We spoke this week with a medical group president looking to deploy a more consistent consumer experience across his health system’s physician practices, beginning with primary care.
The discussion quickly turned to two large primary care practices, acquired several years ago, whose doctors are extremely resistant to change. “These guys have built a fee-for-service model that has been extremely lucrative,” the executive shared. “It was a battle getting them on centralized scheduling a few years ago, and now they’re pushing back against telemedicine.”
With ancillary income included, many of these “entrepreneurial” primary care doctors are making over $700K annually, while the rest of the system’s full-time primary care physicians average around $250K.
The situation raises several questions. Standardized access and consistent experience are foundational to consumer strategy; in the words of one CEO, if our system’s name is on the door, any of our care sites should feel like they are part of the same system, from the patient’s perspective.
But how can we get physicians on board with “systemization” if they think it puts their income at risk? Should the system guarantee income to “keep them whole”, and for how long? And is it possible to create consensus across a group of doctors with a three-fold disparity in income, and widely divergent interests? While there are no easy answers, putting patients and consumers first must be the guiding goal of the system.
As the story begins, a woman goes to visit her grandmother. She is stressed and frustrated by the way that her life has been going— in a way that many can relate. No sooner is one problem dealt with than another one rises in its place.
The woman tells her grandmother that she’s reaching the end of her rope and doesn’t know how she can go on.
Without a word, the grandmother goes to her kitchen, fills three pots with water, and puts the pots on the stove to boil. Once the water is bubbling away, the grandmother puts a few carrots in one pot, several eggs in the second pot, and ground coffee beans in the third.
After about twenty minutes or so, the grandmother turns off the heat and puts the contents of each pot in a bowl.
She then asks her granddaughter what she sees.
The answer seems obvious. “Carrots, eggs, and coffee,” the granddaughter replies.
The grandmother then tells her granddaughter to feel the softened, boiled carrots, to crack the hard-boiled egg and look at it, and to take a sip of the coffee.
Having done so, the granddaughter asks what it all means. The story continues:
“Her grandmother explained that each of these objects had faced the same adversity — boiling water — but each reacted differently.
“The carrot went in strong, hard and unrelenting. However, after being subjected to the boiling water, it softened and became weak. The egg had been fragile. Its thin outer shell had protected its liquid interior. But, after sitting through the boiling water, its inside became hardened.
“The ground coffee beans were unique, however. After they were in the boiling water, they had changed the water.”
The question for the granddaughter — and for the reader as well — is which one represents how you respond to adversity. Are you the egg? The carrots? Or the coffee?
“Think of this: Which am I? Am I the carrot that seems strong, but with pain and adversity? Do I wilt and become soft and lose my strength?
“Am I the egg that starts with a malleable heart, but changes with the heat? Did I have a fluid spirit, but after a death, a breakup, a financial hardship or some other trial, have I become hardened and stiff? Does my shell look the same, but on the inside am I bitter and tough with a stiff spirit and a hardened heart?
“Or am I like the coffee bean? The bean actually changes the hot water, the very circumstance that brings the pain. When the water gets hot, it releases the fragrance and flavor of your life. If you are like the bean, when things are at their worst, you get better and change the situation around you. When the hours are the darkest and trials are their greatest, do you elevate to another level?”
Of course, the question is posed not just as a way to examine how you respond to adversity now, but in order to learn how to adapt in the future.
We are not permanently carrots or eggs or coffee. Perhaps you have responded as an egg before. Perhaps you’re currently feeling a bit carrot-y. But that doesn’t mean that you can’t make a change.