Siu Medical Dean Teaching Managed Care

Article excerpt

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 table.

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 decisons."

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 be.

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. …