This is about two weeks old but still very early in its developmental stages (hey, I was dealing with tax season!).

If Congress doesn’t gut the funding for it, the program will have a significant impact on physicians and patients. Let’s hope it’s a win for both.

Donald M. Berwick M.D., the dministrator of the Centers for Medicare & Medicaid Services (CMS), gives his perspective on Accountable Care Organizations (ACO’s) in this New England Journal of Medicine article: “Launching Accountable Care Organizations — The Proposed Rule for the Medicare Shared Savings Program.”

Here’s the overview to help you get started:

Section 3022 of the Affordable Care Act (ACA) establishes the Medicare Shared Savings Program for accountable care organizations (ACOs) as a potential solution.1 The creation of ACOs is one of the first delivery-reform initiatives that will be implemented under the ACA. Its purpose is to foster change in patient care so as to accelerate progress toward a three-part aim: better care for individuals, better health for populations, and slower growth in costs through improvements in care. Under the law, an ACO will assume responsibility for the care of a clearly defined population of Medicare beneficiaries attributed to it on the basis of their patterns of use of primary care. If an ACO succeeds in both delivering high-quality care and reducing the cost of that care to a level below what would otherwise have been expected, it will share in the Medicare savings it achieves. Read the full article.

What do you think about ACO’s?

Vineet Arora, MD MAPP at the Future Doctors Blog tells the story of two physicians who shared their frustrations about the practice of modern medicine. Rather then get out of the field, they decided to get involved. Read Vineet’s post about physician advocy.

Occasionally one of the young doctors I serve will encounter fraud, or suspected fraud, at their practice. While this post is not specifically about financial planning for physician families, it makes some strong points about how to avoid fraud inside your practice. If you’re not the one who handles this in your practice, you might forward it to the managing partner: Safeguard Your Practice with Basic Controls from the eQuoteMD Blog

One of the things I love about Reed Tinsley’s blog about the business and financial aspects of practice management is the minutia. He manages to encapsulate some of the nitty, gritty details of practice management, and occasionally stumbles into the territory of personal finance.

If you want to retire by stepping down your job duties and participation, you should really read this post. It contains the actual language from one medical practice’s partnership agreement that facilitate a stepped-down retirement for practice partners. Detailed, thought-provoking, and useful.

I’m just catching up on my Medical Economics reading, but there’s a real gem hidden here in the pile of past issues.

The April 19 issue features an article by a Wyoming-based FP who dug himself out of a mountain of school debt and built a thriving practice in a town of only 20,000 in just seven years.

He owns his own 7,200 square foot building, employs four physician extenders (PA’s), and works – get this – only four days a week. He says he has enough ime to coach all four of his kids’ sports, and he’s earning in the top 5% of practictioners.

Check it out: “How I built a successful medical practice in under seven years” by Kurt Hunter MD (and by the way, he actually IS a hunter, and a fisherman, too).

Jacob Goldstein explores the latest demographic shift in the delivery of primary care through his Page One article in today’s Wall Street Journal, “As Doctors Get a Life, Strains Show Quest for Free Time Reshapes Medicine; A Team Approach.”

Goldstein profiles a 32-year old primary care doc who chose to become a hospitalist with well-defined work hours, saying, “My family is as important, if not more important, than my career.”

He also interviews an OB and mother of two young children who cites a “controllable lifestyle” as her reason for moving from a five-physician practice to a position as an OB hospitalist with a large facility in Salem, Oregon. The call was killing her ability to spend time with family.

Interestingly, I found no workable solutions for doctors who want to focus more time on their families and who work in non-primary care specialties like orthopedics, cardiology or oncology. In fact, the article quotes a 50-something surgeon who grumbles about “the new guys” who are dictating their schedules instead of sharing the burden of call.

Goldstein makes a subtle point that might easily go unnoticed by readers who are casual observers of medicine, and that point is the physician’s paradigm of perspective.

He uses the word “hero’ to describe the physician’s self-perspective that involves the one-on-one, 24/7, give-everything-for-the-patient mentality that specialists and old-line doctors tend to espouse. He contrasts this with the “me generation” of doctors who seem to slip easily into and out of shifts, turning off pagers, and passing the baton of care to the next doc on duty.

This simple contrast fails to consider one key aspect of the physician mindset: self-actualization through independent achievements. From what I’ve seen, physicians tend to perform best as leaders above a group, and they tend to compete with (rather than coordinate with) those who are at their peer level. Each physician wants the ability to look at a job well-done and say “I did it.”

This fierce independence stands in stark contrast to the culture of teams. Before the field of medicine can continue to evolve in such a way that physicians can enjoy more time with family through more predictable schedules, there will have to be a change in the culture of physicians that embraces a pro-team model for the delivery of all kinds of care, not just primary care. Specialists have families, too, and they deserve a decent quality of living in exchange for a job well done.

A few years ago I was fortunate enough to meet Phillippa Kenneally. She’s a doc who’s been there, done that, and reinvented herself at least once since then.

If you’re a physician and you’ve ever wondered, “What does it mean if I don’t want to be a doctor anymore?” then you owe it to yourself to check out this blog post about the challenge that comes with your Physician Identity.