Apprehensive, Many Doctors Shift to Jobs With Salaries

[PoliticAverse]

American physicians, worried about changes in the health care market, are streaming into salaried jobs with hospitals. Though the shift from private practice has been most pronounced in primary care, specialists are following.

Last year, 64 percent of job offers filled through Merritt Hawkins, one of the nation’s leading physician placement firms, involved hospital employment, compared with only 11 percent in 2004. The firm anticipates a rise to 75 percent in the next two years.

Today, about 60 percent of family doctors and pediatricians, 50 percent of surgeons and 25 percent of surgical subspecialists — such as ophthalmologists and ear, nose and throat surgeons — are employees rather than independent, according to the American Medical Association. “We’re seeing it changing fast,” said Mark E. Smith, president of Merritt Hawkins.

Health economists are nearly unanimous that the United States should move away from fee-for-service payments to doctors, the traditional system where private physicians are paid for each procedure and test, because it drives up the nation’s $2.7 trillion health care bill by rewarding overuse. But experts caution that the change from private practice to salaried jobs may not yield better or cheaper care for patients.

Read the rest at: http://www.nytimes.com/2014/02/14/us/salaried-doctors-may-not-lead-to-cheaper-health-care.html

[Squinch]

1. This has been going on for a while. Independent practitioners

don't have the negotiating clout that large conglomerates have when dealing with insurance companies. My gyno said that she got around $3000 per pregnancy and birth in her independent practice, compared to her friends whose salaries boil down to about twice that per pregnancy and birth in conglomerates. And she has to pay all her overhead.

She wants to remain independent, but there has been pressure toward this for a long time.

[Scuba]

2. This may be a new trend for Merritt Hawkins, but it's nothing new ....

... as the poster above mentioned, independent physicians lack negotiating clout with insurance carriers.

Additionally, few physicians want to spend their time on the business aspects of a practice. Figuring out the best way to acquire tongue depressers is not wise use of a physician's time. Payroll and accounts payable are a time-consuming nusiance. Billing and collections are a career-killing nightmare.

Hospital-owned physician practices make sense on a number of levels for both parties.

Physician-owned hospitals, on the other hand, are another story. In some glaring cases, specialty groups have opened, for example, a "heart hospital". As owners, their profit motive has resulted in the kind of problems you'd expect. Since reimbursement is based on diagnosis, not actual costs, they've cherry-picked the easiest cases within the cardiac groupings and sent the financial losers to St. Elsewhere. This is crushing the financial picture of the not-for-profit hospital that either takes these losing cases or gets out of the heart business.

[LiberalFighter]

4. Sort of like the cancer treatment place that advertises on tv

there survival rates being the highest. That can always be rigged.

[Sgent]

6. Sorta kinda

I'm generally in favor or non-profit hospitals with professional management, with a combination of community and physician board of directors.

In my experience, the specialty hospitals tend to provide very good care, they just cherry pick their cases.

I'd much rather be admitted to a physician / community supervised regional medical system than a HCA hospital

[mopinko]

3. scare tactics. and from the new york times. shocked, simply shocked.

what bullshit.
i live in chicago. i don't know what the stats are, but the networks are thick here. and they work for me. i don't have to dig up recommendations for every specialist you need at my age, i think i would go nuts.

i saw the university network that i go to grow from a handful of rented offices to a string of major edifices over the 20 years since i took the first kid in for a shot. if i didn't know that it wasn't that way everywhere, and for everyone, i would be tempted to buy into the whole 'first in the world healthcare system'. i have had some amazing care.
i know there are downsides.
but the whole thing has nothing to do with obamacare, except that i will probably help push in all in a better direction. lots of those disincentives are dealt with in the law.

[CTyankee]

5. A friend of my daughter, an anesthesiologist, took a big step when he went to work at a VA

hospital. He is very happy to be a "government employee." I think the benefits lured him in...