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Latest Posts

The End Of Private Practice?

I didn’t need the Wall Street Journal to tell that the days of “private practice” are numbered. According to recent numbers, fewer and fewer medical practices are under the ownership of physicians. Even in my corner of the economically secure State of Texas, small practices are folding faster than beach chairs at high tide.

I was driven out of private practice in 2004 by rising malpractice premiums and plummeting reimbursement. In Texas at the time the trial attorneys ran the place and medmal insurance carriers simply couldn’t keep up with the greed.

Medical practices are just too expensive to run and the services that physicians provide are dangerously undervalued. You do the math. Sure it’s a complicated issue. But the end result is institutionally-employed doctors with institutional pay and the risk of institutional service. Read more »

*This blog post was originally published at 33 Charts*

Practice Medicine For A Year, Rack Up A Half-Million In Overhead?

Newly minted MDs face student loans the sizes of mortgages and might go 18 months without an income if they try to start up their own practice. And although in the words of one student, “Medicine shouldn’t be treated like a business,” physicians still have to operate their practices like one.

That’s resulted in one doctor facing a half-million in operating expenses every year in Manhattan. A half-dozen other new physicians describe their first years in practice in these two profiles, while a third details how Leslie Saltzman, ACP Member, took advantage of some resources on hand and guidance from ACP’s “Running a Practice” section to quickly grow her solo practice into a full-service resource for women’s health. (New York Post, Kaiser Health News, ACP Internist)

*This blog post was originally published at ACP Internist*

When A Vacation’s Not A Vacation

I just got back from extended time off, which brings to mind a post I wrote two years ago:

Here’s an observation: most physicians in private practice don’t take enough vacations. I am often (rightly) accused of this sin. My staff, colleagues, and even patients regularly encourage me to take time off, but still I find it hard.

Why is this? Is it that I love my job so much that I can’t tear myself away from it? Is it that my self-worth is wrapped up in being “the man” for my patients, and being away from this makes me feel insecure? Is work my addiction –- the one place that I have control of my circumstances and positive reinforcement? Perhaps. But I think the reasons are more basic than that. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Why We Need Private-Practice Primary Care Doctors

A recent post on Kevin MD by Joseph Biundo, a rheumatologist, challenged my assertion that primary care doctors can save money:

(In reference to my claim…) That may be true in theory, but I see patients in my rheumatology office every day who have been “worked up” by primary care physicians and come in with piles of lab tests and X-ray and MRI reports, but are diagnosed in my office by a simple history and physical exam.

Prior to that, an article in the New York Times along with a post by Kevin Pho noted the fact that more solo practitioners are leaving private practice and joining hospital systems. Why are they doing this? Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Hospitals: Check Doctor’s Communication Skills Before Buying The Practice

Hospitals today are aggressively buying physician practices in their local markets. Why? Hospitals want to solidify their referral base for inpatient and outpatient referrals as well as increase their negotiating power with insurance companies.

Over 50% of physician practices are now owned by hospitals according to the Medical Group Management Association. As such, many one-time private practitioners are now hospital employees.

Having done physician recruitment in a prior life, I know that before buying a practice that hospitals look at a variety of things including the practice’s patient volume, number of hospital referrals, estimates of patient turnover, and so on. One of the things we did not consider years ago in evaluating and buying a physician practice was the quality of the physician’s patient communication skills and supporting practices. I doubt that things have changed much since. Read more »

*This blog post was originally published at Mind The Gap*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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