Emerging opportunities for physician-attorneys in the purchaser-driven health care industry of the 1990s.
The litigation explosion of the past decade-and-a-half has provided physician-attorneys with a seemingly endless source of opportunities for full- and part-time employment. For this and other reasons, physician-attorneys in the late 1980s still devote a substantial part of their professional time to activities directly or indirectly related to medical litigation. Nevertheless, the winds of change are blowing and soon will reach hurricane force. The excesses of the medical and legal systems (best exemplified by the litigation explosion) have sown the seeds of their own ultimate destruction during the 1990s. As a result of the substantial provider glut, the purchasers of health care are now in charge. To the extent that purchasers determine that professional liability premiums, legal costs, and defensive medical practices increase their health benefit costs, they will redesign benefit programs to provide appropriate financial incentives to channel subscribers to both the high quality, cost-effective providers and alternative medical dispute resolution options other than litigation. As the percentage of lawyers' and law firms' revenues attributable to medical litigation diminishes, one of the first expenses to be cut will be that previously allocable to physician-attorneys for expert medicolegal review and case evaluation. Medical care value purchasing is rapidly becoming the centerpiece of the emerging purchaser-driven health care industry of the 1990s. This should give way to an unprecedented demand by purchasers and providers alike for medical care evaluation, health data analysis, and the implementation of systems to measure and monitor the quality and cost-effectiveness of health care delivery. Providers, especially physician-leaders, can and should play critically important roles in helping purchasers and themselves to evaluate and improve the overall quality and cost-effectiveness of health care services. It is this increasingly important area of expert endeavor in which physician-attorneys can and should find the majority of their long-term professional opportunities. However, to capitalize on this, physician-attorneys must effect a major redirection in their primary emphasis. Although they have a distinctive training advantage in the emerging quality-driven industry over that of physician-M.B.A.s, most physician-attorneys have continued to use these skills in the reactionary world of litigation, which will rapidly go the way of the dinosaur in the 1990s.(ABSTRACT TRUNCATED AT 250 WORDS)