Bruce Scott, MD
Partner and President, Kentuckiana Ear, Nose and Throat
President, Kentucky Medical Association Board of Trustees
Leadership style: Trying to build consensus to focus on the things that unite physicians – our dedication to our patients and our commitment to care – rather than those things that divide us.
Mentor: Bob Goodin, retired cardiologist here in Louisville, a role model as a caring physician and a gifted leader in organized medicine, but even more as a person who understands how to enjoy life.
Dream job as a child: A surgeon. I have always been a person who enjoys fixing things – what could be more meaningful than fixing an ill or suffering patient.
Book on nightstand: “If You Really Want to Change the World” by Henry Kressel and Norman Winarsky (Harvard Business Review Press). Through my activities with the AMA, I have had the opportunity to work with Mr. Winarsky and deeply respect his experience and knowledge.
Hobbies: I love traveling, particularly with my wife and family.
Medical News: Looking back on the past year, how has the healthcare system changed and what is the physician community doing to adapt to the changing environment?
Bruce Scott, MD: There continues to be consolidation within all levels of healthcare. Health plans continue to merge both horizontally and vertically. Hospital systems and even physician groups are consolidating to respond to the changing environment of healthcare.
While the American Medical Association (AMA) and others were able to derail the mega-merger of Anthem-Cigna, the recent vertical merger of Aetna and CVS has been allowed to go forward. Unfortunately, this consolidation likely means increased premiums for patients, reduced choice of physicians and increased administrative control of healthcare.
Hospitals in Kentucky continue their trend of employing physicians; in many communities meaning the end of private practice. It is difficult particularly for smaller practices in rural areas to keep their doors open with increasing complexity of practice and the ever-growing administrative burden placed upon physicians.
Some physicians are responding by joining larger groups or even partnering with venture capital firms. Others strive to remain independent in private practice.
MN: How has the practice of medicine changed over your career? How would you like to see it continue to change?
BS: There have been remarkable advances in medicine over the course of my career with improved treatment and prognosis for many illnesses. As a surgeon, I have directly witnessed the rise of minimally invasive surgery. Patients now have procedures done as outpatients who previously would have been hospitalized for several days and experience less pain, quicker recovery and improved outcomes.
I am excited for the potential of continued advances in immunological and genetic treatments for many illnesses including cancer. My hope is that healthcare can address the social determinants of disease to raise the health status of all members of our community. As a population, we must address chronic illness and move toward prevention with healthier lifestyles.
MN: What are the biggest challenges to practicing medicine in Kentucky? What are the benefits?
BS: Kentucky has a physician shortage which is worsening every year, particularly in the rural areas.
It is no secret that Kentucky has one of the worst medical-legal climates in the nation. Our broken professional liability system places unlimited, unpredictable risks on physicians, weakens quality control, drives up healthcare costs and leaves injured patients in a lottery like system where the only winners are the lawyers.
Unfortunately, the Kentucky Supreme Court just recently struck down the limited liability reform instituting medical review panels that the legislature passed in 2017.
A recent study by the AMA found that Kentucky has one of the lowest rates of competition among health plan with many communities having only one choice of insurer, particularly among Medicaid expansion and Medicare Advantage plans.
The benefits to practicing in Kentucky are the great people and the beauty of our state.
MN: What was the biggest success or accomplishment for the Kentucky Medical Association (KMA) this past year?
BS: The Kentucky Physicians Leadership Institute (KPLI), cofounded by our Kentucky Foundation for Medical Care, is the premier leadership training program for physicians in Kentucky.
This exclusive program which selects diverse physicians from around our state to participate in a year-long series of learning events has allowed us to cultivate leaders who have become champions for issues of importance for patients and physicians. They were instrumental in the success of our recent “Focus on Flu” campaign, in getting the tobacco tax increase this past session, and in serving as advocates in the legislature.
MN: What is your top priority for the Kentucky Medical Association in 2019?
BS: Continuing to work to reduce the administrative burdens that distract physicians from caring for our patients. As a practicing physician myself, I know that physicians are overwhelmed by administrative burdens that do not improve patient care.
Near the top of most physicians’ list of administrative burdens that interfere with patient care is prior authorization. A study published in Health Affairs estimated that physician practices spend between 23 and 31 billion dollars per year on administrative issues such as prior authorization.
90 percent of physicians surveyed reported delays in needed medical care because of prior authorization, not to mention the added stress upon the patients because they are not able to receive the medication, the diagnostic study or procedure that their trusted physician has recommended.
KMA is advocating for transparency, simplification, expediated processes and compliance with published quality standards.