Columbus Monthly / December 2011 / We need to talk

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We need to talk

Primary care physicians and specialists are seeking to increase their dialogue with one another, a development that will benefit not only them, but their patients.

“Can you hear me now?”
Increasingly, Central Ohio physicians are asking that question when it comes to communicating with their fellow doctors. Good rapport among physicians is essential for good patient care—so what is the current state of the relationship between primary care physicians and specialists?

Like many of the changes in healthcare over the past 25 years, the shifts in the way primary care physicians and specialists relate have occurred gradually. The days of relationship building in the hospital lounge are long gone, and each year it seems communication between primary care doctors and specialists has become more of a challenge. With the rise of hospitalists, subspecialties and the pressure to see more patients every day, physicians today rarely have time to devote to face-to-face development of their relationships with specialists. In fact, it’s not uncommon for physicians who have been referring patients to each other for years to never actually meet.

Primary care physicians and specialists have been trained for different things, and a variety of barriers stand in the way of better integration between primary care and specialty care.

“I’ve been fortunate because when I started out practicing medicine, I had ample opportunity to personally interact with my specialists,” says internist Douglas Finnie, MD. “That’s simply not the case anymore.”

So how do physicians effectively coordinate the care of patients? “The better I know my colleagues and their personalities, in addition to their clinical expertise, the better I can match my patients with my referral,” says Finnie. “The patient-doctor relationship is critical and the physician-to-physician relationship is important. I do my best to foster that relationship when patients need specialty care.”

“We all need to understand we’re part of the same team,” says Evan Tobin, MD, a specialist from Ohio ENT. “From my perspective, we work to provide the best care possible and keep our primary care colleagues informed throughout the process.”

In today’s environment, that can be challenging. Larger specialty practices regularly communicate with primary care physicians via formal marketing efforts, while also paying special attention to how they communicate on an individual level. “I can’t even imagine the amount of paperwork primary care physicians have to deal with every day,” says Tobin. “When I send a patient report back, I work hard to assure it’s succinct, accurate and to the point. I want to make their job as easy as possible, particularly if they need to provide follow-up care.”

But physicians readily admit these efforts cannot take the place of real relationships between physicians, and they must also take into account the patient’s perspective.

“If I didn’t have personal relationships with specialists, I would make referrals from the patient’s eyes, meaning, ‘Who is accessible? Who has a good clinical reputation?’ From more of the consumer perspective rather than from a personal relationship with that specialist,” says family physician Edward Bope, MD.

 

Building a community

For the most part, today’s healthcare delivery system continues to be fragmented. This has led to many of the current challenges, such as seeking healthier outcomes, better patient coordination and cost containment. So where do we go from here?

Physician organizations and hospital systems in the Central Ohio area have created or are attempting to create clinically integrated networks. National and local healthcare reform efforts are planning for the widespread implementation of Accountable Care Organizations (ACO) and Patient-Centered Medical Homes (PCMH) as standards of healthcare’s future. These large-scale changes are increasing data sharing, increasing preventive visits and wellness care, improving the management of chronic diseases and providing physicians the tools to better coordinate patient care.

Yet many physicians want more. “We’re finding for many physicians, it’s not enough just to have more tools in the toolbox to provide patient care,” says Columbus Medical Association CEO Phil Cass. “It’s certainly very helpful, but asked about what physicians truly want to see, it’s about the personal relationship between physicians that needs to be improved.” Cass cites extensive research with local physicians, conducted by the CMA, that identified a large gap in professional satisfaction due to less personal interaction among all physicians. “Even as networks are built, the personal relationship needs to flourish as well,” he says.

“What we’ve found is that physicians want to return to a ‘community of physicians’ in the truest sense,” Cass adds. “A manner in which they can relate to each other both on a personal and a professional level. When that occurs, not only is patient care improved, but the creativity and impact on the community are tangible.” Cass points to the creation of the Columbus Medical Association Foundation, Physicians Free Clinic, AccessHealth Columbus and the Central Ohio Trauma System as a few examples of physicians being given the opportunity to create impactful and meaningful programs.

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Creating the space

For more than a century, the Columbus Medical Association has served area physicians. Its mission and purpose has evolved and changed. Many social offerings gave way to advocacy and traditional trade association roles as medicine became more contentious in dealing with third-party influences and the ongoing threats to the patient-doctor relationship.

Now the CMA is again adjusting its evolutionary path to engage physicians where and how they live, rather than operating an organization and hoping it fits into physicians’ lives. “As far as we know, it’s an approach that is not being done anywhere else in the United States,” says Diane May, CMA’s director of member relations and services. “This truly allows physicians to shape the organization and participate with each other at events, or host conversations they want to have that will begin to re-create the long-dormant ‘community of physicians.’ ”

Coupled with the fact that physicians no longer are required to join the state medical association when they join CMA (a recent change to a long-standing policy), physicians are invigorated and flocking to the new CMA as a means to engage their colleagues as they’ve wanted to.

“The Central Ohio marketplace is very competitive. The new CMA allows for physicians from all the hospitals, employed or independent, large or small practice, to come together first and foremost as physicians. It’s something that has been sorely missing,” says Cass.

As CMA began its new direction, one of its first events was the primary care/specialist summit (see “Enhancing the relationship”) to begin meaningful conversations and help bridge the gap between physicians in the best interest of patients.

A host of other physician-identified initiatives are underway or in discussion, including the creation of a physician leadership academy. “More physicians are being required to serve in leadership roles,” says Finnie. “While it’s clear that physicians have years of training to create experts in practicing medicine, physician leadership training opportunities have been few and far between. The creation of a world-class physician leadership academy is being seriously discussed.”

Changes in how physicians relate to each other will take time. “Our current situation did not happen overnight, and it will take time for physicians to fully reengage with each other,” says Cass. “For all intents and purposes, we’ve created a blank canvas that allows physicians to define what they need, rather than what we think they need. That’s good news for medicine and patients.”

 

Enhancing the relationship

On Nov. 9, the Columbus Medical Association convened the “Primary Care/Specialty Physician Summit: Enhancing the Relationship.”

A group of primary care physicians and specialists met prior to the summit to design its flow and opportunities for interaction among attending physicians. The summit addressed issues such as improving communications between primary care physicians and specialists, how scheduling can be made easier and how physicians can work toward better coordinated patient care. 

As a result of the summit, several smaller groups have agreed to continue these discussions going forward.

 

What can patients do?

Patients referred by their primary care physician to a specialist may find the following tips from physicians helpful:

• Know exactly why you’ve been referred.

• Take the time to complete all the intake forms (most offices provide forms ahead of time).

• Bring copies of previous tests, such as X-rays or MRIs (particularly if the tests were done out of network).

• Ask questions if you don’t understand what’s being said.

• Feel free to discuss the next steps with your primary care physician after your specialty visit.

Gary Stelluti provides communications and marketing services to the Columbus Medical Association through Health Care Marketing Strategies, LLC.