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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.

Of course we need to contain costs. And I know, it’s about the patient and nothing else. And all doctors are filthy rich. Of course they are.

Self-annointed experts blather about doctors, medical economics, and solutions. Government bean counters and consultants think they’ve got it figured out. They have no idea what we do, where we’ve been, or the staggering self-sacrifice necessary to manage a panel of chronically-ill patients.

I spent the best years of my life working 15-hour days as a scut monkey training to get where I am. But the next generation will be more judicious. As society sees what doctors do as a commodity, society will see commodity doctors.

The plight of the physician in America is now considered dead last. But don’t cry for me. Cry for yourself.

*This blog post was originally published at 33 Charts*

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2 Responses to “The End Of Private Practice?”

  1. Thanks for the post, Dr V. It’s a great wake-up call with another perspective on our reality. As a family physician in private practice (I own my own debt), I see (and feel) the daily pressures for financial survival, but so far, the incredible satisfaction of being responsive to my patients is still sustaining me to quest for a different financial model for practice. This is such an intense time that it forces each physician and patient to struggle with issues of cost and fairness.
    To the extent that primary care physicians aren’t just feeders for the medical industrial complex, we are one hope for our patients to get the best care possible in a relationship based decision process. As we seek new partners and new business models to survive the next wave of healthcare (when it’s one word, it’s about money) reform, we need to be ever mindful of the importance not just of the patient, but the patient-physician dyad that may secure small victories for both. The small victories, when magnified across millions of patient-physician encounters could “go viral” and win the day. Hang in there, folks.

  2. Alan Dappen says:

    2 mos ago I posted a want ad challenging the private and dwindling number of primary care physicians to stand and join the idea of a direct pay model of care which delivers concierge level care for 30% less than what the insurance driven model is even willing to even pay
    (Doctors Wanted For Hazardous Journey

    Not one taker, not one nibble, Nada.

    My take on the future of primary care is this: As long as primary care doctors remain unwilling to invest in their OWN future and build a cost effective delivery model free of games, tricks, secrets, middle men, paternalistic control, and transparent pricing that is based in real world prices, the word “Doctor” will disappear from general usage for primary care.

    When doctors point saying “X” or “Y” is causing the demise of primary care I’m always reminded of that pointing finger with 3 fingers pointing back at themselves and the lack of insight of how all those deadly bullet holes got blasted right through them. We doctors are not blameless victims for all that’s going wrong.

    The patients make or break questions remains, Do you accept my $20.00 copay?” And the reason for this? The doctors make or break question remains “How much money can I make?”

    Private physicians need to articulate a clean and new vision if they are to have a future at all.

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