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We all know that President Barack Obama is doing everything in his power to try to pass healthcare reform. So far, politics have been at the center of that fight, with people on the left wanting one thing and people on the right wanting another. But how would healthcare reform affect those closest to the flame – employees in the healthcare industry itself.

At first glance, you might think that every doctor would be in favor of a new healthcare system – one that’s meant to help more people – but that’s not necessarily the case. Nor is it the case that every doctor is opposed to the plan.

The Healthcare Reform Plan
In order to understand the debate, it’s helpful to know the basic plan Obama is proposing. There are currently two versions of the bill, one in the House and one in the Senate, but both are similar. If you’re already insured through your employer, are paying for your own insurance plan or are on public assistance, the bill will most likely not affect you. But if you’re employed and under-insured, the plan would give you some relief.

Varying rules would require the self-employed, those employed by a small employer and those employed by a large employer to be covered and only responsible for a certain percentage of the premium. There also would be a public health plan option, which would allow people to purchase a plan that offers coverage similar to what government employees receive.

Another part of the proposed plan would provide incentives to healthcare professionals who use preventative measures to help patients, as opposed to a system where doctors are rewarded based on the number of surgeries they complete or the number of patients they see. This opens the door for a scenario in which those doctors who care more about the actual practice of medicine than the money they receive come out on top.

In Obama’s most recent town hall meeting in Shaker Heights, OH, a suburb of Cleveland, he touched on how healthcare professionals can focus on preventative measures to ultimately drive down costs. For example, he said, a doctor could point an overweight person in the direction of a nutritionist to help keep their weight down before they get diabetes, as opposed to later paying for surgery to amputate a foot.

“But the problem is, right now, that a lot of the health system doesn’t reimburse and incentivize that kind of preventive work and that wellness work,” he said. “And so what we want to do is absolutely in this reform package, there will be reimbursements for and incentives for prevention and wellness, and we’re going to make sure that those are the things that don’t require out-of-pocket costs for the patient so that they’re not being discouraged from using it, but rather they’re being encouraged from using it – that will make all the difference in the world.”

Just What the Doctor Ordered?
So, how do healthcare professionals feel about the plan? That’s a loaded question. On one hand, the American Medical Association has endorsed Obama’s plan. On the other, Sermo, the largest online community of physicians, released a letter opposing the plan, which was signed by more than 13,000 physicians.

You might think that deep down, regardless of what they say, everyone is in it for the money. That’s far from the truth, and the Cleveland Clinic has been able to prove that. The Clinic is often voted among the best hospitals in the country, if not the world, and has managed to provide the best care while keeping costs low, all the while only paying its doctors by salary. Does this lean toward the fact that those doctors who are forced to focus on patient care instead of monetary incentives end up doing the best job?

Obama recently visited the Cleveland Clinic, which he cites as an example of a successful healthcare operation. The Clinic, which began in 1921, has the second-largest group practice model, which allows it to increase efficiency and improve quality by controlling utilization and measuring quality and safety.

All parts of the clinic are integrated, making it easy for different professionals to work together and control and rationalize expenses. The Clinic has a strong health information technology system, which improves communication and reduces medical errors.

“We strongly believe that our focus on quality, efficiency, wellness and prevention combined with clinical innovation and health information technology positions Cleveland Clinic as a leader in healthcare and a model for the future,” Delos “Toby” Cosgrove, M.D., CEO and president of the Cleveland Clinic, said.

Because the Clinic pays its doctors a salary instead of a fee-for-service, there is no room for doctors to have any incentive to order expensive devices or unnecessary tests. Every physician has a one-year contract and doctors don’t receive tenure, bonuses or other financial incentives. Salaries and contract-renewal are based on the results of a comprehensive annual performance review.

The Clinic maintains 40,000 employees, making it the largest employer in Northeast Ohio, the second-largest employer in the state and the largest employer in the history of Cleveland. The institution employs 1,800 physicians and scientists in 120 medical specialties and sub-specialties. Obama said any system similar to that of the Cleveland Clinic would make it easier for doctors to implement some of the proposed changes.

“Now, that’s not maybe the thing that every doctor is going to want to do,” he said. “But there are other ways that we can take that same approach where they start thinking in terms of what’s needed for the patient, and making sure that they’re getting reimbursed for what’s good for the patient, and they don’t then have to worry about what’s the government saying, or what’s the insurance company saying; am I going to get reimbursed for this, am I not going to get reimbursed for this, do I have to fill out 15,000 forms.

“I’ve said before, most people who are doctors or nurses, they didn’t get into it to fill out forms; they got into it to make people feel better, to heal the sick, and that’s what we want to free them up to do, but it will take a little time to get there,” Obama added.

The Mayo Clinic, which Obama also often cites as an example of a successful healthcare system, initially opposed the reform plan, saying lawmakers failed to focus on changing the Medicare payment policy. However, the Mayo Clinic later adjusted its thinking when it became aware the healthcare reform plan would include the development of an Independent Medicare Advisory Council, which would provide a “value-based payment” model.

The Future of the Industry
Healthcare is often considered to be a recession-proof career, which has a lot of recent graduates and those looking for a career change turning to the industry. The President’s Council of Economic Advisers recently released a report predicting that healthcare jobs will show the biggest gains between now and 2016.

However, a June report from MedZilla found that hospital systems have continued to eliminate healthcare jobs and leave open positions unfilled because of a loss of profits, an increase in uninsured patient care and a decrease in reimbursements from insurance companies, including Medicare and Medicaid.

On top of that, there is already a shortage of qualified professionals to fill open positions. Adding to that concern, opponents of the reform bill are worried it will deter prospective doctors from pursuing a medical degree. And some are worried the reform would put doctors in a tough spot by forcing them to make moral decisions, making patients wait long amounts of time for procedures or even turning them away.

In order to combat that type of situation, it has been suggested the bill include a provision that expands primary care and nurse training programs to help increase the size of the workforce. That measure would include strengthening grant programs for primary care training institutions and increasing existing preventive medicine programs. The bill also would improve existing student loan, scholarship and loan repayment programs.

So it seems as though there is a great divide among those in the healthcare industry as to whether or not Obama’s reform plan would ultimately help them. But should that be the main concern? Ask yourself if you’d rather have your doctor focusing on how to add a few more dollars to his wallet or how to take the best care of you.

Perhaps instead of worrying about not making surplus amounts of money, doctors should worry about helping patients any way they can, whether that’s through becoming more aligned with other departments in their institution, focusing on preventative measures for patients or accepting a salary, like those at the Cleveland Clinic.

We all want to make money – that’s half the reason for getting a job in the first place – but does a doctor have an obligation to put the patient first and the money second? That probably depends on why they went into the healthcare industry in the first place.

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