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The Doctor Won't See You Now; he's clocked out
Topic Started: Mar 15 2013, 08:45 PM (517 Views)
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I have noticed a trend towards doctors practicing in large buildings full of other doctors. That seems to have been the trend for decades. Dentists as well. Only my ophthalmologist has his own office. There appears to be considerable overhead savings by doing that. I can't even recall any doctor operating out of his own house even when I was a kid. Maybe in a real small town.

The article that started this thread appears to be political yellow journalism from what I can see.
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Pat
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It is a trend and has been for years. The Orthopedic surgeon I chose is a senior partner to the group. The operate a modern facility with all the latest gadgets. On site, they can operate or for other cases they use a hospital just down the street. Again, doctor owned, not owned by some hospital conglomerate. The same was true of the cataract doctor I used. Large modern facility,a staff of doctors, three locations including one where surgery was performed. Doctor owned. Not all doctors are uninformed about business.
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Banandangees
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jackd
Mar 15 2013, 09:48 PM
Quote:
 
ObamaCare is pushing physicians into becoming hospital employees

Bull.
This trend has been observed almost everywhere in the northern hemisphere since the mid 1990,.
This is all happening with or without the Obaba reform passing.
American medicine has historically been largely a small business operation where most doctors cared for patients in small, privately owned clinics (in rooms a adjoining their homes or even their basement.) That,s really not the trend for what has become a very high tech field of work
* Young doctors are coming out of medical school in the U.S. with a staggering debt burden (average of $600,000 (after subsidies). It is very difficult for any of them to think they can invest (borrow more) in a private business.
* Young doctors now love to be surrounded with high tech equipment, fully functionning labs, competent nursing, experienced collegue. None of which is available in a backyard operation.
*Young doctors have studied medecine, not business management. They walk away from all tasks not related to medecine (hiring, firing, sending bills, collecting bad debts, office maintenance,...
* There is a saving of close 50% on malpratice insurance costs for doctors in hospitals (better back-up if something happens.)
* Bigger health care organizations can provide better, more coordinated care, which is a + for the patient.
* Younger doctors all want more free time, a better family life... a trend observed in most workers. That is more easily achieved when being a salaried employee.
At the end of the day, more salaried doctors, will mean better care for patients.
patients benefit from higher quality and better coordinated care, as doctors from various fields join a single organization. In such systems, patient records can pass seamlessly from doctor to specialist to hospital.
* Private doctor business are much more likely to be the cause of ''unfortunate slip-ups'' that cost over 100,000 lives every year.
Dr Marcus Welby has closed his shop for good
I'm surprised that MR isn't asking you to back all you said with data.... that is if you want us to accept what you say.

I do think that the article is referring primarily to "primary care physicians." Many are now working in hospitals and are known here as "hospitalists." They will see those who will be admitted into the hospital through the ER. Many, under the coming "new system," who presently may have no primary care physician and usually go to the ER for health care needs will be under the care of "hospitalists" who will do the work up and refer to "specialists" as may need be. Again, LECOM is putting out physicians for that purpose... to be hospital employees.... as the article suggests. What may happen, as time goes by, and as Jack D suggests, these primary care physicians come out with considerable debt. They will work for the hospital for a salary which will keep them as "middle income" earners. Eventually many students may look at their income prospects (as primary care physicians) and, in time, it may be looked at in terms of going through several years of rigorous training, producing considerable accumulated debt, for the income as an employee. In time it may reduce the number of young people looking to become primary care physicians. Then, maybe not.
Edited by Banandangees, Mar 16 2013, 02:51 AM.
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Part of that may be the current shortage of GP's which is affecting both the US & Canada. That is largely a matter of demographics.

The problem in the US right now is a transition to single payer, of which Obamacare is the first step. Anyone opposed to that is bound to use any negative medical story as a political weapon.
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jackd
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Quote:
 
I'm surprised that MR isn't asking you to back all you said with data.... that is if you want us to accept what you say

My comments are backed by a 6-7 month study, on that specific subjet, in which I actively participated about 3 years ago, along with Americans and Europeans counterparts.
Heathcare administration, studies and counsulting has been my day job for the last 15 years.....

telco said:
Quote:
 
Part of that may be the current shortage of GP's which is affecting both the US & Canada. That is largely a matter of demographics.

demographics is right,
+ some economics.
Edited by jackd, Mar 16 2013, 04:30 AM.
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Banandangees
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Banandangees
Mar 16 2013, 02:36 AM
jackd
Mar 15 2013, 09:48 PM
Quote:
 
ObamaCare is pushing physicians into becoming hospital employees

Bull.
This trend has been observed almost everywhere in the northern hemisphere since the mid 1990,.
This is all happening with or without the Obaba reform passing.
American medicine has historically been largely a small business operation where most doctors cared for patients in small, privately owned clinics (in rooms a adjoining their homes or even their basement.) That,s really not the trend for what has become a very high tech field of work
* Young doctors are coming out of medical school in the U.S. with a staggering debt burden (average of $600,000 (after subsidies). It is very difficult for any of them to think they can invest (borrow more) in a private business.
* Young doctors now love to be surrounded with high tech equipment, fully functionning labs, competent nursing, experienced collegue. None of which is available in a backyard operation.
*Young doctors have studied medecine, not business management. They walk away from all tasks not related to medecine (hiring, firing, sending bills, collecting bad debts, office maintenance,...
* There is a saving of close 50% on malpratice insurance costs for doctors in hospitals (better back-up if something happens.)
* Bigger health care organizations can provide better, more coordinated care, which is a + for the patient.
* Younger doctors all want more free time, a better family life... a trend observed in most workers. That is more easily achieved when being a salaried employee.
At the end of the day, more salaried doctors, will mean better care for patients.
patients benefit from higher quality and better coordinated care, as doctors from various fields join a single organization. In such systems, patient records can pass seamlessly from doctor to specialist to hospital.
* Private doctor business are much more likely to be the cause of ''unfortunate slip-ups'' that cost over 100,000 lives every year.
Dr Marcus Welby has closed his shop for good
I'm surprised that MR isn't asking you to back all you said with data.... that is if you want us to accept what you say.

I do think that the article is referring primarily to "primary care physicians." Many are now working in hospitals and are known here as "hospitalists." They will see those who will be admitted into the hospital through the ER. Many, under the coming "new system," who presently may have no primary care physician and usually go to the ER for health care needs will be under the care of "hospitalists" who will do the work up and refer to "specialists" as may need be. Again, LECOM is putting out physicians for that purpose... to be hospital employees.... as the article suggests. What may happen, as time goes by, and as Jack D suggests, these primary care physicians come out with considerable debt. They will work for the hospital for a salary which will keep them as "middle income" earners. Eventually many students may look at their income prospects (as primary care physicians) and, in time, it may be looked at in terms of going through several years of rigorous training, producing considerable accumulated debt, for the income as an employee. In time it may reduce the number of young people looking to become primary care physicians. Then, maybe not.
I don't doubt you Jack D. Can you share that study with us.

Time will tell how US citizens view the "quality" of health care. Some will see it as an improvement, some won't I suspect.
Edited by Banandangees, Mar 16 2013, 05:29 AM.
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Banandangees
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Jack,

What did your study show about the compensation of the hospital based primary care physician, and is that specialty increasing or decreasing per 100,000 population (in the US, Canada and Australia; although for Americans, most are interested in US statistics as we are going through a major health care change).

And yes, demographics is a major factor. So, many wonder, even with "universal health care" some may find themselves "out of the universe" when they can't find a primary care physician at a time when a primary care physician is a more sought after physician because of our "expanding health care availability" via ObamaCare.

Will paid-for health care numbers in the US increase under the one payer system (and it will of course) at a time when primary care physician numbers are not significantly increasing per 100,000 population, particularly in rural areas?


In your study, what were your recommendations to hospitals regarding hospital employed physicians, particularly primary care physicians?
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jackd
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Quote:
 
Can you share that study with us.

Sorry, I can't.
1)Most of our studies are not published as they are intended to be used sticky for our health care planning or management purposes.
2) We have a very tight confidentiality agreement preventing me to quote any part of our report to anyone, for whatever reason.
3) You would probably not understand a thing as it is written in a ''foreign language.
Quote:
 
about the compensation of the hospital based primary care physician

In the U.s. hospital-employed physicians compensation is on the increase. 4% increase from 2010 to 2011, 51% percent from 2004.
In the U.S., the doctor--population ratio is decreasing. Older doctors are retiring,(a third of all doctors will retire this decade) aging population requiring more care, more female doctors working much less hours than the older doctor retiring, could create a doctor shortage down the road
Fresh off the press:
2012 workforce study
In our system, all new g.p.doctors MUST be devoting at least 12 hours per week in an hospital... for 15 years after graduating. On average, young doctor work on average 27 hours per week in an hospital (their choice)
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tomdrobin
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I think the "team" model with physicians paid a salary by the institution has been pioneered by highly regarded clinics like Mayo and Cleveland. That's the future of modern medicine. It beats a patient being passed from one specialist to the next, with each one having to get up to speed.
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Banandangees
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jackd
Mar 16 2013, 09:15 AM
Quote:
 
Can you share that study with us.

Sorry, I can't.
1)Most of our studies are not published as they are intended to be used sticky for our health care planning or management purposes.
2) We have a very tight confidentiality agreement preventing me to quote any part of our report to anyone, for whatever reason.
3) You would probably not understand a thing as it is written in a ''foreign language.
Quote:
 
about the compensation of the hospital based primary care physician

In the U.s. hospital-employed physicians compensation is on the increase. 4% increase from 2010 to 2011, 51% percent from 2004.
In the U.S., the doctor--population ratio is decreasing. Older doctors are retiring,(a third of all doctors will retire this decade) aging population requiring more care, more female doctors working much less hours than the older doctor retiring, could create a doctor shortage down the road
Fresh off the press:
2012 workforce study
In our system, all new g.p.doctors MUST be devoting at least 12 hours per week in an hospital... for 15 years after graduating. On average, young doctor work on average 27 hours per week in an hospital (their choice)
Jack,

Thanks for the reference. I'm assuming that the study and consulting that you participated in was possibly done to benefit systems that were already one payer systems; or, a system that was headed in that direction (in the case of the US). What would be the best approach for those systems regarding maintaining/enhancing the quality of care at the lowest possible cost?

The article I linked to on my first post was primarily about the family physician (GP), which in the US is considered one of several (4-5) specialties that come under the heading of "primary care physicians."

Thinking of the GP (in the article), why is the GP heading to hospital based practices. I think several have already hit on a few of the reasons (debt, cost of opening their own office, wages, hospitals competing for their fair share of the patient market, etc.) Yet, the GP numbers are increasing at a slower rate than the other "speacalists." One reason is pointed out in your Link.

Quote:
 
Family Physicians (2006)–“Declining Medical Student Selection of Family Medicine”
A report by the American Academy of Family Physicians states that in order for the country to have enough physicians to meet the demands of the population in 2020, a typical accredited family medicine residency program would need to increase from an average of 21.7 residents to 24 residents. The report suggests recruiting diverse candidates to become family physicians who will most likely serve rural, underserved, and elderly patients.(54)


And as you pointed out, wages for the GP (and primary care physicians) has been booted up by hospitals to about $217,194; but it is still the lowest paid of all the specialties:
http://www.beckershospitalreview.com/compensation-issues/200-statistics-on-physician-compensation.html

Quote:
 
Lowest-paid specialties

Primary care physicians such as pediatricians and hospitalists continued to be paid much less than many other specialties, but psychiatrists held the lowest median base pay at $217,194, according to the AMGA report.


The increase of pay to $219K with no equipment cost overhead by moving into hospital based practices, helps the GP migration from rural to urban; but also gives medical students incentive to move on the higher paying specialties... all of which increases hospital costs if they are going to compete.

The model you used (as did the article I posted) referred to The Cleveland Clinic, the Geisinger Health System in Pennsylvania and the Mayo Clinic in Minnesota as ideal examples of high quality, hospital systems. It should be pointed out that all three have been examples of that high quality, with physician employed staffs at reasonable costs for many years. They have all been privately owned systems and functioned at that high quality level before government intervention into health care.

It's ironic that in moving to a new system, the hospitals need that all important referral system... the base level GP.... especially if there is geographical hospital competition for those patients (it is a business) ..... and that base system is the lowest paying specialty of all the medical specialties; and that system is facilitating a move by the GP from rural to urban for the reasons mentioned; and the incentive for the GP to change specialties, is going to make that 2020 GP goal more difficult without increasing costs. The system is going to have to pay the health care costs (in the new system) of out patient offices whether the costs of those office staffs, the leasing of the buildings/space and equipment is privately owned or hospital owned via the new government cost reimbursement system. I will remain to be seen if, in the US, quality health care, delivered in a reasonable time frame and without "rationing," can be delivered at a lower cost than previously.

It seems to me that something has to give.


Examples of:

Hosptial competition for staff physicians

2011 State Physician Workforce Data Book:
Center for Workforce Studies

Show the states that are well supplied with physicians and those that aren't (migration)

Primary Care Physician Shortage May Undermine Reform Efforts


ADDENDUM

Here is one that may interest Canadians:

The Circle Game: Understanding Physician Migration Patterns Within Canada
Edited by Banandangees, Mar 16 2013, 08:37 PM.
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