Who does your doctor work for?

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Wednesday, July 13. 2022

Who does your doctor work for?

While this link is an advertisement directed towards physicians, it makes clear what is going on in medical practices today: THE DEATH AND LIFE OF THE “PRIVATE PRACTICE PHYSICIAN”

While many physicians might like the idea of independence, for most specialties the need for a large back-office staff requires being part of a group practice. Then, sooner or later, somebody buys the group. The buyer could be a hospital, a giant medical business, or even a venture capital fund.

Things have changed. In many ways, sharing some income and being a part of a larger business makes it easier than being an old-fashioned independent physician. It's not the same thing, though.

Posted by Dr. Joy Bliss in Medical at 13:22 | Comments (9) | Trackbacks (0)

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Rather like getting into legal trouble at work, and the firm will provide you with legal counsel. Right. The legal counsel from the firm has the interests of the firm first, not your interests. So if you going to prison solves the firms problems, you are going to prison. Sorry Charlie.

#1 Milwaukee on 2022-07-13 15:57 (Reply)

My primary care doctor refused to prescribe Ivermectin unless the hospital he works for approves. They don't. He's pretty much a bureaucrat now.

#2 snopercod on 2022-07-13 16:25 (Reply)

There are stories out there that doctors who dared prescribe Ivermectin were in serious danger of losing their medical licences, which would have meant they could no longer legally practice. If that was the situation where you live, can't blame the doctor and the community needs to confront the hospital board.

#2.1 Frances on 2022-07-15 02:19 (Reply)

The only solution to the consolidation of the medical profession is to use monopoly law against hospitals that vertically integrate. There is little to no competition except in large cities. By hiring doctors, nurses and specialists, including pharma, a hospital has monopolistic control in its geographic area.
Securing health services is not like securing food, clothing or transportation. What is worse is that in some states a single hospital corporation controls most of the medical care.
There is next to no pricing information from hospitals and independent doctors, or doctor groups can be restricted from hospital privileges.
The current disastrous operation at hospitals with their mandates and protocols were quite evident during the covid fiasco. That kind of power needs to be stripped from hospitals and left in doctor's hands. It would also be of benefit to curtail the power of state health departments to mandate anything. They are not elected. They are to provide advice and track health trends only.

#3 indyjonesouthere on 2022-07-13 16:39 (Reply)

I have lost four of my doctors in the past three years, they are miserable working in these health care systems owned by large medical groups or large hospital systems. Two left the state, one retired early and one quit and bought her own concierge practice. Would have liked to follow her but can't afford the extra cost after all the very expensive insurance. Between the government and the large systems they spend hours doing paper work (on the computer) every day. Trying to find good replacements has been very difficult and it isn't over. Like Snopercod none would prescribe Ivermectin for covid as the large group followed Fauci's denial of it being effective.

#4 JC on 2022-07-13 17:07 (Reply)

CLASSIC picture! I'm old, and I remember that on a calendar at my Doc's office frm yearrrs ago. Don't see them at the Doc's any more... My Doc was a South Korean fighter jock, and with NASA before he took up medicine.

#5 Sam L. on 2022-07-13 17:50 (Reply)

The author's assumption that the pendulum has swung as far in the "physician as employee" direction as possible is naive. It's going to get much worse.

People were led to believe that if we hoped hard enough, we could have lower costs (more on this later), better quality, and quicker access for all....and it would take is government intervention.

Name something where government intervention achieved those goals? It could happen in the private sector with innovation and competition, but government meddling discourages that.

The government said we would have lower costs, but what the meant is that the price of an individual service would be lower (if the government allowed that service or medicine). But because government was going to mandate the all insurance companies cover sex change operations, drug addiction treatment, and scores of other crapola that many people don't want to pay for, net premiums had to increase, i.e the percent of GDP going to medical care went up.

It became cheaper and, in some cases, easier to see a doctor (or more likely, a PA or NP) for some minor BS that most would never bother to seek care for if the money was coming form their own wallet...but harder to get care for really serious stuff life cancer and cardiac surgery.

As far as quality,..well, the government has that covered. They have lengthy forms for doctors and hospitals to fill out and boxes to check "documenting" that stuff was done. Most of it has little or nothing to do with actual quality, but if it meets the government definition, that's all that's needed. As far as if the stuff is actually done, there's a saying in medico-legal circles: "If it's not documented, it wasn't done." Healthcare in the new era reverses this to meet the quality standards: "If we document it, it who cares if it was actually done?"

One thing the author misses is the new cadre of woke physicians currently graduating form w medical schools and residencies where emphasis is being placed on "health equity" and diversity rather than ending up with the most qualified group of physicians and providing the best care for an individual patient.

My recommendation:
1. Avoid the things that we all know are unhealthy, e.g smoking.
2. Eat right (like a Mediterranean diet).
3. Exercise.
4. Avoid sitting on your a butt for "long" periods - get up and move.
5. Enjoy family and friends.
6. Read the Bible and pray.

#6 mike on 2022-07-13 20:35 (Reply)

The question is, are physicians professional or not. If they are professionals, they answer first to their own moral compass and then to the professed objectives and rules of their profession, not the needs of their practice or employer, whatever the case may be.
Problem is, professionalism has taken a hard hit, in all the recognized professions, law, accountancy, etc.
I think they are just not building moral compasses as well as they used to.

#7 Bob D on 2022-07-13 20:39 (Reply)

"...sooner or later, somebody buys the group..." Why?

One reason, and I've seen this in my own family physician's practice, is that eventually the day comes when one or more partners want to retire. To do that, what used to happen is that a young physician starting out would essentially buy his way into the practice, and eventually become a full partner. Today, because all payments are mediated through insurance companies or Medicare, no one with any talent and in their right mind wants to enter family practice. There's no money it it, thus no supply of young physicians. So who do they sell to? A regional family practice group, or hospital chain. Mine has changed hands twice since being acquired. Apparently these regional medical groups view local family practices they way Wall Street views mortgages--assets to be bought and sold on the basis of financial considerations. Needless to say this comes with a loss of control for the practice, since the acquiring firm wants to "eliminate redundancies" and "take advantage of synergies", which in English means laying experienced people off and hiring cheaper replacements. Every time I take my wife for an appointment there, there is a new set of unfamiliar faces with very familiar dumb looks on them.

There are a handful of "boutique" practices in the area where you pay them an annual retainer and are able to see the docs as long as and as often as you like, but they are always booked and rarely take new patients.

My advice is to keep moving and don't get sick.

#8 Hairless Joe on 2022-07-14 09:19 (Reply)

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Wednesday, July 13. 2022

Who does your doctor work for?