I belong to a generation of physicians who will enter practice at a time when the health care system is undergoing profound change. Many states are expanding insurance coverage. Insurers are changing the way medical care is reimbursed. Hospitals are consolidating. And physicians across specialties are facing new incentives to integrate care to keep populations healthy.
In addition to these changes, my generation faces a professional environment that requires more teamwork, more coordination, and a stronger sense of shared vision. No matter what specialties we choose, we will increasingly work within large health care systems that require physicians and allied health professionals to collectively manage the health of their patient populations within a budget.
Although many obstacles stand in the way of improving our health care system, every day I witness examples of collaboration. As a medical student, I saw team huddles in outpatient clinics that brought providers together around high-risk patients. I saw multispecialty rounds inside the hospital that molded multiple recommendations into an ideal care plan. Then in April of last year, while on a surgical rotation at Faulkner Hospital, I saw perhaps the most powerful and inspiring instance of unity in medicine.
While scrubbing in on a case with my resident and attending, our pagers began to go off. Eleven patients who had been injured in the Boston Marathon bombings arrived minutes later. In the hours that followed, I saw raw determination and shared purpose on the faces of physicians and nurses around me. Their responses were spontaneous, and they were profound. On that day, the collective desire to help those in need—and one another—overwhelmed any divisions in our medical world.
Today, opinions differ over the challenges our profession faces—and how to solve them. As health care costs continue to drive our national debt higher, pressure to slow its growth increasingly falls to my generation of physicians. More than ever, society is asking for transparency and accountability from our profession. As medical students on the wards, we heard talk of an uncertain future. From some physicians, we heard of the rationale behind payment and delivery-system changes. From others, we heard of the pitfalls and frustrations that such changes would bring. Two-thirds of physicians in the United States today believe that health care costs are somebody else’s problem to fix, not one that they themselves should fix.
My generation of physicians will be asked to take a leadership role in addressing health care costs. Medical bills are the leading cause of personal bankruptcy in this country. Companies cut wages in order to pay for workers’ medical care. States cut funding for schools and for food aid because of health care spending. For our patients, our colleagues, and our society, setting our health care system on a fiscally sustainable path is a task worthy of our attention.
We will enter practice in more than 100 specialties and subspecialties. In a world where the human body has been divided into turfs, we will be asked to stitch the turfs back together. We will face new payment systems that compensate us collectively, as organizations of providers, rather than as individual practitioners. And, as with compensation, we will be asked to share risks collectively, rather than individually. The quality of our work will also be measured collectively. In short, our generation of physicians is in it together.
Navigating this change will require us to take care not only of our own patients but also of each other. Our collective accountability for cost and quality makes teamwork across specialties a core physician skill. Listening to each other, compromising with each other, and nurturing one another will be essential as our profession moves forward.
An ethos core to medicine is that the patient-physician relationship is sacred. We need to recognize that the physician-physician relationship is equally sacred. The age of health care reform may come and go, but its legacy might just be in the reminder that becoming a physician is a uniquely collegial privilege.
Zirui Song ’14 is a resident in internal medicine at Massachusetts General Hospital. In 2012, Song earned a PhD in health policy (economics track) from the Graduate School of Arts and Sciences at Harvard University. In January, Forbes magazine featured him in its annual “30 Under 30” series on promising young scientists and entrepreneurs in health care.
Image: Mattias Paludi