Just as the Obama Administration added 31 million to an already overworked and understaffed health care system, the New York Times noted a “quiet revolution” occurring in America that is transforming how medical care is delivered in this country. The impact of this ‘revolution’ “could have a big impact on that law’s chances for success.”
For example, “an increasing share of young physicians, burdened by medical school debts and seeking regular hours, is deciding against opening private practices.” This kind of trend could be extremely harmful to patients who seek doctors, and would only add to the crowded waiting rooms. As a result of this trend, doctors are now accepting salaries at hospitals and health systems, and older doctors — “facing rising costs and fearing they will not be able to recruit junior partners — are selling their practices and moving into salaried jobs, too.”
One only has to look at the numbers: since 2005, the share of medical practices that were physician owned dropped from nearly 80% to just below 50 percent, “and analysts say the slide has continued. Consequently, it could mean that patients see bigger health care organizations that can provide better, more coordinated care, or it could mean patients lose their close relationships with a longstanding doctor. The shift to bigger health care providers is more likely a sign that private health insurance is going to get more expensive for individuals.
Adding to this price increase is the fact that the new health care legislation provides for bundled payments for certain kinds of medical care, which “may further speed the decline of the private-practice doctor and the growth of Big Medicine.” Another issue forcing doctors from private practice is their growing concerns over medical errors and changes in government payments to doctors. The Times noted that “an even bigger push may be coming from electronic health records” (EHRs).
The problem with EHRs is that they are “expensive and time-consuming for doctors, and their substantial benefits to patient safety, quality of care and system efficiency accrue almost entirely to large organizations, not small ones.” Since the economic stimulus plan last year included $20 billion to spur the introduction of electronic health records, older doctors are moving away from private practice to avoid this burden.
For example, Dr. Gordon Hughes, chairman of the board of trustees for the Indiana State Medical Association, noted that “young people coming out of training now don’t want to do much and don’t want the risk of buying into a practice.”
This lack of private practices is disheartening for patients who are used to seeing the same doctor every visit because Big Medicine does not have the same consistency. Moving to a bigger organized health system that tries to push for quality may “put health insurance out of reach for much of the middle class.”
For example, Dr. Michael Mirro of Fort Wayne, Ind., a 61-year-old cardiologist, is among 22 cardiologists, who used to work in one of the largest private heart clinics in Indiana. “But in December, Dr. Mirro and his partners sold everything to Parkview Health, a growing health system that owns the hospital across the street from their building.” The reason for the sale was because they “had to hire more and more people to contact insurers and advocate for people to get the care they needed.”
This trend has been seen across the country for cardiology practices that have been selling out to health systems or hospitals. In fact, Dr. Jack Lewin, chief executive of the American College of Cardiology, estimated that the share of cardiologists working in private practice had dropped by half in the past year. Even more troublesome, Dr. Lewin noted that “the remainder of those left are looking to move in that direction, with or without reform passing.”
In the end, if “patient-centered” care is what Congress passed, having a different doctor for every visit seems to be far from ideal. Many of the changes adopted by congress in the health care package such as limiting imaging self referral, yearly valuation of practices and reporting the value, will only speed up forcing physicians to sell their practices.
Accordingly, Congress should look at ways to save private practice is and own up on its promise to ensure that patients are able to continue seeing their doctors.