- Del Meyer, MD - http://delmeyer.net -

Orange, San Mateo, & Kern Counties

Sheryl R Skolnick, PhD, managing director at BancBoston Robertson Stephens, who is responsible for analysis and recommendations in the health-care arena, was the final speaker at the UCI Health Care Forecast Conference as reported in the The Bulletin of the OCMA. She concluded that 1998 was a disastrous your for health care. She stated that physician practice management companies (PPMs), the group that was designed to protect physicians from HMOs by concentrating physicians into larger networks, are failing because they do not add any value to health care and were predicated on increasing volume. PPMs accepted more and more risk agreements to increase revenues. In the end they turned on physicians, the very group they were designed to protect. After the FPS Management bankruptcy, and MedPartners decision to abandon the PPM business and its forced bankruptcy, they fell out of favor on Wall Street. Dr Skolnick urges her colleagues to stop viewing HMOs as growth stocks but more like traditional insurance companies. She also feels that while further consolidation will occur, the key to the future health-care model will be “deconsolidation.” Smaller and better companies will emerge because “health care is a consumer service industry.”. . . The MedPartners CEO told me at the first CMA La Quinta leadership conference that they were interested in purchasing Hills Physician. Fortunately, Steve McDermott, CEO of Hills, did not take their money and run. We could have been part of their $2 billion write-off.

Barbara Yates, MD, a psychiatrist for San Mateo County’s Elder Mental Health Outreach team makes house calls on the chronically mentally ill. She shares duties with team members who are psychologists, nurses, social workers, and trainees. They travel to varied home settings, from spacious elegant homes in Hillsborough to trailer units in East Palo Alto. She feels there are great advantages to this type of work for the patient, for the art and practice of medicine, for the doctor, and for health-care systems. And it works out well for her in balancing motherhood with two toddlers and part-time work.

“The trained nurse has become one of the great blessings of humanity, taking a place beside the physician and priest, and not inferior to either in mission.” William Olson, MD, president of the Kern County Medical Society, begins with this quote from William Osler (1849-1919) in his tribute to the nursing profession, “the critical part that other staff play in ‘nursing’ our patients back to good health.” He bemoans the criticism and short tempers that are too frequent during these times of high stress, high patient load, and long hours for our professional colleagues. Those make the nursing profession even more counterproductive and work to further the stress these heroines and heroes labor under daily “in the trenches.” He encourages physicians to pass on the comment of a satisfied or appreciative patient and to ask the opinion of a nurse on how best to care for our patients. He quotes behavioral research which confirms that affirmation and recognition of a job well done are often more cherished than financial rewards. He challenges us never to forget in our dealing with nursing, the mainstay of any good relationship: communication, understanding, praise, and reassurance. He then closes with a quote from Charles Mayo (1865-1939): “The trained nurse has given nursing the human or shall we say, the divine touch, and made the hospital desirable for patients with serious ailments regardless of their home advantages.”

Leo van der Reis, MD, Daly City internist, writes in the San Mateo Co Med Assn Bulletin about leadership in medicine. Dr Reis wonders if the current state and national leaders of medical organizations are competent to deal with the problems the profession faces in this time of turmoil? He points out that our titular heads serve for a brief time with some influence but without the skills needed by a chief executive of a major organization, nor are they elected by a process that exposes them to a majority of their membership. Instead of executive directors being the day-to-day implementors of policy and procedures, we should upgrade the office of president and provide a term of four to six years elected by popular vote of the membership. The president should be allowed every opportunity to govern and to select his or her coworkers and associates. Dr Reis feels such a move would induce many inactive members to become involved in their organization. He feels such a well-trained president would be an excellent substitute for the nonphysician lawyers, nonphysician accountants, and other nonphysician lobbyists who are our representatives to-day.