I regret that my posts have been irregular of late. I don’t wish to be circumspect, so please know that my recent silence around health reform is not born of indifference, but a result of my participation in a group studying issues around health reform and whose participants have been asked not to reveal its deliberations until its work has been submitted. So while I haven’t been forthcoming about my thoughts around health reform and its impact on palliative medicine, I’m confident that what hypotheses I might offer hereon will be better informed. And while predicting the outcomes of highly charged and politicized issues such as those surrounding the nation’s health care system is surely not my intent, if I can help frame the key issues for those of us seeking to advance the profession and field of palliative medicine, then perhaps we can better prepare for the sweeping changes that will engulf us.
Back to the question I’ve contemplated a great deal over the past couple of months – will health reform accelerate or stall the progress of palliative medicine? It seems to me that the answer depends upon whether one believes that there exists today a business model that pretty much guarantees a livelihood to a physician practicing palliative medicine full-time. In other words, the practice can sustain itself through patient revenues without having to rely upon subsidies from a hospital or other sponsoring organization (if a hospital , for example, wishes to support a practice because it recognizes the value of a palliative medicine practitioner, by all means such support should be accepted). But there is a big difference between HAVING to GO back to a sponsor to request additional subsidies to relieve the growing pains of a palliative medicine practice, and operating a practice whose value (financially and clinically) is so widely acknowledged that the practice is actually “sought after” by other providers. And while palliative medicine physicians are surely in demand, just as surely palliative medicine practices are not. Therein lies the great disconnect.
As we have learned, it is very difficult to disengage the success (or lack of ) of a palliative medicine practice from its related program. More later on why practices are not in great demand. For now, just ask yourself, how many physicians have you recently heard mention that they planned to start an independent practice in palliative medicine?
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