As he assumed the presidency of the Michigan State Medical Society for the next year, Dr. David Krhovsky preached of the need to “put patients in the center” of the state’s health care system. An anesthesiologist and vice president of medical affairs at Spectrum Health in Grand Rapids, Dr. Krhovsky succeeded Dr. Rose Ramirez, a Belmont family physician, as the elected leader of the 15,000-member Medical Society. He spoke with MiBiz about the Medical Society’s top priorities for the year and the changes occurring today in medicine and health care.
What’s at the top of the agenda for the Medical Society this year?
Maintenance of certification is one that’s sort of a hot-button issue for physicians right now. That just means that if you have been board certified and if you fall in a specialty where you have a time-limited certificate, you go through maintenance of certification in order to keep your board certification current. It’s a very time-consuming and expensive process that’s not been clearly demonstrated to be a guarantee of quality that patients are really looking for.
Graduate medical education funding is always a priority for us and we want to make sure graduate medical education funding stays adequate to meet the need.
Would fully funding graduate medical education help address the physician shortage?
We know that there’s going to be an increasing shortage of physicians going forward and we’ve added medical schools in the state in Kalamazoo, Detroit and Mt. Pleasant. We’re going to have more graduates and they’re going to need places for their residency. We want to meet our need in Michigan by training physicians here and having them stay here, and we think that’s the best way to meet the potential shortage of physicians, especially in underserved areas in Michigan.
Why is it important to do the training in Michigan?
It’s kind of the saying, ‘learn here, train here, stay here.’ It’s the idea that young physicians, especially if they came from the state originally, hopefully they’ll feel a connection with their home if they go to medical school here and then train here.
In your address to the Medical Society House of Delegates this month, you spoke about ‘putting patients at the center.’ What does that mean?
Patients are our ‘why.’ That’s why we exist. That’s why we do what we do. We can never lose sight of the fact that they need to be really at the center and focus of everything we do. Part of putting patients at the center is doing things that make care more accessible, that makes care available when they need it and where they need it, and making it easy for them to get access to providers that they might not otherwise have access to. I’m a real believer in that whole concept.
What has prevented that from happening?
We have a lot of paternalism in medicine … that physicians know what’s best for the patient and the patient is always supposed to bend to our will. The patient really has historically not had a lot of decision-making about their own health care. So we’re trying to eliminate that. I come from an era where there was a lot of paternalism in medicine and I think that physicians my age will have more problems with that transition than young physicians. My experience with the young physicians I see coming up is that they are much more accepting of these changes than some of us older fellows. I like to think of myself as a progressive thinker, so a lot of these things I’m embracing.
What are the biggest drivers of change in medicine today?
This whole switch in how we think about how we deal with our patients, and this whole idea that we’re going to be much more open and transparent. We’re going to enable them to make decisions about their health care, and it’s not going to be something dictated to them. … Payment reform is going to be a huge thing. We’re moving from a system of what we call volume-based reimbursement to a new paradigm of value-based reimbursement. That just means you are rewarded for quality, for good results, for safety. These are major challenges to how we’ve done things historically, but we know that our current system and the rise in the cost in health care is unsustainable for this country.
What do you make of the report this month that said medical errors are now the third-leading cause of death in the U.S.?
The medical errors are a problem and people are trying to get to the bottom of that. I think we know that in most institutions that medical errors are probably underreported and this whole focus on the quality and safety culture is meant to address that. Physicians, along with other health care providers, have to be willing to face errors and have to be willing to acknowledge errors. Transparency with patients has to be paramount. Our responsibility is going to be constantly working toward a safer environment for patients and for health care workers.
How do you respond when somebody sees that data about medical errors and asks questions about how those mistakes happen?
First and foremost, people providing care are human beings and human beings make errors. Errors are a fact of life. But having said that and acknowledging that, health care workers, physicians and hospitals have a shared responsibility to put processes in place that will minimize errors, whether it’s putting in place standard operating procedures, protocols, best practices — those are the things that we need to focus on.