In these posts about covering health reform, I usually don’t point to the big national dailies because a lot of people have already read those stories but a recent New York Times piece, “As Physicians’ Job Change, So Do Their Politics” is a story that may be able to help reporters think about a good local or regional jumping off point for telling aspects of the health reform story in a more narrative, accessible manner, through the eyes and experiences of doctors.
The Times story, by Gardiner Harris, described a shift leftward (or at least less rightward) among physicians. He cited several reasons: younger doctors, more female doctors, and above all more doctors who are salaried employees of hospitals instead of basically being small businessmen (or women) running a practice.
Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors’ groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products.
Even the issue of liability, while still important to the A.M.A. and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs.
He wrote mostly about Maine, but had a few observations about other states, including Texas. Last year Texas physicians opposed the national health reform law by a three to one margin. But doctors who did not have their own practices were twice as likely to support the law. The same goes for female doctors.
How does a story about physician politics translate into a narrative about health reform?
The shift to salaried positions has many causes (including work-balance for doctors who want more time with their families) but the move toward more clinical integration and the formation of accountable care organizations or ACO-like entities will hasten this trend. It is really, really, really hard to explain ACOS clearly and concisely (when an editor of mine recently asked me to give him a nice, tight two-graf description, I began it something like, “One of the challenges of ACO is that they defy simple explanation.”)
But doctors who are joining hospital staffs or whose practices are being bought up by hospitals or who are entering different contractual relationships and affiliations with hospitals have stories to tell. You can also talk about quality measures and “never events” and how that affects physicians and the practice of medicine, particularly in states mandating more public reporting. Through their stories, you can illustrate what an ACO is or isn’t, or how a medical home works, or what “clinical integration” means.
I interviewed a physician in South Carolina the other day, Dr. Angelo Sinopoli, who told me about how the team approach and the use of electronic medical record with clinical decision support was giving him more real-time feedback on his own performance – and he welcomed it.
“You think you are doing something and you might not be, or think you might not be, but you are,” he said. “Seeing real data in as real time as possible made a difference in how we think.” That made me understand an aspect of the electronic medical record that I hadn’t understood before, and readers can grasp that too.
You can explore the changing attitudes and politics along with that – in some states that may be more significant than others, depending on what your state is doing with health exchanges, malpractice legislation, quality reporting etc.
Learn more about how electronic health records could mean new opportunities to improve clinical care and public health, according to David Blumenthal, M.D., the former national coordinator for health information technology. Blumenthal spoke at Health Journalism 2011 as he was leaving his federal position.