Keeping doctors out of the chair and part of the conversation

By Garrett Weldon, PT, DPT, Vice President of Provider Partnerships and Clinical Strategy, healtH2Business


In 1891, an artist named Lukes Fildes completed a painting entitled, "The Doctor." It portrays a concerned physician watching over a gravely ill child. It is remarkably lifelike, perhaps because it is based on the artist’s own experience of losing a son before adolescence. Overlooking the sick child, the doctor is seated in a chair and appears deep in thought. Behind the little girl, with faces of fear and sadness, are the girl’s mother and father. Today, the painting begs the question: who is helping this little girl more? The doctor? The parents? Sure, both are present, but both are also an arm’s length away, immobile and frozen in their inability to intervene. There are no IV poles, cardiac monitors or tests to be run There is simply no active intervention being or to be done.

It wasn't until 1941 that penicillin was first prescribed and arguably changed the way we live and die. Now we have things like cortisone treatments, open heart surgeries, kidney transplants and rapid stroke interventions happening daily. If Sir Fildes were to paint this picture in 2019, I am confident the symbolic physician would no longer be simply sitting in a chair. He would be up on his feet, intervening.

However, having the doctor out of the chair comes with its own set of problems. Misdiagnosis, inappropriate interventions, over-treatment, under-treatment, human errors and debates about how, when, where and on whom to intervene. While these problems can be significant, I for one am still glad the doctor is out of the chair.  

It seems to be too often in the space of employee benefits that conversations turn to putting doctors back into their metaphoric chairs. From my perspective, many of the discussions happening are without consulting a large enough sample size of doctors or hospital systems to speak on their behalf. Often, anecdotal experiences are being used to frame the full provider experience. That is, simply, an error. Of course, doctors make mistakes, some of which even cause premature death, disability or financial hardship. But what if, instead of putting them back into the chair, we sought to give them a voice? What if we brought them to the table of creation? What if we gave them responsibility for a population? What if we worked with them to create and design plans in such a way the emphasis included responsibility and opportunity as opposed to just cost-containment. What if one of our top goals was to allow employers the flexibility they need to sit down with doctors and have meaningful conversations about their employee populations? What if our actions strongly suggested we view providers as a part of our community and in turn an integral part of the solution?

In the upcoming webinar, “Build the dream: Constructing a cost-containment ecosystem for your organization,” I’ll be exploring more of this topic. I will also be sharing my experience as a clinician and how the PPOs and ASO arrangements of today are not conducive to the vision of the healthcare delivery model I had and practiced, which ultimately led me to be a believer in reference-based pricing plans.