One piece of this entire puzzle not addressed is the human resource implications of moving to a professional preventive system where strategic health planning is the major deliverable. Clearly, success would require that everyone (including physicians) take a fresh look at their job descriptions. To do prevention effectively you need a team approach and active team membership and participation for the patients you are pledged to support. The needs of these teams and the skill mix in an enterprise dominated by information and planning would be quite different than our current inpatient teams in labor and delivery or surgical suites or emergency departments. We mouth often our commitment to prevention without ever really acknowledging how fundamentally disruptive such a move would be to our current workforce, measures of success and reward systems, and our educational enterprises which would have to fundamentally transform curricula to deliver the appropriate skills sets and competences for a very different challenge.

Anyway, getting back to UNC, I was touring their new Cancer Center with a young faculty surgical oncologist who was clearly happy to be in Chapel Hill. He had come from a very prestigous institution and I asked him whether it was the new Cancer Center that had sold him on the move. No he said. It was two other things. First, while he loved surgery, he was interested in health policy as well. So the presence of the Schools of Public Health, Nursing, Pharmacy, Business, Journalism and others were assets he valued, as did those who sought to hire him. How did he know that, I inquired. Because they had, during the process, introduced him to their structured but flexible approach to faculty development, defined his broad interests, and committed to a customized approach that would support his professional growth. He had not experienced that at other institutions. But it was the second thing that sold him for good. That was that everyone, on every level who he met during the visits was genuinely nice and the environment was joyful.

What does any of this have to do with “advanced professionalism”? Well back in 1984, as a young surgeon in a rural setting I read Columbia economist, Eli Ginzberg’s classic paper, “The Monetarization of Medical Care”, which closes with these prophetic words, “To secure its long-term financial foundation, American Medicine will require a combination of political leadership and professional cooperation that is not yet visible on the horizon. The great danger is that such cooperation will be delayed past the point at which intervention can be effective.” (6)

Thirteen years later I took a job in New York City and reached out to Eli who was closing in on 90 and still teaching at Columbia. He was my “Tuesdays With Morrie” (7) experience, and several times a year we would share lunch at the Oak Room at the Plaza (8) until he died in 2002.(9) In any case, one of the theories we discussed during those lunches was the pace and direction of the monetarization of medical care. What were the contributors to physicians behaving more like businessmen and less like professionals. One of the theories: that as the joy in practicing medicine declined, for a range of reasons including systematic obstacles and mal-alignment with patient driven goals and expectations, physicians sought to compensate with financial rewards. Stated more bluntly, “If I hate my job, you’re going to have to pay me more to do it?”

Twenty five years after Dr. Ginzberg’s paper, his words are haunting. Have we reached, for lack of leadership and professional cooperation, a “point of no return”. My UNC experience would suggest not. Were we to acknowledge first that the world has changed and with it the concept of health and human potential among the people we serve; were we then to commit to creating community based systems of care that are aligned with strategic health planning and wellness; and in support of these new systems were we to define the human resource needs of these new systems of care and organize teams of varied individuals, supported by new curricula and committed to personalized and customized individual professional growth plans, I believe that health care could be reinfused with joy, and that in turn those who provide the care would be less likely to be confused with business men and more likely to be identified as “professionals”.

References:

1. Magee M. Advance Professionalism. Part I: Desirable Attributes in Health Care Professionals https://www.healthcommentary.org/?page_id=1617