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Three Major Challenges: Quality, Cost, and Balance

Frank J. Jirka Jr, MD
JAMA. 1984;251(14):1867-1868. doi:10.1001/jama.1984.03340380049023.
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There is no question that it's more difficult to be a physician today than ever before. That difficulty is going to be compounded many times in the years ahead.

You know the litany of problems, challenges, and pressures described from every podium at every medical meeting: the greater need for more care; an increasing number of physicians; interspecialty rivalries; freestanding medical centers; cutbacks in third-party payment, private and public; health maintenance organizations; preferred provider organizations (PPOs); hospital-physician relationships; diagnostic-related groups; fierce competition; changing incentives to give patients more responsibility for the cost of their care; increased patient concern about what is done and what it costs; and on and on.

The multitude of problems is overwhelming if we try to face all of them simultaneously. Our only solution is to condense them into three major challenges that are understandable and manageable.

Doing so requires changes in attitude. It requires stern


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