The Physician Employee - An Interview with Mark Berenberg M.D.

 

Mark Berenberg M.D. has had a tremendous and varied career as a physician and administrator.  From primary care to pulmonary specialist in critical care and later as the president and CEO of a multi-specialty group within Partners Health. Dr. Berenberg has worked with some of the nation’s highest ranking hospitals including Brigham and Women's, Boston University, and Tufts.

With the emergence of managed care in the 1990’s, Berenberg sought to find and implement the best possible options for doctors. Experience with for-profit healthcare systems left him disenchanted: “There were new strict regulations and I felt is was very distasteful to physicians.”  

I asked Dr. Berenberg to tell me more about the experience of physicians within these new constructs.

Mark Berenberg, MD:

Physicians weren't appreciated and that’s been the trend lately.  Physicians feel disenfranchised. They are treated as worker bees and don’t have a stake in what’s going on.  When that happens to be the case - when you don’t have a stake in what’s going on, when you don’t have a say in what’s going on financially - as the working doctor it tends to become quite burdensome and I think that’s what happened.

Brigette Flores:

It sounds like physicians’ roles have become less autonomous…

Mark Berenberg, MD:

A physician is considered an employee and that’s pretty much what it’s come down to. Your contract includes hours worked, productivity expectations,a few other factors that go into your compensation package, which are based on some quality measures and patient satisfaction.

But that’s only evolved in maybe the last five to ten years. It used to be ‘eat what you can kill,’ get paid what you could directly and the more patients you saw - the bigger the volume - the more you were reimbursed. That’s not the case anymore.

physician employee interview

As a physician employee, you’re expected to see so many people in so many hours in a day and it's really just mechanized. It’s tremendously impacted the physician’s relationship with patients.  It has hit the primary care field much more than it has in specialties but that’s occurring as well.  Physician reimbursement, in terms of physicians just practicing has trended down in the last number of years.  

Brigette Flores:

How does this all affect a physician’s relationships with patients?

Mark Berenberg, MD:

Patients have become much more experienced and more knowledgeable about their healthcare through the internet and other means.  When they come in for a visit they have very specific questions and sometimes very detailed questions.  They even bring in family members, which is all well and good, but when you are expected by your employer to run on time and you are given 20 minutes for that visit - and that includes all the documentation for the visit which is now done primarily through electronic records - it leaves very little opportunity for any face to face personal interaction between physician and patient which is what I call the joy of medicine. People are talking about bringing back the joy of medicine but it's a long way from happening right now. Patients are very discouraged.

Brigette Flores:

Is there no way to work within the old system? The ‘eat what you can kill’ model?

Mark Berenberg, MD:

There is concierge medicine, which I think was developed down in the South area here [Florida] but has made its way up to Boston, where people pay X amount of dollars a year- could be 6 or 7 thousand dollars - to a physician to provide  24/7 access to that physician. Whatever is reimbursed by the insurance company they get as well but it limits the size of the practice.  You can run the numbers: how much you want to make, how much each person is willing to pay...  I think that concierge service should be part of the physician’s service to the patient's anyway.  

physician employee nterview

I continued to speak with Dr. Berenberg and we touched upon other subjects. I wondered about productivity expectations within the  construct of physician as employee and how restricted time might affect patient satisfaction and interfere with meeting an employer's expectations in that area. You can download his reponse at the link  below.  Be sure to check in next week for Dr. Berenberg's take on the  use of recruiters for medical staffing. 

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