For a five-doctor practice, the Advisory Board Co., a health-care research firm, projects the total first-year cost at between $126,000 and $346,500, including two added nurses.
The upshot: Doctors fear a squeeze as they try to ramp up changes in tandem with evolving reimbursement schemes. “You’re asking a practice that may be only marginally viable as a business to invest in significant infrastructure,” says Glen Stream, president of the American Academy of Family Physicians. “Is the payment model going to be there to support that?”
Some doctors aren’t waiting to find out. Instead, they’re going to work for hospitals, which have greater financial resources and, because of their leverage with insurers, are also often paid more than small practices for the same services. The consulting firm Accenture projects that, by 2013, only around a third of doctors in all specialties will own their own practices, down from about 43% in 2009 and nearly half in 2005.
It is hard to predict what the long term effects of the transition to the physician employee model will be. My guess is that physicians will eventually regret selling their private practices to hospitals and “healthcare systems.”
Example: The Hospital system feels the squeeze and decides that your 3 physician group might just as well be a two physician group. One MD is fired.
Multiply this by however many hospital owned practices there are in the country and imagine the possible outcomes.
#1 — If doctors are horrible then they should be fired. Otherwise, we have a doctor shortage in much of the country, particularly for internists and some specialties, that make it unlikely that hospitals will “lay off” doctors.
Personally, I think there may be more quality control there. Because of a doctor shortage, bad docs can languish in private practice longer. But a hospital or health system isn’t going to risk its accreditation on employing the baddies. Conversely, the good docs can keep their minds and emphasis on treating their patients without having to worry about keeping the lights on and the staff paid.
Sorry Teatime2, but I just witnessed an excellent doctor get squeezed out by a hospital system. Yes hospitals do police their staff physicians, but what I has seen is that budget targets can trump quality physician care. It is a numbers game. The MD in private practice may have their spouse as office manager, whereas the hospital owned physician will have who knows how many administrators’ salaries that siphon off the already shrinking physician reimbursement that was the reason they couldn’t make it on their own.
Undergroundpewster, the hospital physician is generating big bucks for the hospital via diagnostic tests and procedures coming its way. It’s not as if the physician reimbursement is paying for administrators. In fact, my internist tells me she loves not having to squeeze as many patients into her day as possible just to pay the office bills. She says she can see fewer patients and spend more time with them because she doesn’t have to worry about the cost of overhead.
Anecdotally, I have never encountered an office where the spouse was office manager that was operated in a truly professional manner. I’m sure they exist but I’d have to see proof, lol. My gastroenterologist, for instance, is a truly wonderful doctor but his office is the pits because of the family members working there. HIPAA violations abound. The only reason I haven’t changed to a different doc or reported the HIPAA violations is that he really is a good and talented doc. I’ve approached the gals when they start talking loudly about patients in front of everyone and told them that they’re abusing patient privacy but they won’t change. This is the worst case I’ve ever seen but I’ve encountered too many problems with “wifey as gatekeeper” to think that employing the family in the office is a good thing.
Only slightly off-topic. Health care is too bureaucratic, complex and expensive to remain in the “good ole days” of mom and pop practices. And with the student loan situation what it is, fewer American students will be able to afford a medical education. let alone go into debt to set up a private practice. So it seems that doctors increasingly will either work for the government or for hospital corps. At least the docs here are working for a non-profit Baptist health system that is generous in providing care to all who need it and focused on healing rather than big profits.
I guess that docs who really want a thriving and lucrative private practice should go into plastic surgery.
It’s not just the medical profession that is affected. Every businessman I know is frightened and hunkered down because of the torrent of stupid and harmful regulations that those in power are impossing. They are not going to hire or expand because they fear this could bankrupt them, especilally the Obamacare cancer.
It is true that private practice is now impossible and will fade away. We will work for hospitals or the gavernment or maybe open a cash practice which can have a 40% less overhead. Some hospitals are good and some are worse than any mom and pop clinic. I have seen incompetent doctors be sheltered and paid hugh salaries even though the medical staff asked for him to be fired. He had political friends in the hospital administration and board and he was very dangerous. Fortunatly he had few patients since the other doctors would not let their patients go to him. I have seen much more HIPPA violations in hospitals than any private clinic. Nothing was done. so it all depends on just how good the hospit is. Some are wonderful and some are disasters. I doubt that the Republicans would do much to chang all this if they should get in. IMHO
RE: “Health care is too bureaucratic, complex and expensive to remain in the “good ole days†of mom and pop practices.”
Said the government after they made health care too bureaucratic, complex, and expensive for anybody to afford.
Rather like shooting a child’s parents and then pointing out that the child is an orphan and thus will need to go to a nice foster home.
RE: “And with the student loan situation what it is, fewer American students will be able to afford a medical education. let alone go into debt to set up a private practice.”
Of course, the “debt” required comes from monstrous liability premiums, crushing and growing regulations including required mega-thousand EHR systems, and ever shifting, ever growing government codes requiring additional paid staff to keep up with the requirements.
Again — like shooting a child’s parents and then pointing out that the child is an orphan and thus will need to go to a nice foster home.
RE: “So it seems that doctors increasingly will either work for the government or for hospital corps.”
Well — the ones who want to work in massive bureaucracies will. The rest will retire or move to their second career — or — and this is what I advise, delete the whole insurance/government scandal and move to all cash so that we can have a *real* “two-tier” health care system and hear all the patients, including me, squeal and complain about the humanity of it all.
RE: “I guess that docs who really want a thriving and lucrative private practice should go into plastic surgery.”
Right — because if there’s one thing that I want for a doctor it’s somebody who’s content to make 40K a year, fill out some forms, put in the right insurance codes, and refer me to a specialist! I mean — what’s not to like about post office workers?? The very last thing we need are driven, ambitious, hard-working, talented, willing-to-walk-over-ground-glass-shards-to-treat-patients kinds of docs. I just want the average paper-pusher for my doctor, willing to do whatever the ‘puter tells him to.
Speaking of overhead, a family member just had an “outpatient” surgical procedure at the local Catholic hospital, which is ostensibly not for profit. The family member was taken in at 7 AM and discharged at 11 AM. The bill, and this includes no physicians’ charges, was $19,000. My private health insurance now costs more per month than my mortgage and his risen 35% just since Obamacare passed. I’ve lost hope and I cannot stand any more change.