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The Death of the Physician

Remember the traditional family physician who cared for you, knew you, your mother and kids by name, rounded on you in the morning and evening? Sadly that era of medicine is long gone for modern day America. So what happened?

The corporatization of American health care

Where have all the traditional doctors gone? To be fair there are still a few around who have not fallen to the pressures of the new system. But it’s more likely than ever that many of them will be joining the ranks of large doctors groups and hospital chains within the next few years.  But is it their fault?

This new system can be succinctly described as the corporatization of American health care. Where large hospital chains merge with smaller ones, and independent physicians join up with physicians groups for a less stressful life.  A unique combination of increased mandates, skyrocketing medical costs and low reimbursement rates from health insurance companies has fueled this transition over the last decade or so.

From private practice to physicians group

Flat or dropping reimbursement rates combined with high overhead costs for private practice doctors can be seen as the obvious culprits in the death of the traditional physician model. According to a 2012 study from the American Medical Association (AMA), about 40 percent of family doctors are what’s left of private practices.

But these private practices have a whole new set of expensive challenges that put them at a disadvantage compared to their colleagues working for bigger physician groups or hospital systems.

One of those challenges are bigger overhead costs incurred by new technologies like EHRs that practices are required to have in order to stay compliant. Buying, installing, and maintaining an EHR system for even a modest sized private practice can easily cost tens of thousand of dollars. Not to mention the cost of hiring additional staff to manage the EHR all in the sake of better patient care.

Tort reform

Another area that bodes ill for the future of American doctors is the cost of medical malpractice insurance. The rates of this type of insurance have gone through the roof in recent years. Going back 10 or 20 years malpractice insurance was far more affordable than it is today. For physicians operating their own private practices, malpractice insurance can eat up a significant portion of revenues.

Defensive medicine is an unexpected effect of the modern medical malpractice climate that doctors find themselves in, this is because lawsuits are so common. Meaning that every patient receives a full array of expensive tests to confirm a diagnosis, when previously just one test would have been enough. The cost of conducting all those extra tests for a doctor’s office, emergency department or hospital can add up pretty quickly.

Of course this is not the case in every state, some have it worse than others. Many believe that one of the key drivers of America’s health care costs is the failure to reform medical malpractice, also known as tort reform.

Changes from an eyewitness’ perspective

Leonard Nicosia MD is a board certified OB GYN physician living in New Jersey who recently retired after 31 years of practicing medicine. Throughout his career Dr. Nicosia had a front row seat to this changing landscape of American health care.

“I saw the practice of medicine change dramatically over the 31 years I was practicing,” said Dr. Nicosia. “I saw changes happening not only in my own speciality, but colleagues of mine saw their specialities change even more dramatically.”

One of the biggest changes Dr. Nicosia said he experienced was the amount of time he spent with his patients in the hospital.

“Years ago when the family doctor had a patient in the hospital for a week they would go and do rounds in the morning then be in the office for the afternoon. Later they would review lab work for their patients. That was just part of the procedure, they got paid to the come to the hospital, but the patient had their doctor,” said Dr. Nicosia.

Now though the family doctor will very rarely make an appearance at the hospital to see you. Mostly this is a financial necessity simply because they are either not reimbursed at all, or are reimbursed very little by the insurance companies for making the trip. Any time spent out of the office is usually money lost.

Dr. Nicosia offered an example of how it used to work for an OB GYN physician with a pregnant patient. When a patient of his was in labor he would cancel his upcoming appointments for the day and head to the hospital to attend to her all the way up to and including delivery.

Now though because doctors are more hesitant to leave the office, Dr. Nicosia says it’s rare for an OB GYN to be there for the whole labor. Sometimes the OB GYN will coordinate with the attending Laborist physician to try and time their arrival at the hospital to make it just in time for delivery. But other times they will defer to the Laborist to complete the delivery and the patient who wanted their physician deliver them was unable to.

What does the future look like?

With all these changes taking place to the American health care system, newly minted physicians need to be not only savvy medically, but also business minded. Especially if they they plan on operating their own practice.

“When I started, doctors knew very little about the business side of their practice,” said Dr. Nicosia. “Now these young physicians need to be business orientated to survive. If you don’t play the game, and play it more as a business, then you won’t be in practice.”

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