Introduction
The American healthcare system is rapidly changing. Expanding federal programs and emerging insurance exchanges will exacerbate an increasing physician shortage. Many surgeons will consider employment or alignment with health systems for economic stability, improved patient access, cost reduction, and enhancement of quality initiatives.
Methods
This consensus summary of research by the Committee on Socioeconomic Issues of the American College of Surgeons Board of Governors describes some of the salient features of the changing American health care system, and examines characteristics of the "surgical product" demanded of employed surgeons. It defines an approach to assessment of an organization's mission, vision, clinical resources, administrative structures, and processes for sustaining clinical competencies. To facilitate evaluation of financial management principles, including strategies for generating positive business margins while preserving high quality patient care, the document includes an overview of a modern surgical quality assurance program's critical components, focusing on the surgeon's role in maintaining unchallenged advocacy for excellence in patient care.
Results
The critical components of assessment mandate detailed understanding of emerging systems of shared risk and reward. Hospital and health system assessment requires full disclosure of organizational strategy, ability to implement visions and goals, administrative leadership, and fiscal management policies. Organizational clinical strategy, especially related to assuring quality in surgical care remains the core characteristic of an environment that nurtures professional growth and optimizes personal satisfaction.
Conclusions
Accepting employment without full commitment to complete control of clinical care and active leadership in defining organizational financial philosophies will assure the inevitable relegation of both surgeon and patient to the roles of passive participants in an inferior health care system over which neither have any possibility of control.
Joseph J. Tepas, MD, FACS, Tyler G. Hughes Sr., MD, FACS, David S. Aaronson, MD, James L. Kesler, MD, FACS, Richard J. Buckley, MD, FACS, Anthony J. Dippolito, MD, FACS, Matthew J. Wall, MD, FACS, Nipun B. Merchant, MD, FACS, Walter C. Dandridge, MD, FACS, Mika N. Sinanan, MD, FACS, Dale Buchbinder, MD, FACS, Howard L. Sussman, MD, FACS, Andrea Hayes-Jordan, MD, FACS, John C. Chen, MD, FACS, Lewis Wetstein, MD, FACS, David R. Arbutina, MD, FACS, James C. Dennehy III, MD, Adnan Alseidi, MD, FACS, Robert V. Rege, MD, FACS, Aaron S. Fink, MD, FACS, Linda M. Barney, MD, FACS, David W. Cloyd, MD, FACS, Mary E. Fallat, MD, FACS, Deborah S. Loeff, MD, FACS, Kevin E. Behrns, MD, FACS, Selwyn M. Vickers, MD, FACSemail address
Received 28 December 2012; received in revised form 24 May 2013; accepted 24 May 2013. published online 27 June 2013.
The American healthcare system is rapidly changing. Expanding federal programs and emerging insurance exchanges will exacerbate an increasing physician shortage. Many surgeons will consider employment or alignment with health systems for economic stability, improved patient access, cost reduction, and enhancement of quality initiatives.
Methods
This consensus summary of research by the Committee on Socioeconomic Issues of the American College of Surgeons Board of Governors describes some of the salient features of the changing American health care system, and examines characteristics of the "surgical product" demanded of employed surgeons. It defines an approach to assessment of an organization's mission, vision, clinical resources, administrative structures, and processes for sustaining clinical competencies. To facilitate evaluation of financial management principles, including strategies for generating positive business margins while preserving high quality patient care, the document includes an overview of a modern surgical quality assurance program's critical components, focusing on the surgeon's role in maintaining unchallenged advocacy for excellence in patient care.
Results
The critical components of assessment mandate detailed understanding of emerging systems of shared risk and reward. Hospital and health system assessment requires full disclosure of organizational strategy, ability to implement visions and goals, administrative leadership, and fiscal management policies. Organizational clinical strategy, especially related to assuring quality in surgical care remains the core characteristic of an environment that nurtures professional growth and optimizes personal satisfaction.
Conclusions
Accepting employment without full commitment to complete control of clinical care and active leadership in defining organizational financial philosophies will assure the inevitable relegation of both surgeon and patient to the roles of passive participants in an inferior health care system over which neither have any possibility of control.
Joseph J. Tepas, MD, FACS, Tyler G. Hughes Sr., MD, FACS, David S. Aaronson, MD, James L. Kesler, MD, FACS, Richard J. Buckley, MD, FACS, Anthony J. Dippolito, MD, FACS, Matthew J. Wall, MD, FACS, Nipun B. Merchant, MD, FACS, Walter C. Dandridge, MD, FACS, Mika N. Sinanan, MD, FACS, Dale Buchbinder, MD, FACS, Howard L. Sussman, MD, FACS, Andrea Hayes-Jordan, MD, FACS, John C. Chen, MD, FACS, Lewis Wetstein, MD, FACS, David R. Arbutina, MD, FACS, James C. Dennehy III, MD, Adnan Alseidi, MD, FACS, Robert V. Rege, MD, FACS, Aaron S. Fink, MD, FACS, Linda M. Barney, MD, FACS, David W. Cloyd, MD, FACS, Mary E. Fallat, MD, FACS, Deborah S. Loeff, MD, FACS, Kevin E. Behrns, MD, FACS, Selwyn M. Vickers, MD, FACSemail address
Received 28 December 2012; received in revised form 24 May 2013; accepted 24 May 2013. published online 27 June 2013.
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