A recent thought-provoking article in the Fort Collins Coloradoan delves into the future of independent medical practices and the pros and cons of hospital mergers and “closed” healthcare systems like Kaiser Permanente (Kaiser opened for business in northern Colorado last fall) moving into the area. The article notes that the split between employed physicians and independent physicians used to be 40% and 60% (not sure how long ago that was) and that those numbers have now flipped: 60% of physicians are now employed by a hospital or other large medical group, with only 40% remaining independent.
There are a couple questions to be asked with this. Is this switch inevitable? Will almost all doctors be “employed” a decade or so from now? And is this an overall benefit for patients, doctors, and the cost of healthcare, or should we be working to try to retain as many independent medical practices as possible? I would say that the answers depend on who’s being asked.
Whenever there’s a paradigm shift like this, there is usually some nostalgia and “good old days” talk included with resistance to change. This is true of just about any industry and type of change. Some people take to change more readily than others (Jay had to drag me into the computer age – my resistance to change is thankfully balanced by how well he embraces it). I have no doubt that there is an element of this in the notion that physicians shifting from being independent to being employed is deleterious.
But there are also very valid reasons for questioning the movement of physicians towards employment by large medical groups. Roy Poses wrote an excellent article last month about a couple of physician groups who have brought lawsuits against their corporate hospital system bosses, alleging that profits were being put ahead of patient care and safety. These are extreme cases, where patient welfare was obviously not the primary concern – but presumably most large hospital systems and corporate medical groups are under a lot of pressure to grow revenues and profits, especially if they have shareholders. That can lead to corners being cut and doctors being compelled to provide care that is in the best interest of the corporation, even if that doesn’t completely line up with the best interests of the patients. Regardless of the severity of the situation, that’s a bad spot for a physician to be in, and an issue that needs to be addressed in every hospital system.
But there are definitely upsides for physicians and patients as physicians switch to being employed rather than independent. Electronic medical records simplify communication between doctors and eliminate the need for duplicate testing or long wait times to retrieve records. Large medical groups improve the odds that patients will be able to get all the care they need either under one roof (like the Kaiser models) or without having to search around too much – as more physicians become employed by a certain hospital system or provider group, that group’s medical expertise and specialty offerings grows. And there’s an economy of scale factor too: all of the billing and administrative work (which can be immense, especially if a provider works with numerous health insurance carriers) can be handled by one central office, freeing up the doctors to spend more of their time with patients and less of it on paperwork and billing issues. Doctors also cite work-life balance and not having to set up their own electronic medical records system as pros of working for someone else.
But some doctors prefer to hold onto their independent status, and that’s easy to understand too. The Coloradoan article notes that the major medical groups in northern Colorado have said that they are committed to working with doctors who remain independent, and that will help to keep at least some sort of balance between the number of doctors who are employed and the number who are independent. From a patient perspective, the take-away here is a reminder that every physician’s office is different. If you’re shopping for health insurance and/or a doctor, make sure you ask lots of questions before you buy a policy or receive care in a non-emergency situation. Find out whether your doctor is independent or employed, and ask questions to see how that situation could impact you: How much time will you get with the doctor? What’s the on-call situation in case you need care outside of regular business hours? How do referrals to specialists work? How does your health insurance policy handle out-of-network claims? How are medical records handled? Are prescriptions written using an electronic system? Have these discussions before you buy a health insurance policy and before you choose a doctor. You might find that you like a health insurance system like Kaiser with it’s numerous on-staff doctors, or maybe you prefer an independent doctor and a PPO-style health insurance plan. Whichever you choose, it’s better to know what you’re getting before you find yourself in need of medical care.