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Over my nearly 40-year career as an internist in St. Louis, I’ve had the great fortune of practicing in a clinical and economic context that has allowed me to have very rewarding experiences taking care of my patients and building many lasting relationships. It has been frustrating to watch our industry evolve, pushed by regulation, bureaucracy, consolidation, new poorly conceived technologies, adverse economics, and an increasingly complex but poorly supported patient population. I’ve seen colleagues become disillusioned and patients get lost in the shuffle of an increasingly complex system.
Where others have become cynical, I am able to remain optimistic and energetic for my work. I have more conviction now than ever before, and the reason is clear. My clinical/economic context has me, with my colleagues, responsible for not only the clinical outcome but the cost of care as well. In an appropriately funded and long-term contract, we literally get paid to keep patients happy, healthy, active, and energetic for life. Our compensation is very well aligned with achieving health outcomes and eliminating inefficiencies.