RSNA: Amid struggles, collaboration can help physicians succeed

CHICAGO—Despite a number of worrying trends in healthcare, physicians who redefine the culture of medicine in favor of collaboration have a chance to rise to the challenge, according a plenary session lecture delivered at the RSNA annual meeting this week.

Speaker Darrell G. Kirch, MD, president and chief executive officer of the Association of American Medical Colleges in Washington, D.C., offered his encouragement, but not before setting a pretty bleak scene, at least according to some metrics.

For example, Kirch said you can’t deny the numbers when it comes to the success of the Affordable Care Act at reducing the uninsured rate to approximately 11.4 percent, the lowest since tracking began. However, the flip side of improving coverage is a growing physician shortfall of somewhere between 46,000 to 90,000 by the year 2025, according to Kirch.

“More people may have insurance, but we’re already seeing more people who say they can now afford care, but they can’t get access to a physician,” said Kirch. “The shortage is already hitting many areas and many populations.”

He also lamented a lack of funding for academic medical centers, which Kirch noted make up about 5 percent of all hospitals but provide 23 percent of all clinical care and 37 percent of charity care. While medical schools have expanded, a bottleneck has developed at residency thanks to flat funding (when adjusted for inflation) for training residents over the last 18 years.

Kirch noted National Institutes of Health (NIH) funding has effectively been flat since 2000, echoing the lecture from NIH director Francis Collins, MD, PhD, on the same stage during RSNA 2014.

Rounding out the more sobering section of his talk, Kirch compared the oft-referenced graph of high U.S. health spending relative to other advanced countries against a graph of social services spending, which found the U.S. lagging behind.

“If we don’t provide those kinds of supports, should it surprise us when we admit a patient, treat them heroically…send them home, but they have no car to get to clinic, no resources to get their prescriptions filled, and bounce back in the hospital?” asked Kirch. “It’s not a medical care problem, it’s a social support problem.”

Seizing the moment

Pivoting from the problems to progress, Kirch outlined a number of things physicians must do moving forward, beginning with establishing a new collaborative culture.

The old model of healthcare was individualistic, hierarchical and competitive. Combine these attributes with today’s pressing challenges and you get a recipe for disastrous morale. Kirch said nearly half of physicians today report feeling burned out at work, while 7 percent even report suicidal ideation.

Kirch called on attendees to flip the script and embrace a more collaborative, patient-centric model that would have the side effect of reducing isolation. Rather than simply form committees that are teams in name only, truly work in partnership with clinical colleagues to maximize value.

"We need to transcend this culture of rugged individualism and figure out how to be much more collaborative."

Kirch closed by project the image of Luke Fildes’ 1891 painting, “The Doctor,” which depicts a physician in deep concentration next to a sick child. "Can we retain that connection with the patient?” Kirch asked.