Posted on 06/08/2013 10:26:23 PM PDT by grundle
First went the dinosaurs, then the dodo. Are physicians in private practices next on the path to extinction? The trends show the numbers of physicians practicing privately are steadily dropping. Some blame Obamacare for pushing doctors out the door. Is this accusation based on fact or fantasy?
Survey says A 2012 survey of physicians conducted by the Doctor Patient Medical Association, or DPMA, found that 90% of respondents thought the U.S. medical system was on the wrong track. 83% said that they were actually thinking about leaving the profession. 95% of physicians responding to the survey thought that private practices are losing out to corporate medicine.
Who's to blame? Nearly two-thirds said the government was the root of most of their problems. Even more identified the best solution as reducing government involvement in medicine.
Keep in mind a couple of things about this survey, though. First, faxes were sent to fewer than half of all active physicians in private practice. Only 4.3% of these surveys were returned. The responses don't necessarily accurately represent the opinions of physicians nationwide. Second, Obamacare wasn't specifically mentioned in the questions asked.
However, a 2013 physician survey by Deloitte that did use statistically valid sampling methods appears to confirm some of these concerns, albeit with lesser intensity. This survey found that 57% of physicians think that "the practice of medicine is in jeopardy." Only 31% gave the U.S. health care system a favorable grade. 62% said that more physicians will retire early because of how the practice of medicine is changing, with around 75% saying that fewer qualified individuals will pursue medicine as a career.
Regarding Obamacare, 44% of physicians think that the law is "a good start" compared to 38% who think that it is "a step in the wrong direction," with 18% undecided. 93% of physicians are concerned about being paid too little for services performed under episode-based bundled payments, which was promoted in Obamacare. More than half of physicians expect their incomes to fall dramatically over the next three years.
Doctors in the house The reality is that, regardless of physicians' opinions about Obamacare, the law is contributing to more doctors moving away from private practices. Health care reform emphasized close collaboration between health care providers through Accountable Care Organizations, or ACOs, and bundled payments. Many expected private physician practices to be acquired with this focus -- and they were right.
A 2011 survey by the Medical Group Management Association showed almost 75% more doctors employed by hospitals since 2000. Less than half of all U.S. doctors now work in private practices. An article published in the New England Journal of Medicine attributed acceleration of this trend to Obamacare.
HCA Holdings (NYSE: HCA ) , the nation's largest private hospital chain, embarked upon a major hiring campaign for physicians over the last few years. A key impetus behind this wave of bringing new doctors on board came from the ACO emphasis in Obamacare.
Hospitals aren't the only organizations scooping up physicians. Major insurers have also gotten into the act as they adapt to the new health care landscape created by Obamacare.
In 2011, UnitedHealth Group (NYSE: UNH ) bought Monarch Health Group, a large physician group in Southern California. UnitedHealth's Optum business segment previously purchased two smaller physician groups in the region -- AppleCare Medical Group and Memorial HealthCare Independent Practice Association.
Humana (NYSE: HUM ) acquired Metropolitan Health last year. Metropolitan Health operates a network of physicians and other clinical professionals who focus on providing care for Medicare beneficiaries. Humana also bought Concentra, with its 300 health clinics spread across 40 states, in 2010.
No-good goodbye? Will this trend of doctors saying goodbye to their private practices be a good thing? Not necessarily.
According to one estimate, Medicare pays more than $1 billion per year than it would otherwise when doctors work for hospitals. That's largely because hospitals receive higher reimbursements from the government program for many specialty services than individual doctors would.
Another potential issue stems from the possibility that hospitals could push doctors in their employment to pump up numbers of admissions and tests. Health Management Associates (NYSE: HMA ) is under investigation in several states for possible actions including the "medical necessity of emergency room tests and patient admissions." A 60 Minutes story in December focused on some of these alleged admissions issues. The company disputes these accusations.
Of course, if you own stock of hospitals that are hiring away physicians from private practices, the trend is probably quite welcome. In large part due to the impact of Obamacare, hospital stocks have soared. HCA shares are up more than 60% over the last year. HMA stock gained more than 130% during the same period.
The way of the dinosaur and dodo? Physician private practices will almost certainly continue to decline, but they probably aren't headed for total extinction. Some doctors will resist the temptation to work for larger entities, even if their pay suffers as a result.
While the shift away from private practices was already under way prior to Obamacare, the legislation definitely threw gasoline on the fire. As a result, perhaps another federal action is now needed: adding physician private practices to the endangered species list.
I know several nurses earning “nursing practitioner”, because of all the clinics offering so many jobs for NPs (but not doctors).
No worries, Obama will let into the Country thousand of third world Doctors. He will convince the AMA to loosen the standards. These clowns will butcher Americans by day, and hack Government computers by night.
“Ah, but you lose the two thirds you don’t want anyway...”
The two thirds of patients that was lost to the practice may have only contributed a relatively small amount (if any) to the profit margin. Doctors in self pay practices can offer relatively lower rates to self pay patients because of much lower overheads, ie less paperwork, phone calls, collection efforts etc.
There will be a lot of people that want health care services, but do not want to fill out all the paperwork for the subsidies and pay for over inflated ‘insurance’. Even the low information others will realize that it is cheaper for the average family to pay for some doctor visits, diagnostic tests or even a minor procedure out of pocket than it is to pay $20k for a 0-care budget plan.
Other factors are also still up in the air. We still don’t know whether in the federal exchange states, subsidies will be available (no funding in 0-care law). And if you file your taxes as not to receive a refund, whether this prevents enforcement of the mandate tax/penalty.
So you keep the third that doesn’t have any money because they spent it paying fines for not having insurance?
You pretty much just described the process by which corporate America, and our education system, are being strangled to death by administrative bloat.
The IRS has a well established mechanism for tapping into your personal assets to collect taxes you owe.
Obamacare pushed me out after 20 years in private practice as a FP in a rural area. I am now an employee. I get time off and benefits and a much higher take home pay. Of coarse, I am not as FREE but at least I am not going broke trying to pay the HIGH overhead of a private practice. Sad and cruel but, That is just the way things are going to be.
Certainly, I am in a “different place”. I am able to “go Galt” in a sense. I am able to get by on very little and so I can have patients who want MY advice and folks who I am happy to help. I don’t have many of the headaches others do. Admittedly. I don’t pay much in taxes to the feral gummint, either. IMHO, we would all be in a better position if we ALL made the choices I have. Sure, I could make 6 figures and pay enough in taxes to keep a family of six on welfare. I choose not to. Folks with debt need to figure out if they really want to practice medicine bad enough to contribute to the immoral behavior of the feral gummint. Read Boenhoffer. “To do nothing in the face of evil IS evil.”. Go Galt.
See above.
See above
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