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They will approve nursing home care for them, but not the intensive cognitive rehabilitation that they need, unless the rehab physician fights an epic authorization battle that can take 10 days or more to overturn the denial of services! The “prior authorization” process for imaging studies and non-formulary medications is also designed to wear down the providers and passively deny services to patients, thereby saving costs for the insurers. ” for their physician, waiting to speak to an insurance customer service rep with an algorithm that determines whether or not the patient is eligible for the service – unrelated to the physician’s judgment or the particulars of the patient case. For the rest of us, our pattern of judicious prescription of tests, services, and procedures should win us a break from the daily grind of begging, wheedling, and cajoling payers to allow us to get our individual patients what they need, every single time we order something.

Physiatry (also known as Physical Medicine and Rehabilitation or PM&R) is a national leader in pain management education, and is the author and promoter of  the majority of continued medical education (CME) courses on reducing opioid prescribing in favor of alternative pain management strategies. This test is very helpful in picking up potential misunderstandings in how prescription meds are to be taken, and identifying cognitive deficits that might preclude accurate self-administration of prescription meds at home. To that end, we feel strongly that limiting medications to those only truly necessary, as well as making sure that patients can demonstrate safe-use of their medications (or have a caregiver who can do this for them), can reduce hospital readmission rates, falls, unwanted drug side-effects and accidental drug-drug interactions. Test-driving” patient competency at medication self-administration, in the setting of responsible de-prescribing in a monitored clinical environment, is a highly valuable (though sadly under-reported) benefit of rehabilitation medicine.

The largest agencies are strongly against automated physician-client matching software (which is essentially what VMS does) and argue that they destroy the customer service experience for both hospitals and physicians. Although I am philosophically opposed to being listed on a hospital purchase order along with IV tubing and non-latex gloves, the truth is that such matching has brought me higher-paying assignments at good quality hospitals that do not hire locum tenens physicians outside of a VMS system. Online job-matching sites will probably take a big chunk of market share, but won’t “own” the space because they don’t provide the logistical, legal, and credentialing services that physicians enjoy from agencies. However, given that agency fees add about 40% costs to physician hiring, there is strong motivation to find alternative hiring strategies, and I suspect that Millennial physicians won’t mind doing extra work for higher pay.

The New Yorker recently featured a long essay about a popular new episodic work style sweeping America: the “gig economy. the sharing economy; the gig economy; the on-demand, peer, or platform economy—but the companies share certain premises. New companies such as Nomad Health are poised to revolutionize the gig economy for physicians. I suspect that the gig economy is going to change how physicians engage with the healthcare system – and that within a decade, a large segment of the workforce will be part-timers and short-timers.