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by
Rick Moran

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February 15, 2014 - 3:44 pm
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Doctors are leaving private practice to become employees of hospitals, according to this story in the New York Times. The decline in private practice physicians actually began a few years ago when changes to Medicare forced many physicians who practiced individually or in small group offices to make the move to a salaried position in a hospital.

But there is no doubt that Obamacare has exacerbated the problem. The onerous recordkeeping is one big reason why private practice physicians are becoming extinct. Private physicians can’t afford the extra employees to meet the demands of Obamacare paperwork.

Dr, Paul Hsieh explained in a PJ Media series we published on the rollout of Obamacare:

The second component of Big Medicine is the shift of doctors away from independent private practice and towards becoming hospital employees. Doctors face many of the same pressures as hospitals. As eWeek reported, “Doctors are abandoning their private practices to join large health organizations so they can lower their costs and meet government mandates on electronic health records.”

By becoming hospital employees, doctors lose autonomy, but enjoy more regular hours and a more predictable salary. In return, hospitals gain access to a guaranteed supply of patients from their employee-physicians. Last year the Washington Post reported, “[T]he number of physicians who own their firms dropped from 57 percent in 2000 to 43 percent in 2009, and it’s projected to continue falling to 33 percent by 2013.” As oncologist Patrick Cobb recently told CNN, “We have a joke that there are two kinds of private practices left in America. Those that sold to hospitals and those that are about to be sold.”

[...]

In contrast, the shakeup in health care is towards greater — not lesser — consolidation. This is because the government — not patients — will be increasingly in charge of the money. Under ObamaCare, government is projected to account for a whopping 66% of overall health spending. More centralized control of health spending will inevitably mean more centralized control of health care.

Nor is this centralization of health care some “unintended consequence” of ObamaCare. Rather, it is an explicitly desired goal. In 2010, Obama health advisor Nancy-Ann DeParle wrote in the Annals of Internal Medicine that the health law will “accelerate physician employment by hospitals and aggregation into larger physician groups” and that “physicians will need to embrace rather than resist change.”

Whether physicians resist the change or not is beside the point. The precipitous decline of private practice physicians will allow hospitals to jack up their prices — exactly the opposite effect of what the government intended with Obamacare.

Top Rated Comments   
They're easier to control in hospitals, aren't they?
8 weeks ago
8 weeks ago Link To Comment
Hospital based care is going to a teaming concept where you don't have a doctor, you have a team of doctors, none of whom really know you. But no matter, you're unlikely to see the same doctor twice in a row. There is no doctor - patient relationship. There isn't even someone in charge to appeal to. The goal of the team is to get you out the door as quickly as possible. They don't do complex. It's all cookbook diagnostics and cookbook treatment. I expect both morbidity and mortality will go up from this shift in the way care is given. Hospitals are good at some things but not all things. yet if you are tied to a hospital that's lousy at heart surgery good luck with that heart condition. If your doctor is in private practice, he's working for you to get you the best care possible but if he or she works for the hospital guess where his loyalty lies; it's not with your care.
8 weeks ago
8 weeks ago Link To Comment
A doctor in private fee-for-service practice makes money by giving excellent care and having his patients brag about him, so that his practice grows. He stays at the office till everyone has been seen, then goes to the hospital to see more, when everyone else is home eating dinner. Surgeons can be up all night with an emergency, then have a full day's schedule ahead of them the next day.

The fundamental change with hospital based medical practices is that most are akin to HMOs, in that they often receive money up front, and have to pay for any care they give, out of that pot. The doctor will be paid a salary and will have no incentive to see more patients than the hospital dictates, so he will leave every day at 5 PM, and waiting times will get longer and longer. Surgeries will be delayed with waiting lists, and outcomes will undoubtedly suffer -- for those who live long enough to get the operation. Doctors will have productivity targets and audits, and will be expected to cut costs to the hospital, particularly when premiums are prepaid, as they are with HMOs.

I used to point out to my patients that if they saw the doctor's parking lot was full of Mercedes, those were paid for with money the doctors were paid to give excellent care. The Mercedes you see in the parking lot of an HMO were paid for with money the doctors were paid to NOT give care.

Topknife -- a Surgeon
8 weeks ago
8 weeks ago Link To Comment
All Comments   (34)
All Comments   (34)
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In medicine you can have quality of care, speed of treatment, and low costs, but the problem is that you can only choose 2.

Now with B.O. care you get to choose none.
8 weeks ago
8 weeks ago Link To Comment
No surprises here; the Americans got exactly what they wanted when they voted for Obama and Sandra Fluke. The US government will supply plenty of condoms etc. and everyone will be happy.
8 weeks ago
8 weeks ago Link To Comment
Look no further than Cleveland Clinic, the monopoly that Obama clamed as the example for the nation. The bought out all the small practices, shut down services through state regulation by limiting equipment and services that can be provided by a small business. Now instead of the $120 to go see a GP, you have to pay $600+ to the Cleveland Clinic.

They call it 'negotiated rates'...Its cheaper for us to fly to Dallas and get care than what it costs to go two blocks over to the Clinic monopoly.

Now Cleveland Clinic is in its second round of massive layoffs due to Medicare cuts.
8 weeks ago
8 weeks ago Link To Comment
I wanted to add what I think is frequently overlooked. During the time that the Obama administration was framing the Obamacare plan, CEO's of many hospital systems were included in the discussions. Also included were representatives of the IT companies that market EHR's in the US. Is it any surprise that the only winners are larger hospital systems and the IT companies? You can bet that the hospital CEO's were not thinking of their attending physicians when they were helping to write the regulations. Perhaps that's why they (attending physicians) have almost ceased to exist.
8 weeks ago
8 weeks ago Link To Comment
Oh it was one particular IT company that really made out like a bandit and that was EPIC. Its Billionaire founder Judith Faulkner serves on the Health Information Policy Committee - the only representative on that committee who owns an healthcare IT company...http://www.healthit.gov/policy-researchers-implementers/health-it-policy-committee. The requirement for EHR's were put in to place under Bush's TARP bill. 'Meaningful use' is the phrase being used to bring all healthcare IT into some form of standardized practice. The Federal Government is giving Docs and Hospitals financial 'incentives' if they meet certain EHR benchmarks that comply within a certain time frame. So why does ONE IT company get the inside track on all of this because Ms Faulkner is a big time liberal donor - crony capitalism at its best - now move along nothing to see here...
8 weeks ago
8 weeks ago Link To Comment
There are really only two types of physicians as hospital administrators see it.

One type brings in revenue because of specific skills or patient preference. A well known orthopedic surgeon, in a private group practice who is the best "knee guy" in the area, is an example.

The other type are a drain on resources as the hospital sees it. Take Emergency Medicine, Hospitalists, radiologists, or pathologists. So far as the CEO can see there is no reason for doctors like this to have a private practice at all. All of the income is derived from the hospital base. Nobody picks their favorite Radiologist.

They do indirectly because the referral based ortho surgeon is not going to be happy with untimely or substandard Radiology or ER service. Yet the Orthopedic "knee guy" depends on referrals from the primary base. When the busy primary care group gets bought up by the "University Clinic of North America"whatever they must funnel the patients to UCNA.

The strategy is to capture primary care. That is the referral base. So they buy up primary care docs and build these wonderful buildings with lab and everything. Nice salaried jobs with coverage, time off and 401k.

There is no going back on this trend. It has been going on since before Obamacare which accelerates the process. Now government and big business are on the same page. In another era we would call that fascism (socialism is something else).

8 weeks ago
8 weeks ago Link To Comment
They're easier to control in hospitals, aren't they?
8 weeks ago
8 weeks ago Link To Comment
To elaborate, this is similar to the regimes wide-spread attack on small businesses. Fascist overseers want the entities that they are controlling to be few in number; the more there are, the harder it is to control them. So, the fascists reduce the numbers of small businesses, medical professions, fraternal organizations, churches, etc., etc. And by "reduce", I mean "force out of business". Remember GM in 2009; lot of dealerships were shut down for what appeared to be no good reason, since fewer dealerships mean fewer sales. The fascists did it to eliminate the dealerships they would have had a hard time contolling. Likewise, GE gets massive government assistance since GE is an ally of the fascists. Mom and pop gets shut down. Even if Mom and Pop wants to cooperate, the fascist knows he isn't getting the bang for his buck by having to deal with hundreds of thousands of little guys. Too many throats to choke. Better to have on Jeffrey Imhelt who can be willingly bribed and coerced.

And who is better equipped to fight the State than doctors. They have prestige, money, loyal patients, and influence.

There won't be any independent doctors in a few years. That's when the Death Panels will really kick in. When the docs livelihoods can be pulled from under them, they will have no choice but to go along with Dr. Emanuel and pull the plug on the elderly people he decides are too expensive to keep alive. After all, the fascist elite have to have the fund to maintain their lifestyles.
8 weeks ago
8 weeks ago Link To Comment
"The precipitous decline of private practice physicians will allow hospitals to jack up their prices — exactly the opposite effect of what the government intended with Obamacare."

Isn't that what happens with almost every (ostensibly) good-intentioned law? "Let's pass a law requiring everyone to be insured!" Result: Less people insured. "Let's pass a law requiring hospitals to charge less!" Result: Hospitals charge more. "Let's pass a law requiring employers to pay their employees more!" Result: More people unemployed, earning no pay at all.

"A private practice physician is independent and the decisions he makes for your care are based on what’s best for you, not what some green-eye-shade hospital bureaucrat thinks is “efficient” or “cost effective.”

Hospital Administrator: "Dr. Smith - you're spending too much time with your patients - you need to intimidate them into not asking any questions! From now on, you must only spend 3 minutes or less with them! We get paid by how many people you see, not by how much time you spend with them! The numbers are what is important, not the people! Besides, if you spend too much time with them, you might catch something."
Dr. Smith: "Yes sir, I'll do my best."

8 weeks ago
8 weeks ago Link To Comment
"I can’t believe that this switch is ultimately in the patient’s interest."
It isn't. It's not meant to be. The whole program is meant to benefit government; money, and control over the population, are the goals here.
8 weeks ago
8 weeks ago Link To Comment
Slightly off topic, but "good to know." I work at a regionally well-known hospital in the Mid West. We downsized staff in December of 2012 by 320, a considerable drop for us. Our local paper talked about "re-organization" in preparation for health-care reform, and buried the layoff numbers in the final paragraph. Today, our payor mix pays at roughly 150% of Medicare. We know that the ACA will drive that number to 100%. We see it happening already. To "support" this change we will be down-sizing again, to both clinical and administrative staff.

The move isn't necessarily all bad. We have under-performing physicians and staff like any institution. But ... the story remains entirely un-covered in the local media. And I have yet to see much discussion of similar down-sizing that must be happening at the national level. A huge chunk of resource is moving OUT of medicine and its happening now, not two years from now, not delayed by any Presidential action.
8 weeks ago
8 weeks ago Link To Comment
Hospital based care is going to a teaming concept where you don't have a doctor, you have a team of doctors, none of whom really know you. But no matter, you're unlikely to see the same doctor twice in a row. There is no doctor - patient relationship. There isn't even someone in charge to appeal to. The goal of the team is to get you out the door as quickly as possible. They don't do complex. It's all cookbook diagnostics and cookbook treatment. I expect both morbidity and mortality will go up from this shift in the way care is given. Hospitals are good at some things but not all things. yet if you are tied to a hospital that's lousy at heart surgery good luck with that heart condition. If your doctor is in private practice, he's working for you to get you the best care possible but if he or she works for the hospital guess where his loyalty lies; it's not with your care.
8 weeks ago
8 weeks ago Link To Comment
"...you have a team of Doctors." This is no different than the "Walk-In Clinics" in Canada, (much like our "Urgent Care Centers" here). If you need to see a Doc right away, but it's not an E.R. type need, you go to these clinics & get the "Doctor on duty", whether you have a Primary Care Physician or not. You wait up to 6 months to see your Primary Doc with an appointment!! You often wait up to 6 months to see a Specialist after being referred by your Primary Doc. My aunt's boyfriend in Quebec waited to see an eye specialist for 6 months & went blind in the process. My Father-In-Law waited 6 months to see a Cardiologist & died of a heart attack. My Mother-In-Laws Primary Doc retired & now she is on a LONG waiting list for a new one...when enough people either die or move away, she will get a new Doc. She (& many other Canadians) often say to each other, "you just can't afford to get sick anymore", but ALWAYS out of earshot of any Americans. A part of the reason Hubby immigrated from Canada to the USA is the abysmal medical care provided by socialized medicine.
8 weeks ago
8 weeks ago Link To Comment

I don't think it's necessary to disparage the motives of the docs to realize that they will have metrics and bosses which will determine their fate, perhaps as much as patient outcomes.
8 weeks ago
8 weeks ago Link To Comment
Which leaves me wondering as to the future of "concierge" medicine.

If I understand correctly "concierge practice" simply means outside of any insurance/gov't or third-party reimbursement system which could also include the various "minute clinics" in the strip malls and drug stores of the land. I know this does not have to be Park Avenue upscale by nature. Here in Northern Va I see many such cash-on-the-barrelhead practices that seem to cater to specific immigrant populations.

"Medical tourism" has long since ceased to be for millionaires only and it has long since ceased to be for plastic surgery and other frivolities exclusively. I can imagine this growing even bigger and more organized...especially as regards standards, practices, and an internationally-accepted rating system.

I recall in Canada a few years back there was some talk of building private hospitals on Indian reservations out of reach of the government. That would certainly make for an even shorter trip to obtain care outside of the system. Dunno what became of that.

One way or another, working outside the system means an enormous amount of crap and red tape can be avoided. Outside the country, this includes malpractice insurance, lawyers and "defensive medicine" though there is an obvious danger there. One would hope a truly free, fiercely competitive market would become self-policing.
8 weeks ago
8 weeks ago Link To Comment
There must be a lot of variants of the concierge concept. I am new to Medicare and I have a supplemental plan as well - but after losing my GP over Obamacare concerns and due to my own concern about becoming just a faceless number in the system, I signed up for a "Personal Care Physician" program at a cost of $200 per month. All routine tests, physicals, blood tests and life style coaching are included. They don't touch any insurance plans as far as I can see. At first it seemed an extravagance but one recent medical incident revealed to me the value in such a program if you can afford it. The physician actually answered phone calls or returned them within the hour, stayed in contact with the ER doctors and referred and followed up with the subsequent specialists - all of whom did take insurance. The affect was rather dramatic - appointments quickly, extra attention and deference from the referred practitioners and an overall less stressful resolution of the problem. It remains to be seen if the value proposition will always be there. It has already been suggested by one physician that such a service was unnecessary. But we'll see. I feel that we are all headed for Medicaid-like or VA-like service and this is not an unreasonable fee to pay to avoid something like that.
8 weeks ago
8 weeks ago Link To Comment
One concierge program, MD/VIP, is built around an annual physical for which the patient pays cash directly to the doc with no participation by an insurer.

After the physical, the doc accepts the patient's insurance or Medicare for all subsequent care during that year. In return for the (expensive) physical, the doc limits the number of patients in his practice and appointments can generally be had within a few days, and sooner in any kind of emergency.
8 weeks ago
8 weeks ago Link To Comment
THANKS for the tip on MD/VIP!! I hadn't heard of them, but will look into them for 2015. They appear to be more "wellness-focused" & that is how Hubby & I live. We JUST got squared away with our new "O''Drama-Scare" Doc, who seems OK, but if we are unhappy with him by the end of the year we will strongly consider MD/VIP. Our new insurance is our THIRD in 7 months, so I am now an EXPERT at picking out a Health Insurance Plan!! Our Premium POS through COBRA ended when COBRA did on 5/31/13, then we slid down-scale to a Good PPO & paid $125.00 more per month for it & O'Drama cancelled that on 12/31/13 & an equivalent PPO was out of our financial reach at an additional $350.00 per month, so we AGAIN slid down-scale to a Crappy HMO. Our new HMO Doc is exactly what (with my SIGNIFICANTLY lowered expectations) I wanted...a Doc who will "rubber stamp" my requests for what I KNOW I need & order such tests & Specialists. Both Hubby & I eat healthy, excercise regularly, & have a good BMI, so under "O'Drama-Scare", that's all we can hope for.
8 weeks ago
8 weeks ago Link To Comment
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