More Doctors Giving Up Private Practices

A quiet revolution is transforming how medical care is delivered in this country, and it has very little to do with the sweeping health care legislation that President Obama just signed into law.

Traditionally, American medicine has been largely a cottage industry. Most doctors cared for patients in small, privately owned clinics — sometimes in rooms adjoining their homes.

But an increasing share of young physicians, burdened by medical school debts and seeking regular hours, are deciding against opening private practices. Instead, they are accepting salaries at hospitals and health systems. And a growing number of 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.

As recently as 2005, more than two-thirds of medical practices were physician-owned — a share that had been relatively constant for many years, the Medical Group Management Association says. But within three years, that share dropped below 50 percent, and analysts say the slide has continued.

For patients, the transformation in medicine is a mixed blessing. Ideally, bigger health care organizations can provide better, more coordinated care. But the intimacy of longstanding doctor-patient relationships may be going the way of the house call.

There are political consequences, too. As doctors move from being employers to employees, their politics often take a leftward turn. This helps explain why the American Medical Association — long opposed to health care reforms — gave at least a tepid endorsement to Mr. Obama’s overhaul effort.

Gordon H. Smith, executive vice president of the Maine Medical Association, said that his organization had changed from being like a chamber of commerce to being like a union.

I went looking for a doctor earlier this year....when they heard I would pay cash...they said...”Sorry, we cannot accept anymore cash patients.” (NO, I am not Medicare.) However, I’ve heard since that those docs who DO accept Medicare pmts, can only have a certain amount of CASH payments....so, this particular practice must have hit their limit.....gov’t regs...they are soooo great!

The complexities of modern medicine pretty much make standing alone impractical and maybe impossible. The skilled group of associates surrounding the primary Physician can not be maintained by only one person.

A group of some sort is pretty much a must. In remote areas it may be necessary but in populated areas, there is no way one doctor can get everything done and be cost effective

As doctors move from being employers to employees, their politics often take a leftward turn. This helps explain why the American Medical Association — long opposed to health care reforms — gave at least a tepid endorsement to Mr. Obama’s overhaul effort.

The New York Times misses the point, again. Less than 1 in 8 doctors are AMA members. AMA stopped representing doctors a long time ago. The AMA is a business, and derives most of its revenue from Medicare/Medicaid billing codes, which it has a monopoly on. Doctor membership dues account for a decreasing share of the AMA's revenues, and subsequently, representing its members' interests has become a secondary function of the AMA. It's primary function is to increase its own Medicare/Medicaid-derived business.

"It is my understanding that HCFA in1983 granted the AMA what has been characterized as a “statutory monopoly” by agreeing to exclusively use and promote the AMA’s copyrighted CPT code for the purposes of reimbursing Medicare and Medicaid bills from doctors for outpatient services. As a result of HCFA’s and the federal government’s endorsement of the AMA’s copyrighted outpatient code -- to the exclusion of all competitors -- private insurance companies and others were also forced to adopt the CPT as their billing standard as well. The CPT code has thus become a fixture in doctor offices around the country. This predictably led to a financial windfall for the AMA in the form of CPT-related book sales and royalties approaching $71 million a year according to a report by the Wall Street Journal." From 2001 letter by Trent Lott

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