The Evolution in Medicine

From the Back Porch – Evolution in Medicine

This articles is written strictly as an opinion piece from Dr. Manny Quinones and is not to be interpreted as the opinion of the Texas Medical Board.

“So why on earth is Manny writing an article again?” Well, I’ll tell you why. Because for some time now, many things have gone unsaid, and if anybody would ever say them, it would have to be me. I know I may make some of you happy, thinking “Gosh I’m glad someone said something about that,” and others of you may say, “I can’t believe somebody said that!” So here goes.

In my book there are a few rules you should never break, lines you should never step over. One of those is never to bite the hand that feeds you. So what happens if you don’t work for yourself or for other physicians? Unfortunately, when you don’t work for yourself or for other physicians, having an opinion about how you take care of your patients can really be anxiogenic. So why would you ever want to work for an entity you have no control over, no hope of ever governing or leading, and worse yet, one that might have you in violation of the Corporate Practice of Medicine Prohibition here in Texas? Let me tell you a little about how I started my professional life and how it has evolved and maybe you will understand where I am coming from.

Evolution in Medicine – Learning to Walk

When I finished my residency in Family Practice in 1985, at the encouragement of a very dear friend, I went to work for another Family Practice doctor. That didn’t work out very well because I thought I would become an equal partner as he had promised, but that was not on his priority list. Me not being shy about my concerns landed us in opposite corners. So I was “released” and I started in solo practice two years after starting my practice. I had the pleasure of working closely with 3 other FP’s during my tenure of solo practice and they went off to do other things alone which I respected.

Then about 10 years into my solo life, my friend Dr. Hugh Wolf approached me and invited me to join one of the Santa Rosa groups. I was reluctant but realized 25 years ago that the days of solo primary care medicine were coming to a close in my lifetime. So, I joined Solomon Anthony, and eventually we merged in to HealthTexas. A few years later, together with my very astute, well informed and prophetic partners, HealthTexas decided to buy itself away from Santa Rosa. That divestiture process was very complicated, expensive and did not make us any friends.

This was and remains the greatest metamorphosis of my professional practice life. We suddenly had wings. Since that time, through sacrifice and hard work, we have managed to advance HealthTexas to become a premier provider of healthcare in the greater San Antonio market. And we have managed to do so remaining totally physician governed and owned. We created a management company which manages HealthTexas that is entirely owned and governed by practicing HealthTexas physicians. If you retire from HealthTexas you cannot be an owner and must sell your shares back for younger partners to acquire and help lead the group in to the future. And therein lies the basis for this discussion.

Evolution in Medicine – Responding to Change

There are only two types of people who embrace change – business consultants and wet babies. But you get to decide which one you will be. In any business, change is inevitable and inescapable. How you are able to manage that evolution is what divides the satisfaction and success from discontent and failure. The Corporate Practice of Medicine, where physicians are controlled by non-physician entities does not end in satisfaction and success. No matter how the relationship starts off, when it comes to deciding on your success or the success of the corporate entity and its bricks and mortar, you will never win. Non-physician corporate entities do NOT have your best interest in mind. And the Corporate Practice of Medicine is illegal. Section 164.052 of the Texas Occupation Code specifically says “Physicians may not purchase or sell a medical degree, license, or certification for application to TMB for a license to practice medicine.

Physicians also may not permit another to use the physician’s license to practice medicine, nor can a physician assist another unlicensed person, or a partnership, association, or corporation in practicing medicine.” Case law has made it clear that physicians cannot be employees of corporate entities. The Courts have held that allowing a non-physician entity/corporation to employee a physician has the potential to commercialize the practice of medicine and destroys the physician-patient relationship. I see this and you see this time and time again – something not getting approved because of cost. What do you think happens when you work for that entity?

Evolution in Medicine – Corporations in Care

The Corporate Practice of Medicine Prohibition is rooted in an unwavering desire to protect the public by prohibiting non-physicians from practicing medicine. You were created to take care of patients and to heal. You probably trained at a time, as I did, when we were not taught to run our offices like a business. As a result, many of us fell victim to the ever growing demands of insurance companies, government agencies and payers along with non-physician entrepreneurs who see the art of practicing medicine as a money cow. By creating more hoops to jump through, you have become so frustrated that the easy road always looks tempting.

Electronic medical records, star ratings, HEDIS scores, survey scores, Google Stars, Press-Gainey ratings, TPMP requirements – the list goes on and on. Because of this, many of you have chosen to contract with entities which may or may not run afoul of the law and the Corporate Practice of Medicine. Please be careful if you choose this road. We are all subject to the Corporate Practice of Medicine Prohibition and the Texas Medical Practice Act. You have to know the law and get good legal advice.

From my side of the fence, I can tell you that life is great. The recent transition in leadership at HealthTexas has been smooth and seamless. My partners have strongly embraced the idea that we should all get to chase our dreams by supporting one another. This has allowed me to stay involved in Organized Medicine, and to accept Gov. Gregg Abbott’s invitation to sit on the Texas Medical Board. And also to pursue my ranching and hunting passions. I am very happy doing what I do, and have been blessed with good health thus far. I have no desire to retire, and no plan on slowing down.

Evolution in Medicine – The Outlier

HealthTexas is in growth mode, and the Group has challenged me to open and establish our 16th area office in Helotes. I believe we have the best model for success we could hope for. Established and governed by physicians, with the management company having only HealthTexas practicing physician leaders and owners. This came with a lot of sacrifice and hard work, and the willingness of its physicians to buy in to the concept that only practicing physicians know what is best for their patients. And only physicians should be able to determine what is and is not needed to achieve the best possible outcome for those who rely on us for healthcare. We do not protect someone’s bricks and mortar, and we are not in the Practice of Medicine to protect stockholders in a corporation. We strive to practice efficient, evidence based medicine with the goal of excellent outcomes – every patient every time. HealthTexas is the antithesis of the Corporate Practice of Medicine.

From the back porch, feet up, sun going down, I am Manny Quiñones.