Elsevier

World Neurosurgery

Volume 105, September 2017, Pages 997-1000
World Neurosurgery

Perspectives
The Healthcare Landscape: Are Doctors Agents of Change or Impediments to Change?

https://doi.org/10.1016/j.wneu.2017.06.099Get rights and content

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The “Golden” State: California Neurosurgery Acquires the Midas Touch

California—nicknamed the “Golden State” for its precious metal resources in the 19th century and for the color of much of its landscape (especially in drought years)—is on the cutting edge of issues such as technology, environmental change, and social policy. Apple is synonymous with cutting-edge technology; Tesla presents Elon Musk's vision for environmentally friendly transportation; the State of California has defied the U.S. federal regulation banning research using human embryonic stem

The Changing Healthcare Landscape: Can Today's Doctors Be the Gardeners?

Castlen et al2 have presented a scholarly summary of issues confronting not only neurosurgeons but healthcare professionals in general with regard to the structure of healthcare delivery. With input from both sides of the Atlantic, one can hardly argue with the final sentence of their abstract: “Ultimately, physicians need to be allowed to retain relative autonomy over their practices as they support and participate in administrator-led efforts toward distributive justice.”

Unfortunately,

Administering versus Managing: Who Is the Optimal Gardener for the Healthcare Landscape?

Castlen et al2 cited evidence that a hospital with a CEO/president having an MD degree in general were more likely to be top performing than hospitals whose chief administrator lacked the MD degree. A lesson here may be that the type of training—of physicians and hospital administrators—makes a difference in the efficacy of the hospital's healthcare delivery. Ultimately the goal is optimal patient outcome (i.e., long-term outcome) with minimal resource expenditure. The data must be long term to

The Changing Healthcare Landscape: Doctors Can Cultivate, Not Deforest!

The track record of physicians in the United States regarding transformative leadership is not promising. For example, physicians vigorously opposed Medicare when it was proposed and enacted in the 1960s. At present nobody wants to repeal Medicare, and politicians, such as Senator Bernie Sanders (who seriously challenged Hillary Clinton for the Democratic nomination in the 2016 presidential elections), make it a centerpiece. However, there are examples of progressive healthcare organizations

The “Golden” State: California Legislators Trump Physicians

In late April 2017, the California State Senate Health Committee approved Senate bill 562 to be sent forward to the State Senate Appropriations Committee: “This bill, the Healthy California Act, would create the Healthy California program to provide a comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state.”9

Although it is uncertain at present if SB562 will become law in California, it encouraging that

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Commentary on: The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice by Castlen et al. World Neurosurg 102:420-424, 2017

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