THE END OF THE PRIVATE PRACTICE OF MEDICINE — Economic Consequences to Us All

A recent Wall Street Journal article http://online.wsj.com/article/SB10000872396390443713704577601113671007448.html?mod=WSJ_hp_mostpop_read described an increasing and frightening trend in health care today–the purchasing of  physician's practices by hospital chains. 

 This is not merely the end of private practice medicine as we know it–it actually is resulting in increased health care costs.  As a private practice physician I fear the day when medical care in this country will be accessed only through such large organizations.  The motivation for physicians joining up with such hospital mega-groups is multifactorial.  There is an increasing fear among physicians that they will be marginalized in the onslaught that is occurring. 

ACOs (accountable care organizations) are the legacy of Obama care.  They act as giant purchasing organizations in which Medicare and insurance payments will be bundled and directed to them.  Distribution to the hospital, nurses, physicians and administrators will come out of this pot.  Small private practice doctors fear they will be left out of the game if they don't join.  But more significant and pernicious is the reality that hospital-based organizations can charge MORE than private docs themselves. 

 The article describes the increased costs of procedures that were formerly performed by private practice medical practitioners.  The cost of cardiac catheterization and testing may becomes enormously higher under such settings.  I am sure the cost of what I do–upper endoscopy and colonoscopy are likewise inflated by such arrangements.  Then there are the intangible aspects of losing small privately run practices–the ability to provide individualized care in a small, compassionate setting.  When institutions take over, there is a different mind-set among workers and patients.  They become a number.  They will deal with the employees of a large company who have little concern whether that patient/client is satisfied or not.  This is not a slam on any one individual.  It is the nature of business.  Small (mom and pop) businesses just provided more personalized care.  The small practice strives to satisfy their patients because they cannot aford not to!  It is not that complicated. 

Adding layers of bureaucrats to the practice of medicine inevitably slows down the process, de-humanizes the process and leads to dissatisfaction for patients and practitioners.  Add to that the cost increases that are now emerging and you have the perfect storm–for disaster in the practice of medicine.

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