Got Docs (Yet)?

Anyone who’s been paying attention in the past couple of years already knows that hospitals and physicians have been busy rushing into physician employment contracts, in the second big wave of physician hiring, which has emerged a decade and a half after the first MD employment wave. In fact, a new Center for Studying Health System Change (HSC) study released August 18 provides a fascinating overview of how that employment trend is playing out in a dozen different markets nationwide.

Does history really repeat itself? Well, no, not exactly. While some of the same economic, reimbursement, and strategic elements are present this time around, others are quite different; what’s more, at least some healthcare leaders have learned certain lessons around physician employment that will hopefully make this wave’s experiment turn out differently. As we all know, in the early 1990s, many hospitals, fearing that their competitors would snap up the same physicians, hired doctors wildly into contracts that ended up actually diminishing M.D. productivity, while doing nothing to improve care quality.
This time around, in contrast, both hospital leaders and physicians are entering into contracts with at least a major dash more of caution and savvy. Whether or not physician employment will be broadly more successful this time around will depend on a number of different factors, including some that are essentially out of hospital leaders’ hands. But at least the employment arrangements are being handled more thoughtfully overall than they were a decade and a half ago.
All that being said, it will be inevitable that physician employment will cut both ways when it comes to IT strategic planning. On the one hand, the opportunity to relatively quickly move large groups of physicians to a unified EHR and clinical documentation platform must surely rank as one of the top “pluses” of physician employment. On the other hand, there is the tremendous likelihood of intensification of physician demand for improved levels of IT service and responsiveness. Independent physicians may threaten to sidle over to the hospital or health system down the street, but employed physicians can be expected to want more, faster, and with greater accountability and transparency on the part of the IT departments in their organizations.
We can also expect CMIOs’ responsibilities to broaden and deepen even more as a result of physician employment, and their leadership and governance duties to multiply. Meanwhile, if the CIO-CMIO relationship in a hospital-based organization isn’t already finely honed, it had better move towards becoming so as a new wave of physicians comes directly on board, as any obvious cleft between the CIO and CMIO will lead to serious IT governance and execution problems down the road.
I believe that many, many good things could come out of the growing trend towards physician employment. But when it comes to IT strategic planning and execution, as with any other dimension, one should take it as a given that there will be unintended consequences—and that the planning and preparation had better be made all the better in anticipation of those consequences.