Our practices are attached to the swinging pendulum of healthcare debt, reimbursement and corporate drivers.  This blog is not intended to highlight the potential trends of ACOs, hospital mergers and acquisitions, or the impact they will have on the quality of physicians’ professional practices and our patients.  After all, so many providers are well aware of the changes on the horizon.  Many more healthcare professionals are intimately aware of business practices and much more willing to partner with or be employed by healthcare organizations than to weather it alone.  This, too, is part of the swinging pendulum that physicians should be mindful of.  There can be some very positive outcomes for all, but it is important to remain at decision tables and as proactive stakeholders.  To do so, it is essential for physicians to grow more robust and cohesive groups in order to be proactive agents of change.

As clinicians, we are true content experts who must be directly involved in key decisions that are integral in reshaping the face of health care.  By partnering with hospitals and insurers to maintain our ability to get paid – but without being intimately involved in how we are able to render care, driven by modified reimbursement mechanisms – might be the kiss of death this time around.  After all, it’s Medicare with a facelift.  Physicians are criticized for not being business savvy, not being organized enough to hold ground with larger lobbies that impact our careers, or being too far removed from corporate interests.

However, this is far from the truth.  Much of what drives niche markets in health care, corporate interests, as well as entrepreneurial possibilities, are well aligned with what drove most of us to become healthcare providers.  We are driven to go to medical school. We are passionate about being doctors, striving for excellence, not accepting mediocrity for our patients, and remaining loyal to the practice of medicine while recognizing opportunities in the marketplace.  Even more vital to corporate and business successes, physicians are genuine competitors.  By in large we strive for excellence and success because we are deeply passionate about the mission, not moving in a linear tunnel vision manner for a goal or exclusive bottom-line gains.

We need to consider ways of growing our voice and power, not just through our specialty societies, but through our state medical societies as well.  Greater and more dynamic communication between state medical societies would also offer a means to scale essential resources and ideas linked through social media.  Increasing membership and, most importantly, proactive membership deliver value.  As physicians we are a very unique “tribe.”

Leadership in the new millennium is noted to be part of everyone, not simply top-down or bottom-up mantras.  Physicians are healthcare leaders not managers.  I recommend researching and reading Seth Godin’s Tribes We Need You to Lead Us.

NHMS needs to grow membership.  Take it upon yourselves to bring two new members to NHMS in 2015.  See it as an immediate opportunity to share commitment, increase leverage and create change.  NHMS is an opportunity for physicians to become new leaders and support physician leadership in our state, and take NHMS into the future. NHMS is a tremendous resource and advocate for our patients and our careers.


Lukas Kolm, MD

Please send your comments or questions to president@nhms.org or post a comment below.


While applaud your advice to have physicians be at the table as health care reform and reimbursement reform are underway, I think it is important that we bring more than just passion and entrepreneurialism to that table. As I tried to impart during my year as NHMS President, it is critically important that physicians cultivate positions of leadership in order for their voices to be truly respected at those tables. And that means that while we maintain a focus on clinical excellence we also educate ourselves in terms of business issues including finance, negotiations and quality improvement. The game is changing but it is changing primarily from an individualized entrepreneurial focus to a team or system focus. And that means that physicians need to be knowledgeable about what constitutes a team and how to wield influence and leadership in that team.

@Lukas Kolm, Agree; there are indeed many powers that can be employed in our common work as physicians. Nice that you are giving a focus and asking for action. There is the power of individual action, the power of leadership and the power of group action. Someone said: "If you want to travel quickly, travel alone. If you want to travel far, travel as a team."

@John Robinson, yes, learning the language and skills of leadership and group membership (finance, negotiation, QI, among others) will indeed improve your efficacy and your bona fides at any table you wish to join.

Regarding recruitment to NHMS, what other story or point of view might encourage someone to join NHMS? (...in addition to the reasons in Lukas's last paragraph. This question is meant for anyone.)

I agree with much that has been said. I think. My observations however, have shown me that physicians that cultivate leadership positions (especially at the expense of clinical practice) become just that. They become thought leaders, CMOs, wonks and health administration entrepreneurs and frankly become "them" and not practicing clinicians. This is disheartening to say the least but it is my observed reality. Employed docs become beholden to their employers. That's just the fact of the situation regardless whether medicine or ball bearing manufacturing. Physicians "at the table" are more witnesses to their own professional wreck entranced by the same morbid fascination that rubberneckers demonstrate to a crash on Northbound I-93 during ski season. There is no "I" in team and sometimes there is a good reason for that. I received a lovely email today from my local hospital regarding electronic physician ordering and that there are apparently some rebels that use the hospital so infrequently that they are not using the system mandated by the hospital to remain in what the hospital calls "compliance". These outliers are threatening a continuation of unsafe practices and must be educated by the Executive Committee. They reference the bylaws and that we have consented to the bylaws in our credentialing application. Since the vast proportion of "physicians" are hospital employees and they are voting these issues, I see my position and the position of my department as not being represented by the "medical staff" of Concord Hospital. I find the "team" attribute too thin to warrant my agreement especially right after the Borg has once again spoken and the message again is that resistance is futile. If you want to travel at all, it is probably best to own your own means of transportation.