Independent physician practices have been under attack for decades, with government using its payment and regulatory powers to exert control. Today, more and more physicians are being forced to sell their practices to hospitals or join mega-practice groups to survive. Others sadly close shop.
A 2020 survey by The Physicians Foundation found that 12% of all U.S. doctors either closed their offices during the pandemic or planned to do so within the year.
Devorah Goldman of the Ethics and Public Policy Center explained last week in The Wall Street Journal that “consolidation is wiping out private practices and making medical care costlier and worse.” In “The Doctor’s Office Becomes an Assembly Line,” she reports that in 1983, more than 75% of physicians owned their own practices; by 2018, the number dropped to 46%.
A slew of letters to the editor (“What Ever Happened to ‘Patient First’?) responded to Devorah’s article, with complaints that the doctor’s true customers have become government, insurance companies and hospital systems.
“I am one of those independent private practitioners mentioned in Ms. Goldman’s article who will be shutting down my practice,” wrote Dr. Marc Rosenblatt of New York. “For 30 years, I accepted all insurances, saw patients the same day if need be, treated some for free and personally kept aware of every aspect of their care.
“But Medicare threatens me with 9% cuts for not compiling data for the system, the insurers hire private companies to demand refunds on payments they made to me years ago, and I recently received a check for $280 for performing a difficult cataract surgery” which doesn’t even cover staff costs.
Alan Blum of New York spoke for patients: “Many older doctors practice medicine because they enjoy it. But they don’t enjoy having to see a certain number of patients an hour, they don’t adapt easily to the new system, and when pushed they simply retire. We’re losing all that knowledge and experience, right when we boomers are aging and need knowledgeable doctors.”
And Blum describes the all-too-familiar experience of “what you have to go through to speak to your doctor with these new medical groups. First, you are told to call 911 if it’s an emergency. Then, you get a whole speech about Covid. Next, you are told, ‘We are experiencing unusually high call volumes,’ and get put on hold. After endless repeated babble and noise that passes for music to some, you finally get the phone tree…”
Hugely consequential decisions are being made in Congress, by the Biden administration, and before the U.S. Supreme Court about who really will control medical decisions in the future. Hippocrates once again points us in the right direction: focus on the doctor-patient relationship.
The happiest physicians I know are those who opt for true private practice with Direct Primary Care practices. Here’s a good paper from Heritage, co-authored by leading DPC physician Dr. Lee Gross, on how it works. These doctors live the Hippocratic Oath, spending their time focusing on patients rather than computer screens to answer to bureaucratic masters. We must preserve and protect the doctor-patient relationship and, as we begin 2022, the Galen Institute remains committed to that central goal. Our Health Policy Consensus Group’s Health Care Choices 20/20 proposal points the way.