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Physician Independence Not Incompatible With Reform

Philip Betbeze, for HealthLeaders Media, January 27, 2012

As a result, many independent physicians are throwing up their hands about their ability to remain so in an environment that appears to actively discourage physician independence. These are the practices that are acquired on a daily basis by the nation's hospitals and health systems, whose leadership seems to often equate physician acquisition with physician alignment.

From the physician's point of view, the bottom line is, well, the bottom line. Businesswise, it's difficult, and arguably more stressful, to maintain your independence. There's a degree of safety in employment.

As an employed physician, your job and standard of living isn't quite as dependent on the whims of the federal government or the difficulties of contracting with commercial insurers. Then again, you can't make your own decisions.

So says Russell Libby, MD, the president-elect of the Virginia Medical Society and a frequent commentator on what I write in this space each week. He says giving up your independence as a physician is just that: giving up.

"I'm not sure what employment achieves other than consolidation" he says, arguing that consolidation doesn't necessarily achieve benefit to the community. "That doesn't mean there aren't examples of that, but in a partnership, community benefit is a consideration as it evolves. When you look to be acquired, it's because you're giving up."

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3 comments on "Physician Independence Not Incompatible With Reform"


Patrick Watterson (1/30/2012 at 12:49 PM)
As part of one of the few Physician/PA/NP owned practices in the Triad are, we are seeing many practices join hospitals. This is not always good for the community as the hospital needs admissions and ancillary services from these employed providers. Instead of a CT we can do in office for $700, the hospital is happy to do it and bill for $2500. One of the best things about our practice is we can change quickly where as larger practices/hospitals have to go to 8 committees to make a decision. Employment is not the cure for all that is wrong with health care.

bob (1/30/2012 at 9:21 AM)
Independence is no longer a viable option for the long run, but there are other ways to go besides employment by a hospital or any other organization. the best way is to form a real group practice organization, governed and managed by the members of the group. Such groups can contract with hospitals and health systems without losing control. Go group practice!

Nathan Kaufman (1/29/2012 at 10:32 AM)
Lack of scrutiny and Not being a cog in a wheel (a wheel that is hopefully led by physicians) has resulted in a health care system producing highly variable quality, abusive practices by a significant minority of providers, astronomically high costs, poor access and poorly coordinated care. Talk to the physicians Mayo or Virginia Mason about their impression of the highly fragmented independent physician model! Under an employment model you have to worry about how a bigger machine works.. not just the practice but the community's healthcare delivery system. And the scrutiny is coming regardless of if you are employed or not... tiered networks, value-based compensation for physicians etc. I wonder why Kaiser is one of the fastest growing health plans in the Fairfax area!!!!