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Why is it a problem for physicians to be employed by a hospital instead of a private practice? Is this a problem, or just a trend? Surgical physician employment trends in 2019 and the healthcare practice managers’ challenges with surgeon employment in the United States. Surgeons are increasingly choosing the hospital or a surgical group and are becoming employees and not employers. This paper will examine the trend of why doctors in general and surgeons, in particular, are no longer opening private practices in the community. As a future healthcare management professional, an examination of the identified problems need to be researched and analyzed to have a clear understanding of the conventional conflict of independence versus employment. As healthcare management professionals we can be on both ends of the spectrum. Healthcare managers could be put in the position for hospitals as a recruiter for private physician services or conversion from employee physicians to private practice. It is imperative to understand the market for each position and have a solution to maximize patient satisfaction and retention within the healthcare organization. One of the reasons why I chose this topic is to expose some of the reasons. Data from the ever-changing healthcare industry shows that the establishment of private medical practices ten to twenty years ago for many doctors was standard. Currently, it seems that most physicians are becoming employees and I believe that this is by design from the industry leaders. I also intend to expose the new grooming methods of physicians by the education system. Surgical residents now have mandatory days off and workweek maximums. In earlier times, surgical residents worked hard and put in many hours for surgery rotations because they were going into private practice and had to be a master of their craft. Statistically, surgical residents are coming out of training and joining hospitals. We must reconnoiter these practices in healthcare.
Surgical Physician Employment Trends
Collectively in the United States, private practice for many doctors was an industry standard. Currently, it seems that most physicians are becoming employees. This research is intended to expose the new grooming methods of physicians by the education system. According to many current sources, surgical residents now have mandatory days off and workweek maximums. In earlier times, this was considered to be taboo. As a right of passage to be a surgeon or a surgical resident hard work and countless hours of surgery rotations was a badge of honor that was not bestowed until a thirty-six hour surgery or trauma case was achieved because they knew they were going into private practice and had to be a master of their craft and a teacher of the art of keeping the patient alive. Currently, surgical residents are coming out and joining hospital organizations instead of private practice. Why should we be concerned as potential patients or healthcare providers? One must analyze the indirect methods that are allowing hospitals and insurance companies to monopolize the healthcare industry. Indirectly hospitals are buying all of the private practice that are competition and hospitals are aligning with insurance companies to get better payments from insurance companies with the of collection doctors under them. As a strategy, the hospitals collectively have all of the primary care providers, and gastrointestinal doctors in the area, if all referrals stay in the hospital and not outsourced private practices end up being strangled into submission from insurance and hospital influences. In my opinion, as well as data collected, this may and can change the healthcare industry from capitalism to selective socialism.
As a healthcare management professional, this also boxes everyone in from being a partner or a freelance practice manager. In my opinion, this change will also control our market for the salary or percentages of medical practices within the industry. I hope that this trend will revert to physician independence and capitalism before it’s too late.
Fundamentally the commencement of the private medical practice liquidation has begun. An article by (UCLA, 2019) states.” Duty hours of a resident must be limited to 80 hours per week, averaged over four weeks, inclusive of all patient care activities, house clinical educational activities, clinical work from home, and all moonlighting practices.” Figuratively speaking theoretically this is a good way to improve continuity of care for the patient but is it best for the physician in training? Especially when these rules are applied to a surgeon in training with the assumed knowledge of surgical skills that only have a set time to complete life-saving training and must know what to do when the patient is dying on the operating room table. As we all may be future patients one day should we as a society be concerned? Who will the surgeon call when they are alone with a patient or multiple critical surgical patients at 2:00 am and scanty training? In my opinion, to change this critical training is a mistake and we may never experience the negative impact but someone will one day. An article by (Isaacs, S. L., Jellinek, P. S., & Ray, W. L., 2009) discusses the health of some physicians’ private practices. “The decline of physicians in independent practices is greater among medical specialists than among surgeons or primary care physicians. Data shows the low percentage of primary care practitioners in independent practices. This data also reflects the serious problems of overworked and underpaid primary care doctors and the issues they have faced for many years. The low or decreasing percentage of physicians in independent practice is not quite the same as others but is intertwined with, the decline of small physician practices (those with 10 or fewer physicians), whose numbers decreased by nearly 15% between 1996 and 2004, during which time the numbers of physician groups of all other sizes (except group- and staff-model health maintenance organizations) were increasing.
In the healthcare industry discussions among physicians have reached a peak of understanding of the awareness in their element. There are many reasons for the decline of private practices including but not limited to medical acquisitions by hospitals.” This method is now common for independent practices.This business technique is not new but it is driven in part by the renewed efforts of hospitals and other large organizations to acquire lucrative specialty practices that they believe has medical and status value. “At a fundamental level, third party payers’ aggressive efforts to reduce on ever-rising health care costs through managed care and other reimbursement controls appear to have been the significant driver.Independent physician practices are at a particular disadvantage in contract negotiations because antitrust provisions from bargaining collectively prohibit them consequently, they have little economic leverage.
Moreover, reimbursement rates have remained stagnant, even as practice costs have risen. As a result, many independent physicians have seen their incomes decline. This change has hit primary care physicians particularly hard since their income base is comparatively low. Reports from around the country suggest that this squeeze has led a growing number of physicians to give up an independent practice, driving them either into salaried positions in larger organizations or into early retirement. It may also be discouraging new physicians from entering independent practice. Along with these economic forces, demographic trends, most notably the increase in the proportion of women in medicine, have affected independent practice. Many women physicians, and increasingly men entering practice, prefer the relative financial stability of hospitals versus self-employment.”(Isaacs, S. L., Jellinek, P. S., & Ray, W. L., 2009). An article by (Harris, 2010)titled“More Doctors Giving Up Private Practices” further validates the reasoning for the employment stratagem utilized in the new healthcare contrivance. “With these systems, private insurers often have little negotiating power in setting rates and the Congressional health care legislation makes little provision for altering this dynamic. If anything, the legislation contains provisions including efforts to combine payments for certain kinds of medical care that may further speed the decline of the private-practice doctor and the growth of Big Medicine.”New concerns over medical errors and changes in government payments to doctors are driving a trend away from small private practices. Additionally, an even bigger push may be coming from electronic health record laws. The new computerized systems are expensive and time-consuming for doctors, and their substantial benefits to patient safety, quality of care, and system efficiency accrue almost entirely to large organizations, not small ones.
The economic stimulus plan Congress passed included $20 billion to spur the introduction of electronic health records. This was detrimental for older doctors, the change away from private practice can be wrenching, and they are often puzzled by younger doctors’ embrace of salaried positions.”(Harris, 2010). A physician interviewed by Harris by the name of Dr. Hughes delves into his experience of the new changes. He states “When I was young, you did not blink an eye at being on call all the time, going to the hospital, being up all night,” said Dr. Gordon Hughes, chairman of the board of trustees for the Indiana State Medical Association. “But the young people coming out of training now don’t want to do much call and don’t want the risk of buying into a practice, but they still want a good lifestyle and a big salary. You can’t have it both ways.”(Harris, 2010) In many ways, 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, helping avoid the kind of dangerous slip-ups that cost the lives of an estimated 100,000 people in this country each year. And yet, the decline of private practices may put an end to the kind of enduring and intimate relationships between patients and doctors that have long defined medicine. A patient who chooses a doctor in private practice is more likely to see that same doctor during each office visit than a patient who chooses a doctor employed by a health system.”(Hughes & Harris, 2010) The patient population at large has no idea of the changes in medicine and their impact on their care. A powerful statement byDr. Paul A. Ruggieri, a general surgeon in Fall River, MA, and author of a new book “The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry.” “A potential casualty of employment in a hospital system may be the ability to disagree with the organization openly. Will surgeons, as highly paid employees, be confident enough to speak up against hospital policies affecting patient care without worrying about corporate retaliation? Will employed surgeons be able to speak out against hospital cost-cutting measures that infringe on patient care without being labeled whistleblowers or troublemakers? Can they voice their displeasure without worrying about the security of their job? If you are branded “not a team player,” referrals may dry up. Or, you may suddenly be “asked” to take more emergency room call. You may also be asked to travel farther to see patients and generate surgical business in another town. You may be replaced. You could end up as a surgeon without a practice. If let go, you may discover that the clause in your contract prohibiting you from practicing within the area drives you out of town.” With these potential issues on the shoulders of doctors will our quality of care improve in general as patients I think we all should be worried about these issues. Dr. Paul A. Ruggieri also brings up additional points and flaws that could be applied at any point during employment.
He also questions other employment challenges, “Will employed surgeons be able to openly highlight waste and fraud without fear of losing their jobs? As highly paid employees, surgeons risk much if they criticize the organization that employs them, even when the intent is improved patient care. Knowing the economic stakes of speaking against the corporate team, I suspect many may choose to be silent. Dr. Paul A. Ruggeri mentions that “Now that more surgeons are giving up their independence and joining the ranks of the employed, will they have the ability to unionize?” It is a proven fact that historically, “surgeons have been an extremely independent breed of a physician, perhaps too independent for their own good. For whatever reasons doctor’s egos, stubbornness, and a view of themselves as well above the average working professional that have money, and competitive edge surgeons have never been able to use their political muscle to influence hospital behavior. Instead of being able to unionize freely decades ago, surgeons may now be forced to in order to survive.”(Hughes & Harris, 2010)
Conclusion and Future Study
In conclusion,Why is it a problem for physicians to be employed by a hospital instead of a private practice? Is this a problem, or just a trend? I am in agreeance with Dr. Hughes. The writing is on the wall for all surgeons. The era of the independent surgeon is drawing to a close. Surgeons whose economic and surgical lives are directly influenced by the corporate entities that employ them will care for more and more patients. What, if any, impacts will this dramatic shift in the surgeon’s professional world have on the access and quality of surgery practiced in the future? It remains to be seen.”(Hughes & Harris, 2010)The force of the healthcare industry sitting powers are in charge and independence is being removed from this sacred profession and it is being turned into a job and no longer a practice of the healer with an oath. A statement by a physician in an article by (Klasko, 2017) “As “older” members of the profession, our responsibility is to stop telling kids not to be doctors. Instead, we must help create a healthcare workforce that selects and educates professionals who embrace change. We need physicians who can advance an academic and entrepreneurial model, who understand that creativity is key to our success, and who can be leaders as opposed to followers of healthcare transformation.” This paper was a direct segment of my life as a Surgeons First Assistant who has felt and seen this takes place to a surgeon who I worked with for 14 years of his 18 year practice this a real event taking place in medicine and there is no one in their corner fighting for freedom to be who they were meant to be and that is your doctor, not the hospital’s doctor.
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- Charles, A. G. (2013, April 01). The Employed Surgeon: A Changing Professional Paradigm. Retrieved August 5, 2019, from https://jamanetwork.com/journals/jamasurgery/article-abstract/1485559
- Duty Hours & Record Keeping. (n.d.). Retrieved August 8, 2019, from http://surgery.ucla.edu/duty-hours
- Harris, G. (2010, March 25). More Doctors Giving Up Private Practices. Retrieved from https://www.nytimes.com/2010/03/26/health/policy/26docs.html
- Isaacs, S. L., Jellinek, P. S., & Ray, W. L. (2009). The Independent Physician — Going, Going . . . New England Journal of Medicine, 360(7),
- The solo general surgeon is a dying breed. What is next? Retrieved from http://skepticalscalpel.blogspot.com/2014/08/the-solo-general-surgeon-dying-breed.html
- Unti, J. A. (2019, January 01). The Solo Surgeon in the Modern Hospital. Retrieved August 5, 2019, from https://link.springer.com/chapter/10.1007/978-3-030-01394-3_30
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