Accepting the maybe

Tags: perspective, hurley

By Janet Hurley, MD

In my leadership duties for the Texas Academy of Family Physicians and within my personal job as family physician and operational chief of primary care for Trinity Mother Frances Health System, I continue to see pockets of skepticism, frustration, and fear among my primary care physician colleagues. In some of my most difficult assignments, I have felt that the greatest barrier occurs when some physicians go straight to the negative with their thoughts as we begin discussions.

Our specialty is rife with physicians that go straight to the negative. When we consider the high rates of physician burnout in our country we begin to understand why this is true. Primary care physicians have felt overworked and underpaid for quite some time. The current fee-for-service payment system has created inefficient patient management practices that prevent care for simple conditions over the phone, lead to unnecessary follow-up appointments, and encourage physicians to pack more patients into their clinic day to generate volume. Transitioning these practices to a value-based payment world is truly a challenge. 

When family medicine leaders reach out to constituents in private practices, we commonly find that physicians do not trust their nearby hospital administrators, they see neighboring practices as competition, and they are quick to blame insurance companies for most of their payment problems. While a lot of this frustration is justified, it hinders their ability to make the necessary changes in their practice that will make them viable in the medical marketplace of the future. I propose another way of thinking. What if instead of going straight to the negative, we begin accepting the maybe.

Maybe hospitals really do understand the need for a strong primary care infrastructure within the community to provide good care to the patients they serve. Maybe their appeal to provide EMR support, shared savings benefits, or other amenities to local physicians is generated with honest intent.

Maybe insurance companies really do want to partner with us to create a higher quality, lower cost health-delivery product for our communities. While we realize every business needs to make money to stay afloat, maybe we can begin to believe that insurers see patients as more than covered lives.

Maybe we will realize that employers are the true customers in the insurance marketplace and they value our ability to see their employees efficiently so they can receive the needed treatments and get back to work.

Maybe we will realize our desire for autonomy must also come with accountability. The future health care marketplace will demand a commitment to following evidence-based guidelines and providing reports on quality. We should realize that patients are demanding this and they are becoming much more sophisticated in their research efforts and physician selection. We should be motivated by a desire to improve and not offended because people ask about our credentials and quality ratings.

Maybe we can accept that there is strength in numbers and that integrating with neighboring independent primary care physicians or health systems will make the transition to these changes more palatable.

Maybe we will realize our true customers are our patients and they are demanding these health care changes as much as anyone else.

Once local primary care physicians begin to have collegial discussions with hospitals, insurers, or employers, maybe these other entities will begin to trust that the physicians care more about their patients and the community than their own bottom line. And maybe, just maybe, primary care physicians will once again enjoy being doctors.

Janet Hurley, MD, is TAFP Treasurer and the operational chief for primary care for Trinity Mother Frances Health System, South Region. Read her blog at

1 Comment

  • Karen Shrader said

    Maybe if the fraud, waste, and abuse in the health insurance and pharmaceutical industries was fixed, physicians would/could be more optimistic. I personally spoke with Sen. Lloyd Bentsen in 1986, in his office in Washington, DC, regarding health care costs, access to care, disparity in payment rates for primary care physicians, and other topics;absolutely nothing has changed for the better since then. The infinite insanity has not stopped, and has only gotten worse, IMHO.

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