By Robert J. Jackson, MD

It's hard to be a doctor these days. In new and multiple roles, physicians are busier than ever. Called upon to be part Albert Schweitzer and part Donald Trump -- we must balance the competing interests of new and powerful stakeholders, provide quality care and still somehow manage a successful business. Add to the mix an atmosphere of what seems like constant change, and today's doctors face unprecedented pressures. Sometimes it seems difficult to know what to do. But physicians should not only try to navigate the new marketplace, but strive to take the reins and determine the direction of the health care as well.

How Do You Lead When You Can't See the Parade

How do you lead in today's seemingly amorphous health care system? Sometimes it seems like physicians are at the mercy of invisible and more powerful forces beyond their control. Health care reform and rising costs have resulted in a host of potential new players, too -- ACOs, health care exchanges, etc. -- along with the usual suspects. A recent foray into the physicians' lounge at a local hospital brought home the point: a group of physicians were lamenting what the federal government might do to them and that conversation soon digressed into what their hospital administration might potentially do to them. Likewise, physicians today seem to feel less and less confidence in their abilities to control their destinies.

It's understandable. Unrelenting rising costs are a tremendous concern in health care. Consider: We spend 18 percent of our Gross Domestic Product (GDP) on health care. Additionally our federal government spends more than 24 percent of its budget on Medicare and Medicaid. And even with legislative reform, health care costs are expected to double by 2020. These rising costs have increased pressure, financial and other, on all stakeholders -- physicians, providers and patients -- and transformed the marketplace. How do we stabilize or reduce costs and maintain quality care? It's a question for everyone involved, but often the physician's office is where the rubber meets the road.

I'm a Doctor, Not a Businessman

In order to do provide better care, physicians have been encouraged to change the way they operate -- to use the latest technology designed to record their performance, track patient conditions and outcomes, prescribe electronically. Increasingly, we're also approached by hospitals, physicians, and other providers to consider partnerships that will be financially beneficial. Meanwhile, they must still maintain a profitable business. How do you pay attention to all of these issues and still manage your livelihood? Most doctors became doctors because they enjoy helping people, not because they want to manage small or mid-size companies. So, physicians have unique pressures relative to other stakeholders in health care. But these pressures arise due to physicians' prominence within the system. Due to this unique position, physicians have a singular opportunity to change the direction of health care and their role within the marketplace.

A Changing Vision - Physicians Must Lead

Physicians are the nexus where all health care stakeholders meet. This central role gives them unique perspective and authority in helping shape what might be most effective -- in terms of cost and quality -- for all involved. This also provides them with the challenge to take the lead in determining the future of health care. But first, physicians must re-imagine their own role. Instead of seeing themselves as powerless -- like the earlier example of our lamenting docs in that hospital lounge, physicians must understand their role, realize it is pivotal, and act.

Physicians must provide leadership by helping patients get engaged in their own health; in working with other physicians, particularly regarding the relationship between primary and specialty care; and finally, in working with other players in the health care system, particularly hospitals. If our health care system is going to thrive, physicians must take the lead.

While doctors may not be able to change the direction of health care overnight, we can all be more proactive. There are several opportunities for you to lead in your community:

• Get Involved in your Physician Organization - There are unlimited opportunities to be involved in your physician organization. Physicians can serve as a board member, committee member, Medical Director or position themselves as an influential leader for performance improvement, technology or patient centered medical home. Your involvement may be as simple as attending a meeting; the important thing is to begin to take on a more active role.
• Get Involved in your Professional Medical Association - It's a great way to stay updated on current issues, network with peers who may have similar concerns and maximize your efficacy through action within a large organization.
• Participate in MSMS Physician Leadership webinars - In the Education section of the MSMS website, members will soon be able to access leadership webinars on topics including inter-professionalism, leadership traits, finance, health care law, and more.
• Participate in the BCBSM Physician Group Incentive Program (PGIP) - PGIP representatives throughout Michigan meet quarterly and collaborate on initiatives designed to improve the health care system in Michigan. PGIP meetings are open to representatives of physician organizations and Organized System of Care groups and invited guests. For more information, visit the BCBSM PGIP website.

Doctor Jackson is Medical Director of the Accountable Healthcare Alliance, and Medical Director of the Medical Advantage Group.