What's the difference between practicing psychiatry and heading
the SIU Medical School?
"Now my patients have tenure," quipped Dr. Carl J. Getto, who
has traded his diagnostic couch for an administrative conference
It doesn't take long for Getto, 48, dean since last fall, to
describe what's troubling the minds of his faculty and students in
particular - and medical practitioners in general - as they face
new uncertainty in their profession.
"Managed care" is its name, and "less money" is its game.
The spreading concept has a foothold elsewhere, including
Wisconsin, where Getto formerly was acting dean of the state
university's medical school. But it is still fairly new to Central
and Southern Illinois, he said.
Put simply, managed care means that insurance companies or
Medicaid or whoever is paying the bill will pay an alliance of
doctors and hospitals a flat sum to take care of somebody.
More than ever, profit will depend on efficiency and teamwork.
Getto's job is to steer each year's 74 graduating physicians
from Southern Illinois University toward new ways of doing old
things. (The first year's training is based at Carbondale and the
next three at Springfield.)
"Managed care is not a natural inclination for doctors," Getto
said in a recent interview at his office in Springfield.
"The biggest addition to teaching that managed care is causing
us to think about is adding cost as an issue when we look at
treatment," he said. "Not that it is the overriding issue - and I
think there's a misperception that anytime you talk managed care
you're talking about cheap. That's not the case. What you're
talking about is weighing in cost as one of the factors in making
The purpose of managed care, of course, is saving money. And
that, SIU's students are coming to realize, may mean less earnings
in their future.
"In most managed care plans, the risk of whether or not you're
going to have enough money to pay for all the care you agreed to do
is shared by the physician and the plan," Getto explained. "So the
physician is actually put at risk financially."
Another challenge of change, he said, is reorienting doctors,
typically quite independent, to get them to work well in tightly
woven teams of physicians and other health professionals.
Getto, who holds a master's degree in business administration
as well as credentials as a medical doctor specializing in
psychiatry, said it is too soon to determine what the impact will
His message to students:
"That they will make a very reasonable, comfortable living as
physicians. That the finances of medical care are changing. That to
be a physician in the future, one needs to know how to work in a
system different from the traditional system of the past. That we
can provide them with a lot of the tools for dealing with that. And
that part of why they went into medicine - to help people and to be
of benefit to communities - is actually going to be more possible
in the future. …