Physician Practice Choices and its Impact on Health Care Reform

The days of a doctor getting out of residency and hanging up their own shingle are becoming a thing of the past. (When the Doctor Has a Boss, WSJ – 11/8)

There are certainly many legitimate reasons why this is the case. Increasing in overhead and red tape make it difficult, if not impossible, to start your own practice. The need for size to compete in the market and negotiate with insurance payers is another reason. The desire for quality of life and ‘lifestyle’ on the newly minted physician’s part must be incorporated as well into this trend. We see it when we interview new physicians in our practice as more chose to start after a few months break from residency to ‘real job’. This is a trend which was not seen in the past.

Does this mean that most physicians will be employed in the future? I think the answer to this is a qualified yes. The qualification is by whom they will be employed. There are certainly large practice models such as Kaiser and other that incorporate physicians as part of the health plan which manages the care of the population for which they provide care. Hospital will continue to gain share of physicians from the simple fact that more and more physicians are approaching hospitals to buy out their practice. So what does that hold for the future?

If physicians are not careful they may find themselves on the outside looking in as health care changes over the next decade. It won’t happen in Congress but in small ways; as state legislatures pass new regulations and hospitals negotiate for more dollars to provide total health care for a population of people. Cost of care issues will dominate the discussions in the future. None of these are done with malice and if physicians are proactive enough we can develop a win-win-win scenario.

The first win involves our patients as the cost of care is lowered and more patients are able to receive appropriate and adequate (but not excessive) care. The second win is for the system as new ways are developed to improve the health of the population. The third win involves a robust and innovative physician-hospital-outpatient system that allows all to prosper as the first 2 needs are met.

The reality is what we have today are great silos of care and little coordination between and across the silos. That future holds great opportunity and great risks for those willing to take the chance to define it. Anyone care to place a bet with me?