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Fighting the Tide Against Independent Physicians

Philip Betbeze, for HealthLeaders Media, November 11, 2011

They have huge debt, generally, and they're not sure when they'll ever be financially whole again, given the expected clampdown on their future earning potential.

In an excellent story in the forthcoming November issue of HealthLeaders magazine about the realities driving physician employment at hospitals, my colleague Karen Minich-Pourshadi says that the percentage of truly independent physicians, according to the American Medical Association, has been declining by 2% a year and is projected to decline by as much as 5% annually by 2013.

I can empathize that it's a dark landscape for some.

At least one relatively deep-pocketed organization is doing the best it can to hold back the tide not only of doctor departures from the field of medicine, but also departures for employment in big institutions.

"Because bigger is not always better," says Lou Goodman, president of the Physicians Foundation, a nonprofit grant-making entity that was formed with a $115 million endowment. The endowment came from a group of physician societies who won about $1.5 billion in retrospective and prospective relief resulting from a class action suit in 2003 against several major insurance companies.

Physicians alleged, successfully, that the companies were using a hidden system (colloquially called a black box) to deny reimbursements to which physicians were entitled under their contracts with the insurers.

The foundation has awarded about $28 million in grants since its founding, and usually funds research and ventures that are in the business of keeping physicians who want to be independent.

"All the incentives are arrayed against it," he says. "We're collecting information, through our medical practice task force, with a survey of young physician needs. They're not seeing a lot of alternatives to employment."

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1 comments on "Fighting the Tide Against Independent Physicians"


Arun K. Potdar (11/15/2011 at 8:50 PM)
I am glad to see that you have brought this subject in the forefront of all the discussions going on in the US in health care reform platform. I spent my working life in the various aspect of the American Health Care Systems starting with regulatory bodies and ending in the executive management of Medical Campus. Your article is not only on the mark it is an eye opener for the new physicians. I have been studying and following the reform movement in health care and I want to say that; a physician employee is the worst employee you can have. I worked for a staff model HMO and what happened to these noble professionals is appalling to narrate here. Yes there is a way for physicians to remain independent but they need to be entrepreneurial non only in practice but also in the idiosyncrasies' No longer you have the advantage of prevailing and customary charge based reimbursements and that is what RVS based fee schedules are. A new physician entering in the market is by default well verse in modern technology in handling electronic communications and for such an individual operating under IT dominated decision support systems is a that proverbial, "piece of cake" and that is what we are looking at in the twentieth century Medicine. The opportunity for the new physicians to be innovative and proactive are enormous' Feds are funding it. My own alternative to Hospital based or worst; Managed Care owned Physicians is to set up an MSO; albeit a bad concept of eighties but an organization concept that can be adopted to meet the challenges of tomorrows health care with physicians directing it. I developed one model that will give the physicians the freedom they must have and the reward they deserve while reducing this dominance of the Third Party Payers (TPP) organizations on the care of patients. No longer a Hospital CFO will discharge a patient as a New Yorker Magazine's cartoon depicted it in early eighties .