And Then There Were None

In the US, approximately 30% of physicians work in practices that they own. This number has been dwindling down over recent years. Perhaps more surprising, the number of women doctors who are self-employed are a mere 18%.

Many hospitals and other corporate entities are actively looking to purchase the remaining practices. It is not just to make money from that practice, but to make money from services that are shifted to their own corporation. While there are federal laws in place to prevent kick-backs in exchange for services, there are no rules as to who can own and run a medical practice. And when someone owns the practice, they can control where services are performed.

Many may wonder why doctors are selling out but the simplest answer is that private practice is just not worth it. As self-employed doctors, we are not only responsible for all the patients in our practice, we are also responsible for the business. Tax laws and accounting principles are foreign languages to many doctors. And new regulations are aimed at decimating those remaining at the reins of their own medical practice.

Why are doctors leaving private practice?

• Burn-out: in private practice there is no life-work balance. Work always comes home with us, whether it is trying to balance the books or keeping up with ICD coding. Doctors, for the most part, just want to cure diseases and save lives.
• Run away regulations: We were tormented with meaningful use requirements and implementing EHRs. But now, MACRA rules have ramped up the stakes. If we do not comply, we will suffer serious financial penalties (or “negative adjustments” as the politicians call it). And the massive bill itself predicts small practices will not be able to comply. For many of us, it is easier to turn over the control of our practices than try to comply with this nonsense.
• Insurance companies’ control: Increasingly, diagnostic tests and medications are being denies. The hoops of attaining prior-authorizations for these services is a nightmare. Sure, this holds true wherever a doctor may work. But, larger groups and corporations can afford to have staff dedicated just to this task. In a small practice, it is disruptive and costly.
• Unhappy patients: We struggle to give our patients our best, but often are decisions are yanked away by third parties looking at their own bottom lines. Patinets are increasingly unhappy as they pay more for less services. And doctors feel trapped in the middle. Patinest deserve better than they are getting and we are often immobilized by these third parties in offering help.
• Isolation: Doctors in small practices are islands unto themselves. We are not allowed to join together to negotiate contracts or unionize. We are not allowed to collectively bargain or protes. With all the looming destruction coming down the path of the healthcare system, it is scary to be alone these days.

While there are many reasons doctors are leaving the folds of self-employment, there are some who remain. FOr me, I think that a practice run by a doctor fully understands the needs of its patients more than any big company could.  All too often, patients are triaged by phone trees to even get an appointment. The human touch in medicine is vanishing. Yet, often that is the best medicine and that is why I will stay on my own island until the end. This is rthe best I can do for my patients rather than be driven by corporate overlords. I will remain standing until there are none. And, on that day, I will cry for my patients because then they are lost.

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