The End Of Private Practice

Times are a changing. With the increasing government control of healthcare and the increasing power of lobbies change is already underway. This involves not just obamacare, this has been going on for the past five years or so. Currently, about half of all healthcare insurance is via the government and their programs, Medicare, Medicaid, and tricare. There is nothing wrong with these programs but as with anything the government does, it is subject to political forces, I.e. lobbyists. Insurance companies and hospitals have lobbyists but doctors don’t. Some may think the AMA represents doctors but like AARP, they mainly sell insurance and they get $300,000,000 a year to determine billing codes that Medicare utilizes. Thus, they easily agreed to obamacare when the government threatened to remove their stipend if they didn’t support it. How does this all affect doctors? Well doctor have not seen a significant pay increase in almost 15 years. Imagine trying to run your own practice when the costs of everything has gone up but you are making the same each year. Drugs cost more, nurses cost more, insurance costs more but the only way to afford it is by you making less. Most people think doctors make too much and some do but most don’t. In fact, this freeze in how much doctors are getting paid has led to many doctors closing their practices to work for someone else. Once upon a time, few doctors worked for companies, now over 60% are employees of hospitals or large health care companies. How can they make more working for a company then for themselves? During the same 15 years that doctor’s reimbursement hasn’t increased, hospital pay has increased. This is many due to the facet that the hospital lobby spend upwards of $20,000,000 a year on lobbing for more money and that lobbying has paid off. Thus, the hospitals can pay the doctors more than they could make on their own. Why would a hospital want to do this? Control… Once the doctor is owned by the larger healthcare company, that doctor is encouraged to refer within that company’s structure. Thus, that one doctor, who is now an employee, sends all his MRIs to the hospital, all his surgeries to doctors that work at that hospital, etc. you will not be referred to the best doctor, you’ll be referred to the best doctor that helps the company’s bottom line. The hardest thing for the patient is to determine who is a employee physician and who is not. Unlike when a doctor owns something, such as a lab or imaging center, hospitals don’t have to disclose ownership of doctors, MRI, or anything else. If a doctor owns a MRI, he has to inform you that he is an owner and that you have options to go elsewhere but hospitals and companies don’t have to disclose this. This obviously also makes it hard to be in private practice. With more and more doctors being employees, the pie shrinks for those who are not owned by a larger company. Since patients who see the employee doctor are referred to other doctors who are employees or directly affect the hospitals bottom line, fewer doctors are referred to those not owned by a larger company. Eventually, private practice doctors won’t be able to compete. Now one might ask, why is this bad? Maybe it would be good that doctors are all employees? If one thinks logically about it, if you don’t have to justify your existence (the harder you work, the more you get paid) then you’ll do the minimum to get paid. What this means is that if you’re an employee doctor, you’re going to only do simple cases and anything complicated will be referred out. Thus, you’re more likely to hear “I can’t help you” then you might be used to. Why would a doctor do complicated cases when he has a stead stream of clients and when he can still be personally sued? That’s right, employee doctors still have personal malpractice insurance and you sue them personally not the hospital. Why would a doctor risk his house or retirement when he doesn’t have to encourage people to refer to him? Thus, with the elimination of private practice your options go down and it may be harder to find doctors to work with complicated cases. Ironically, the hospital lobby wants to control the doctors since they realize that controlling the means of production means more only for their pockets. Obamacare has made private practice a dead practice since now doctors can’t own hospitals, labs or diagnostic centers. Doctors have no other way to broaden their income and when 70 cents of every dollar earned is used to pay expenses, doctors are getting squeezed. Within twenty years, when you see a doctor you’ll have no options. He will send you to the company surgeon, the company hospital or whatever even though it might no be in your best interest. I have written to congressmen that hospitals should have to inform you of doctors who are employees and that you have other options but given that money runs this government, I doubt that will happen. I have a nephew in medical school and he states that all of his classmates just assume they will be employees. Given that hospitals are guaranteed a monopoly by the government (In most states, there is a CON law or certificate of need law which means that each hospital is guaranteed a monopoly of a certain area or population without competition), you may only have one choice to your healthcare in your location. It is amazing that hospitals don’t have to compete. Hospitals will tell you that the CON law keeps costs down but every study shows the contrary and it also allows hospitals to not have to improve care. Imagine if your local hospital that provided poor care had to compete against a new and better hospital? It might have to change! The Con law is essentially like Burger King saying that McDonalds couldn’t have a restaurant nearby because burger prices would rise. Ridiculous. The hospitals fight tooth and nail to keep the CON law. People have gone to prison selling CON’s for new hospitals (Scrushy) because it is worth millions per CON or new hospital. Anyway, hospitals are guaranteed monopolies in many areas and they are buying up doctors and soon you’ll only have one burger joint in town to go to. Will prices go down? No, they’ll go up since you’ll have no choice unless you leave that hospitals area. This may seem extreme but the reality is that more and more doctors are employees and that your options are already declining.

2 Comments

  • anniegirl wrote:

    This is exactly what has happened to the healthcare system in NW Florida “Sacred Heart Care”. I have been a medical profession for over 30 yrs. When I moved to Fl. 10 yrs. ago I was flabbergasted that the healthcare system was failing to providing quality care. It was and still is frightening. My only advantage was knowing the ins @ outs of the system. So I keep jumping through the hoops. So as this will most likely fall on deaf ears stop abusing the system, be proactive and work to make it better, yes I am talking to you, to all of us. You don’t have to be a medical professional to say no to poor health care. Just say yes to I’ll take control of my health care by being proactive and not abuse the system. It is hard enough for us who truly need quality care to get it. So if you are one of Dr. Haufe’s patients embrace the gift you have been given. Do what he asks you to do because in our corner of the world he is our salvation and our friend. And you can take that to the bank!!

  • .

    tnx for info!

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