AAPL Chief on NYT Op-Ed: Loss of Physician ‘Autonomy’ Underscores Industry’s Complexity

Historical medical staff models are under pressure to change, Peter Angood, MD. says on the heels of the New York Time_s _opinion piece.

For generations, the health care industry was built upon many historical structures and processes. Among them was the given that hospital physicians were in control of care decisions.

Nowadays, the focus is on the bottom line. So change in an evolving system is needed to still deliver quality care, says Peter Angood, MD, president and CEO of the American Association for Physician Leadership.

“The historical medical staff models and their interface to hospitals and health systems is complex, and now one of those interfaces that are under increased pressure to evolve and change,” Angood says.

Angood's comments come on the heels of an Oct. 10 op-ed in the New York Times, in which Sandeep Jauhar, MD, laments “the gradual loss of autonomy by physicians.”

A generation ago, physician leaders ran most hospitals, and medical staff offices commanded great influence over how care was delivered, Jaquar writes in the Times’ op-ed. Today, less than 5 percent of America’s roughly 6,500 hospitals are run by chief executives with medical training.

“Independent practices are also disappearing, as hospitals buy them up and put doctors on salary,” writes Jauhar, a cardiologist and author of the book, Doctored: The Disillusionment of an American Physician . “The result for many physicians is the feeling that they are pawns of a big organization that does not want to hear, let alone act on, their concerns.”

Yet, Jauhar asserts, “when day-to-day decision-making is done by people with clinical training, it appears that patients do benefit.”

Angood affirms that physicians in leadership roles and CEO roles demonstrate positive impacts on organizational performance.

“That is why so many systems are especially seeking physicians for these top roles,” he says.

In the article, Jauhar focuses on Tulare Regional Medical Care, a troubled, small community hospital in California, where the board voted to “terminate the elected leaders of its medical staff office” and appointed a new one "without an election."

Angood says the case emphasizes the health care industry’s increasing complexity.

“This is an important example because it highlights the depth of change that is required for effective physician engagement, effective physician leadership, and successful, high-performing health systems that deliver quality safety, efficiency and value,” Angood says.