Tuesday, June 28, 2011

Doctors Adapting and Trying to Survive

Close your eyes and think of a doctor.  Do you see a Marcus Welby type? A middle aged, smiling and friendly gentleman who makes house calls?   Is his cozy office staffed by a long time nurse and receptionist who knows you well and handles everything for you?  If that is what you envision, either you haven't been to the doctor lately or you are in a concierge practice where you pay a large upfront fee for this type of practice.  Whether you live in a big city or a rural community, small practices are dissolving as fast as Alka Selzer.  Hospitals and health systems are recruiting the physicians, buying their assets (unfortunately not worth much) and running the offices.

Doctors are leaving small practices and going into the protection of larger groups and corporations because of economic changes that have made it harder and harder for small practices  to survive.  The need for computer systems,  increasing regulations, insurance consolidation, skyrocketing overhead and salaries coupled with low reimbursement has signaled the extinction of the Marcus Welby practice.  Some older doctors are finishing out their years and will shutter their offices when they retire.  Young to middle age physicians are selling out to large groups and new physicians would never even consider this type of practice.  They are looking for an employed model from the outset.

Every doctor (I know) who is currently in private practice  is weighing his/her options for survival.  Doctors are learning and performing new services for which patients will pay out of pocket.  Botox, anti-aging therapy, weight loss, retainer services, home visits, cosmetic services, acupuncture, prolotherapy and medical directorships are all outside of the Medicare/Insurance payment world.   Physicians are surviving with these creative revenue producers and doing the best that they can.

The world of medicine has changed. Health Care Reform is rewarding integrated care and this will be good for patients and quality.  Doctors need the capital that large systems can provide to put in the electronic health record (ehr) and support its use.  They need the protection of health systems to pay their overhead and ensure that employees are trained.   It is unlikely that large organizations can run lean offices but they can provide standards that improve care and patient experience.  I am in favor of practice standards and a continuum of care between primary care, specialists and the hospital.

Marcus Welby practiced in a silo.  He could remove your appendix, deliver your baby, deal with your wayward teenager and help grandma die peacefully.  The truth of the matter was he had no technology except hand-holding and about 10 medications to offer.  

This is 2011 and things have changed.

10 comments:

Anonymous said...

A bittersweet development. I remember my doctor in upstate NY who was the village doctor. Everyone went to see Dr. Redmond. Now, my very young, female doctor is in a medical practice that I like a lot. We've had the same pediatrician since our twins were born 15 years ago, and our son 12 years ago. She is wonderful, attentive, has a GREAT advice nurse who is a great resource and filter on when we should be seen or not. My primary care doctor, hmmm, not so great. She is well-meaning, but I think, over the top with wanting to do tests. As a patient I know tests are a moneymaker, so I'm not completely in synch or trusting of this process. What is your experience and thoughts on all the changes in medical care? Thanks for thoughtful post.

Anonymous said...

I miss Dr. Welby. I love my primary care MD and my specialists but it is rare that I don't detect stress, mental preoccupation, or a bit of hurriedness. I am actually seeing continuity of care with hospitalized patients. It is good to see.

Anonymous said...

With regard to anonymous who was concerned about her well meaning primary care MD who has a propensity to do tests: some MDs have been trained that way. Some are now being trained to do more of a physical exam with incisive questions. Some are just thorough and some are concerned with litigation. Me, I'd rather be safe than sorry.

Grow Light said...

Most surveys suggest that the current generation of physicians coming out of residency is more interested in work-life balance than previous generations. Physicians are ultimately responsible for their patients' health.

Michael Kirsch, M.D. said...

How many of your readers actually know who Marcus Welby is? Is he known only to aging fossils like us?

Toni Brayer, MD said...

MichaelKirsch, M.D.: You may be right. Even further back was Young Dr. Kildare. The other commenters seemed to know who he was. Maybe we should allow Anon but ask them to state their ages. haha

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