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INSPIRATIONAL
MEDICINE
Finding the Silver Lining
WHEN THE PASSION OF PHYSICIANS AND
FEDERAL REGULATIONS COLLIDE IN CONCERT
By Alan M. Preston, MHA, ScD
There are many reasons why a person gravitates to the practice of
medicine. In a LinkedIn post last year, an article suggested that there
are 4 primary reasons why a person might want to become a physi-
cian. To paraphrase the four reasons, they are:
There is a driving force from within to heal people, be of service
and/or save the world. These people are motivated by the purpose
and not necessarily by the money.
There is a need to have a lucrative career in addition to healing
people. These people are motivated by both money and service.
There is a desire to be a part of a successful profession. These peo- crease of patients, it is a plethora of new rules and regulations.
ple know that being a physician is a high paying profession and they
are mostly focused on the career and accolades that inure them in
such a profession.
There is a family expectation to become a physician. One or both
parents or grandparents were physicians and their family expected
them to become a physician. They are doing their family duty.
Regardless as to the why people gravitate into the practice of med-
icine, once they are a practicing physician, there is an intrinsic re-
ward in helping people. Obviously, some are more passionate than
others in the practice of medicine.
Most physicians are seldom prepared for the onslaught of regula-
tions that often distract from the practice of medicine. For many
physicians, the constant regulatory environment is driving many to
abandon their practice, sell it to a hospital or other entity, or become systems as opposed to small private practices.
an employee of another entity as to attempt to avoid dealing with
the plethora or rules and regulations that take away from the practice
of medicine. All businesses must deal with increased regulations;
however, many physicians enter the practice of medicine because of
the passion of helping people, not to become entrepreneurs in run-
ning a complex business with complex regulations.
Recent surveys of physician satisfaction of the practice of medicine
offer clear and compelling results. The Physician’s Foundation con-
24 San Antonio Medicine • November 2016
ducted a survey to understand the state of physicians in 2014. They
received over 20,000 responses and many trends emerged.
The 2014 survey indicated that there is pressure on physicians to
meet the demand for their medical services, as over 80 percent of
physicians reported being overextended or at full capacity. To some
degree, this is not surprising given the demands that the Affordable
Care Act (ACA) has placed on existing doctors. Anytime the mar-
ketplace creates a greater demand for services and does not allow
time for the supply to catch up, there will be providers who attempt
to meet the higher demand loads. Thus, many doctors feel over-
whelmed. The demands placed on doctors now are not just an in-
And when there is rapid change to any business model, the mar-
ket changes swiftly as to adapt to the change or get left out and per-
ish. Those who wait too long to adapt in a changing healthcare
marketplace can find themselves alone and with few options. As
Plato said in the Republic, to paraphrase; “necessity is the mother
of invention”. And the marketplace has responded to the maze of
regulatory framework in ways that offer help to many independent
physicians.
Nevertheless, physicians must maintain the highest standards of
care as they manage over 1.3 billion patient encounters per year.
Physicians also must implement electronic medical records and a
wide array of other medical and practice management technologies
required by the ACA. Many physicians feel they must adjust to this
new inverted business model that features large integrated health
For the small independent physician practices, the marketplace
has created many options for continuing their services. Unfortu-
nately, some physicians have decided to give up their “indepen-
dence” and autonomy and have elected to go with an integrated
delivery system. Others have found solace in participating in a