” for you.  Whether you are an employed physician working for a multi-specialty group, a hospitalist working for a large system, working as a locums, or the owner of an independent practice, knowing what your work-style is and deal-breakers are is crucial to making a choice that is right for you.

Leveling the Playing Field

As previously noted, there has been an insidious consequence of the remodeling of our healthcare system.  The emergence of Burnout as a very real influence on physicians’ professional and personal lives has resulted in the call for the evolution Triple Aim to the Quadruple Aim:  by adding a goal of improving the wellness of physicians and staff to the original initiative, the Quadruple Aim would then become a standard each physician, CEO, and health system could be held accountable for. (2)  We all know the data on Burnout and its impact on quality of patient care, let alone a physician’s quality of life; physician wellness should be central to the evolution of our healthcare industry as it continues to grow.  By taking the time to be knowledgeable about the infrastructure of our healthcare system, being in tune with your professional needs, and prioritizing systems that emphasize physician wellness, you are well on your way to choosing the path that is right for you on your Adventure in Medicine.

To read more on Market Driven Healthcare by author Kathryn C. Peisert in the Career and Life Planning Guidebook for Medical Residents, follow this link: Market Driven HealthCare – What you need to know before searching for a position



Dr. Megan Vermeulen is the Director of Content Strategies at and Associate Program Director at Rowan University SOM Family Medicine Residency Program.

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