Monday, December 6, 2010

Private Practice Doctors Health Reform Dilemmas

Doctors face two major dilemmas in dealing with the crush of health reform: One, what to do about it in the present? Two, what new practice models will they enter to replace their current modes of practice?

With regard to the first question, doctors over the next one to three years say, in a survey of 2600 physicians sponsored by the Physicians Foundation and carried out by Merritt Hawkins (Health Reform and the Decline of Private Practice), they will exercise the following options - 26% of physicians will become employees, part-time workers, and administrators, operate cash-only. The remaining 74% say they will retire, work part-time, close their practices to new patients, become employed and/or seek non-clinical jobs. For now, the safest and most popular havens are becoming employed by hospitals or becoming part of larger groups or integrated health organization.

The answer to the second question is more elusive. Most of the new models - medical homes, accountable care organizations, new alignments with hospitals , community health centers, worksite clinics, and concierge and cash only practices are untested on a broad scale and entail major financial risks , loss of autonomy, practice style changes, and an unprecedented level of trust in corporate leaders in hospitals or other large corporate organizations.

Another Strategy

Another strategy, seldom mentioned, is for physicians to appeal for understanding among policymakers, politicians, and the public at large for consideration of the profound consequences of reform.

Present Trends

If present trends continue - abandonment of private practice by those currently delivering care, inabilities of private practice physicians to economically sustain their practices, physicians dropping out of caring for Medicare and Medicaid patients, medical students seeking employment with 40 hour work weeks, growing shortages of primary care physicians and certain broad based specialties - the nation will face an unprecedented access crisis to physicians.

One Question followed by Others

These trends raise a fundamental question; what good is expanded access without physicians? And that question leads to other questions: What incentives can we offer to encourage medical students to enter primary care? How do we stem the exodus from private practice? What are effective market-based alternatives to onerous government regulations? How do we make patients and health consumers more sensitive to the true costs of care? What steps can we take to make medicine a more attractive profession to bright young people? What draws people into medicine? How can we change the system so doctors can spend more time with patients and less time with paperwork and requesting, or even begging for permission to perform diagnostic and therapeutic procedures? How do we encourage disruptive innovations to make health care cheaper, more convenient, in decentralized settings?

For Answers

To answer these questions and to inform the American public what is at stake at ground zero when they seek medical care, we need more objective studies and surveys like those conducted by the Physicians Foundation. And we need the cooperation of the media to inform policymakers, politicians, and the public.

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