HM17

Adapting to change: Dr. Robert Wachter


 

Robert Wachter, MD, MHM, has given the final plenary address at every SHM annual meeting since 2007. His talks are peppered with his one-of-a-kind take on the confluence of medicine, politics, and policy – and at least once he broke into an Elton John parody.

Where does that point of view come from? As the “dean” of hospital medicine says in his ever-popular Twitter bio, he is “what happens when a poli sci major becomes an academic physician.”

That’s a needed perspective this year, as the level of political upheaval in the United States ups the ante on the tumult the health care field has experienced over the past few years. Questions surrounding the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the continued struggles experienced by clinicians using electronic health records (EHR) are among the topics to be addressed.

Dr. Robert Wachter, hospitalist, department of medicine, University of California, San Francisco
Dr. Robert Wachter

“While [President] Trump brings massive uncertainty, the shift to value and the increasing importance of building a strong culture, a method to continuously improve, and a way to use the EHR to make things better is unlikely to go away,” Dr. Wachter said. His closing plenary is titled, “Mergers, MACRA, and Mission-Creep: Can Hospitalists Thrive in the New World of Health Care?”

In an email interview with The Hospitalist, Dr. Wachter, chair of the department of medicine at the University of California San Francisco, said the Trump administration is a once-in-a-lifetime anomaly that has both physicians and patients nervous, especially at a time when health care reform seemed to be stabilizing.

The new president “adds an amazing wild card, at every level,” he said. “If it weren’t for his administration, I think we’d be on a fairly stable, predictable path. Not that that path didn’t include a ton of change, but at least it was a predictable path.”

Dr. Wachter, who famously helped coin the term “hospitalist” in a 1996 New England Journal of Medicine paper, said that one of the biggest challenges to hospital medicine in the future is how hospitals will be paid – and how they pay their employees.

“The business model for hospitals will be massively challenged, and it could get worse if a lot of your patients lose insurance or their payments go way down,” he said.

But if the past decade of Dr. Wachter’s insights delivered at SHM annual meetings are any indication, his message of trepidation and concern will end on a high note.

The veteran doctor in him says “don’t get too distracted by all of the zigs and zags.” The utopian politico in him says “don’t ever forget the core values and imperatives remain.”

Perhaps that really is what happens when a political science major becomes an academic physician.