primitives discuss physicians moving out of private practice

[franksolich]

http://www.democraticunderground.com/114211471

Oh my.

PoliticAverse (8,227 posts)    Sun Feb 16, 2014, 04:00 PM

Apprehensive, Many Doctors Shift to Jobs With Salaries

American physicians, worried about changes in the health care market, are streaming into salaried jobs with hospitals. Though the shift from private practice has been most pronounced in primary care, specialists are following.
 
Last year, 64 percent of job offers filled through Merritt Hawkins, one of the nation’s leading physician placement firms, involved hospital employment, compared with only 11 percent in 2004. The firm anticipates a rise to 75 percent in the next two years.
 
Today, about 60 percent of family doctors and pediatricians, 50 percent of surgeons and 25 percent of surgical subspecialists — such as ophthalmologists and ear, nose and throat surgeons — are employees rather than independent, according to the American Medical Association. “We’re seeing it changing fast,” said Mark E. Smith, president of Merritt Hawkins.
 
Health economists are nearly unanimous that the United States should move away from fee-for-service payments to doctors, the traditional system where private physicians are paid for each procedure and test, because it drives up the nation’s $2.7 trillion health care bill by rewarding overuse. But experts caution that the change from private practice to salaried jobs may not yield better or cheaper care for patients.
 
Read the rest at: http://www.nytimes.com/2014/02/14/us/salaried-doctors-may-not-lead-to-cheaper-health-care.html

Squinch (6,889 posts)   Sun Feb 16, 2014, 04:18 PM

1. This has been going on for a while. Independent practitioners

don't have the negotiating clout that large conglomerates have when dealing with insurance companies. My gyno said that she got around $3000 per pregnancy and birth in her independent practice, compared to her friends whose salaries boil down to about twice that per pregnancy and birth in conglomerates. And she has to pay all her overhead.
 
She wants to remain independent, but there has been pressure toward this for a long time.

Scuba (35,465 posts)    Sun Feb 16, 2014, 05:00 PM

2. This may be a new trend for Merritt Hawkins, but it's nothing new ....

... as the poster above mentioned, independent physicians lack negotiating clout with insurance carriers.
 
Additionally, few physicians want to spend their time on the business aspects of a practice. Figuring out the best way to acquire tongue depressers is not wise use of a physician's time. Payroll and accounts payable are a time-consuming nusiance. Billing and collections are a career-killing nightmare.
 
Hospital-owned physician practices make sense on a number of levels for both parties.
 
Physician-owned hospitals, on the other hand, are another story. In some glaring cases, specialty groups have opened, for example, a "heart hospital". As owners, their profit motive has resulted in the kind of problems you'd expect. Since reimbursement is based on diagnosis, not actual costs, they've cherry-picked the easiest cases within the cardiac groupings and sent the financial losers to St. Elsewhere. This is crushing the financial picture of the not-for-profit hospital that either takes these losing cases or gets out of the heart business.

LiberalFighter (31,521 posts)    Mon Feb 17, 2014, 03:29 PM

4. Sort of like the cancer treatment place that advertises on tv

there survival rates being the highest. That can always be rigged.

Sgent (4,048 posts)    Sat Feb 22, 2014, 02:27 AM

6. Sorta kinda

I'm generally in favor or non-profit hospitals with professional management, with a combination of community and physician board of directors.
 
In my experience, the specialty hospitals tend to provide very good care, they just cherry pick their cases.
 
I'd much rather be admitted to a physician / community supervised regional medical system than a HCA hospital

And then inevitably, the hypochondrial primitive, who's had every affliction and ailment known in the history of mankind--excepting, unfortunately, none of the incurable fatal ones:

mopinko (40,365 posts)    Sun Feb 16, 2014, 05:20 PM

3. scare tactics. and from the new york times. shocked, simply shocked.

what bullshit.

i live in chicago. i don't know what the stats are, but the networks are thick here. and they work for me. i don't have to dig up recommendations for every specialist you need at my age, i think i would go nuts.
 
i saw the university network that i go to grow from a handful of rented offices to a string of major edifices over the 20 years since i took the first kid in for a shot. if i didn't know that it wasn't that way everywhere, and for everyone, i would be tempted to buy into the whole 'first in the world healthcare system'. i have had some amazing care.

i know there are downsides.

but the whole thing has nothing to do with obamacare, except that i will probably help push in all in a better direction. lots of those disincentives are dealt with in the law.

We'll see; the mopinko primitive's not known for her far-sightedness.

CTyankee (38,959 posts)    Thu Feb 20, 2014, 04:51 PM

5. A friend of my daughter, an anesthesiologist, took a big step when he went to work at a VA hospital. He is very happy to be a "government employee." I think the benefits lured him in...

[JohnnyReb]

Government hospital + government doctors = government quality healthcare.... ....just what the DUmmies ordered.

The government funds the hospital, the doctors are paid by the government(indirectly but still gov. paid) healthcare system(Obamacare) and the doctors don't have to worry about malpractice insurance or losing their lincense = some piss poor healthcare.

[BlueStateSaint]

Government hospital + government doctors = government quality healthcare.... ....just what the DUmmies ordered.

The government funds the hospital, the doctors are paid by the government(indirectly but still gov. paid) healthcare system(Obamacare) and the doctors don't have to worry about malpractice insurance or losing their lincense = some piss poor healthcare.

IIRC, there's no real protections for malpractice in Obamacare.  I could be wrong, but that's what someone on this site has said.

[Delmar]

Response to PoliticAverse (Original post)Sun Feb 16, 2014, 04:18 PM
Squinch (6,896 posts)
1. This has been going on for a while. Independent practitioners

don't have the negotiating clout that large conglomerates have when dealing with insurance companies. My gyno said that she got around $3000 per pregnancy and birth in her independent practice, compared to her friends whose salaries boil down to about twice that per pregnancy and birth in conglomerates. And she has to pay all her overhead.

She wants to remain independent, but there has been pressure toward this for a long time.

Even if she doubles the $3000, that's still only $6000.  Someone needs to tell this gyno to get into amputations--that's where the real money is.  The gyno is probably kicking herself in the ass for not getting into family care and the sweet amputation bucks that go along with it.

Right now . . . if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's 30,000, 40, 50,000 dollars immediately the surgeon is reimbursed.

Jovencito Barry August 12, 2009 Portsmouth, N.H.