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Doctors Work to Balance Business of Medicine with Patient Care

John Commins, for HealthLeaders Media, January 11, 2010

Believe it or not, there are some physicians out there who only want to practice medicine, the noble profession to which they've dedicated their entire lives.

For some reason, claims coding updates, haggling with insurance companies, monitoring the new walk-in clinic across the street, recruiting new partners to the practice, and developing relationships with referring physicians don't interest them.

Depending upon who's talking, these medicine-only physicians represent either a dying breed or a growing trend.

David R. Neiblum, MD, says these single-hat physicians are disappearing. "We're probably seeing it less so than in the past, where people used to go into practice and not worry about anything except seeing patients and doing clinical activities," says Neiblum, the managing partner at West Chester Gastrointestinal Group, an eight-physician practice in West Chester, PA.

"Now, if you are an owner or a partner in a practice, the business part of it becomes large depending upon your role in it," he says. "So much has changed in healthcare with reimbursement issues and having to worry about increased costs and decreased reimbursement. There is much more of a focus on what we are allowed to do, how to code properly, how to stay in compliance with Medicare regulations, and so on. There is so much more bureaucracy and governmental intrusion and rules that we have to be cognizant about, not just practicing and winging it. You see a patient and you have to know 'are you coding a three-level office visit or a four, and if you code a four can you prove you did that much work?' "

Kenneth T. Hertz, a senior consultant with Alexandria, LA–based MGMA Health Care Consulting Group, is in the other camp, claiming that younger doctors are more inclined to shirk their business duties.

"One of the things we are finding is that a lot of the young docs coming out of school want to go into practice and do one thing: practice," he says. "They don't want to deal with the business side. They don't want to deal with governance issues. They don't want to deal with any of those issues. So, what is happening in some of the practices we are working with, the senior docs are asking ‘what can we do to get the younger docs to get interested in the business side of the practice, the things that need to be done to keep the practice going?'"

To some extent, Hertz says the negligence starts in medical schools. "The business side is something that is simply not talked about in medical school," he says. "In medical school, you 'learn how to be a doctor.' The issues related to running a practice, to how do you code and document properly, to how do you deal with personnel issues, are not talked about."

Because physicians make money when they're practicing their highly skilled profession, it's understandable if they don't want to waste time on less-profitable distractions. But, Hertz says, physicians in private practice have to accept that they are businessmen as well as healing professionals, and that both the clinical and business sides of the practice come with important responsibilities.

"There is the notion of the more time you spend practicing, the more money you make, sure," he says. "But as a business owner, you have certain responsibilities. In that sense, running and owning a medical practice if you are in private practice is really no different than owning the UPS store."

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