The Physician's Choice: Independent Practice, Community Impact

Through her presidential initiative, PAMED President Lynn Lucas-Fehm, MD, JD is exploring the landscape of health care and the myriad of choices physicians face in today's rapidly changing health care environment.

In this episode, Dr. Lucas-Fehm sits down with Jill Owens, MD the current Delegate Chair for Pennsylvania at the American Medical Association.

Dr. Owens has a variety of experience over her 25 plus years of practice of owning her own practice in her hometown in rural Pennsylvania, back when private practice was still a viable path for entrepreneurial physicians. Join us as we explore her journey, her passion for advocacy, and the impact she continues to make on organized medicine.

For the full episode, visit www.pamedsoc.org/PhysiciansChoice

Visit www.pamedsoc.org for more.

Transcript

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The views expressed by podcast guests are their own. Their appearance on the podcast does not imply an endorsement by PAMED of them, or any entity they represent. Welcome to PAMED Talks, a podcast brought to you by the Pennsylvania Medical Society. I'm Myla Merkel, and in each episode, we dive deep into the heart of medicine and patient care in Pennsylvania. As part of her presidential initiative, PAMED President Dr. Lynn Lucas-Fehm is continuing to explore the evolving landscape of health care and the myriad of choices physicians face in today's rapidly changing health care environment. Today, Dr. Lucas-Fehm sits down with Dr. Jill Owens, the current delegate chair for Pennsylvania at the American Medical Association. Dr. Owens is a graduate of the University of Pittsburgh School of Medicine and completed her residency at Saint Vincent Family Medicine. She's board certified by the American Board of Family Medicine and a fellow of the American Academy of Family Physicians. With nearly three decades of leadership at both the state and national levels, Dr. Owens has been a thoughtful and dedicated advocate for the medical community. She's a former president of the McKean County Medical Society and has long served as the Pennsylvania Delegate to the AMA. In recognition of her outstanding service, She was honored with the PAMED Everyday Hero Award in April 2020. Join us as we explore her journey, her passion for advocacy, and the impact she continues to make on organized medicine. Dr. Owens has a variety of experience over her 25 plus years of owning her own practice in her hometown in rural Pennsylvania, back when private practice was still a viable path for entrepreneurial physicians. So I've actually when I came out of residency, the trend was just shifting away from private practice. I'm a pretty entrepreneurial person, though, and still wanted to have my own practice. And at the time, hospitals really, were trying to help us get started and launch us into our own practices. So I took that opportunity with a little rent to own practice and started my own 25 years ago in my hometown in Bradford, Pennsylvania. So, it's been quite a ride and quite an experience. And I still maintain that practice myself, although probably the last three, actually three to five years, Covid, is really what, pushed me into doing more administrative stuff at the time. But, other than that, I've maintained the practice all the way through. And so it's, it's been an interesting journey. And as part of that, I was helping to oversee the hospital owned practices, so not practicing among them, because I still had my own private practice, but trying to help bring the private practice mentality to, you know, the employed physician practice of the hospital system that I was in. So it's been an interesting ride. And and I will tell you now I've finished that role. I concluded my time there last September, as the CEO of the health system. And it's good experience, I think, for me now to to see that and then come back to where I'm at, I really do draw my, you know, personal pride and also my, you know, the rewarding aspect of the of practicing medicine from seeing patients on a day to day basis. And so that's where I am. This journey reflects a deep commitment to patient care and independence, but it also sets the stage for a broader conversation. What happens when private equity and large health systems begin to dominate? There's movement going on at all stages of people's careers. So when we're looking at large health systems versus working for small health systems or a private practice, what would you tell them as some guidance as to why you're, what you have elected for your practice model, is something they should consider? Yeah. So of course, I'm going to tell you private practice is the best because it is. But I think, you know, physicians tend to be entrepreneurial. Right. And definitely as I mentioned, I am but I think, you know, you don't go into medicine as a physician if you want to take orders and, you know, just be another cog in the process of the health system. And, you know, I didn't find comfort there even in the CEO role. You know, we had a bigger health system over top of us you give up your autonomy and how you're practicing and how many patients you're seeing and what your practice type is. And, you know, somehow hospitals and health systems are better than others at helping you to navigate that. But at the end of the day, it's a business to them. It's not you know, they're not in it for the patient, It raises the questions of physicians being at the helm, not just in clinics, but in hospitals as well. Leadership isn't about titles, it's about values. Again, I would want physician led. And I think, you know, it's one of the other things that I I'll take the time to mention it since it's, it fits in this context, is that, I think physicians should be leading health care across the country, not just in their physician private practices or physician groups. We're in it to make sure patients get what they need. And and, you know, are trying to find the most cost effective ways to get things to the patients that need them, keep their access in check. And you know, that kind of stuff. I think, if you had more physicians leading the industry, at all levels, I think we would be in much better shape than we are now. So kind of a long way around your answer. But, it does mean a lot to me. This vision challenges the status quo and calls for a return to patient centered care. But how do we get there? For Dr. Owens, advocacy is the bridge between frustration and change. Her journey into advocacy started with reluctance, but quickly became a mission. Great question. And PAMED is, a great resource to do that. So advocacy is the key. And I will tell you, you know, my story and advocacy has not been one. I didn't go into advocacy wanting to be an advocate for myself, my patients or any, you know, my business or any of it. I went in because Dr. Anita Herbert, who is an occupational health doc here, was active in the Pennsylvania Medical Society, going to the meetings. And I somehow found myself drawing the short straw. And being the president of our McKean County Medical Society one year and she's like, you got to come to, you know, to Hershey, to the meeting with me. Advocacy quickly became a cornerstone for Dr. Owens, contacting legislators about policy and practice models in the medical payment system, which often fails the patients that are doing the work. It isn't just about fairness, it's about sustainability. If physicians aren't valued, the system suffers. So what next? What are physicians struggling with? And right now, the biggest thing we're struggling with is they don't pay enough to the physicians and, you know, the health care team to be able to execute the job that they're doing, and especially in private practice, although it hits the employed physicians, too, because, again, having run two hospital system with lots of employed docs, they're not getting paid enough, which means the physicians have less of a role and less of a value, so to speak, in the system, because they're not, you know, their income is not generating the biggest end of the hospital revenue anymore. So all of a sudden, you know, we are not a valuable member of the team, which is just incredible. We are the ones providing the care and doing all of the clinical work. We should be the most valuable member of the team. And so I think and that's where the payment system is just totally screwed up. And I will tell you, I wish I had the answer to this. But I don't. But I think, you know, they need to start putting the payment to the work that's being done to take care of the patients and give the patients more autonomy and say, in the decision making and give the physicians and the rest of the health care team more of a say. And in what's how those dollars being spent, rather than these bloated administrative juggernauts of, you know, big health systems and things and bigger is better. Bigger is not better. We need to be knocking on their door and talking about this stuff. We need to talk about the issues that are important to not just us as physicians, but our patients. We know their access issues. We know a lot of them are in rural areas are driving hours to get, you know, to see a gynecologist and deliver their baby or even see their primary care doctor. I had patients, when I was actively practicing day to day that we're driving over an hour to see me. So, you know, that kind of stuff, you really, there needs to be a shakeup in the system, and the payment has to change to get the money where it's needed, instead of these corporate giants that are, you know, blowing the money on, you know, again, layers and layers of administrative, overhead, that's not really helping where it's needed, which is at the bedside with the patient or in the office chair with the patient. So, and again, there's only one way to change that and then is to go to Washington or go to your, you know, Harrisburg or wherever you're at where your legislators are at. And I think making the relationships with them, the personal relationships, so that they understand and you can have a conversation with them and not, you know, you're not just going there to pitch whatever, issue is at the top of your list for the day. It's not just about the payment system. It's about the access to care in rural communities. Hospital closures throughout the state have created health care deserts, lack of access, with many patients facing long commutes and limited transportation options, especially in low income populations. Rural America, I mean, look, all of medicine needs a lot of attention. But I think in particular, there are areas in rural America. I think there's one area in Pennsylvania where women might have to drive, two hours to see an OB. There's this huge, just huge, they call them health care deserts sometimes. What in particular can help drive more physicians, more ability to take care of our rural communities? Yeah. So I think that OB desert that you're referencing is up here. We don't have good public transportation system here. We do, but it's limited. You know, we don't have the same kind of system that you'd have in a city. So, you know, those kinds of things really impact access. And I, you know, again, I if I had the solution, boy, I don't know if I'd be doing the jobs I'm doing, I would be doing something much, much bigger. through it all. Doctor Owens, his medical practice has attracted interest from regional health systems and private equity firms. But selling, she says, means handing over control, becoming a passenger rather than a driver. And that's a trade off. She's unwilling to make. think over the years, my practice has been, courted by every health system in the region and a few private equity. But, once you sell, you know, you've you've given the keys away, and then you're going to have to ride in the car and not drive it. Yeah. You know, that's a, that's a trade off that I'm not willing to make at this point in my career. And actually, now that I'm getting older, I'm less likely to let somebody else drive. So anyway, I probably won't ever do it, but, you know, again, I think there there's some promise, the fact that, you know, other, other people can be part of that. And maybe that leads to where I think practice you should go, which is physician owned groups. So let the equity come from groups of doctors in that way, at least you have trustworthy partners who are in the game with you and know the business and know the clinical side and know what it takes to practice. Because again, the less educated in clinical medicine the person is above you, the less likely they're going to be able to help you execute that business. Medicine is unique because it's not. It's not like making widgets. You know, you can't have just any person who's gifted in finance or gifted in, you know, whatever, business acumen they have come in and start to dictate how to do it. Those were clips from the interview between Dr. Lynn Lucas-Fehm and Dr. Jill Owens as a reminder that with leadership, advocacy and a commitment to patient care, a physician's voice can be louder than ever. By sharing physician experiences and insights, Dr. Lucas-Fehm’s Presidential Initiative highlights how physicians can support each other in making decisions that uphold the integrity of the medical profession and ensure the best outcomes for patients. To watch and listen to the full interview, visit the Presidential Initiative webpage at pamedsoc.org/PhysiciansChoice Stay tuned for more episodes of PAMED Talks, as we continue to explore the vital topics that shape our medical community and patient care in Pennsylvania. If you enjoyed today's conversation, please consider leaving us a rating or review. It's one of the best ways to help others discover the show, and it lets us know what you're loving and what you'd like to hear more of. If you haven't already, be sure to follow or subscribe so you never miss an episode! Remember, every step forward in health care starts with a conversation. Thanks for being part of ours. Until next time.