Saturday, January 7, 2012

Reports Of Our Demise

I shuffled some papers on the desk to avoid looking into the hospital administrator's eyes. His lips curled into a half baked smirk as he talked. I marveled at the tailored suite and the crisp tie.

He was a business guy. And it didn't take long to ascertain that he saw me as an asset. I was a widget; an interchangeable part. If one physician wasn't on board, find another. I imagined that somewhere in his slick briefcase there was a list with each physician's name and two columns. Check marks were neatly penciled in to demarcate the doctor's status. Pens were never used because they were not erasable.

The majority of the conversation was like a Peanuts cartoon where most of the words sounded like distorted rubbish. Occasionally my ears would perk up as a phrase caught my attention.

Blah blah blah, blah blah ACO blah blah blah ICD-10. Blah blah blah blah healthcare reform blah blah ACA.


When are we going to stop talking of Armageddon? We treat private practice as the red headed step child, and not the predominant mode of physician organization. We huddle in the corner of dark alleys and wait for the boogey man that never comes.

And we jump ship the minute the going gets tough, and become employed physicians. It's what happened in the era of HMO's and it's whats happening now. The scramble to escape the unknown becomes more important then thinking about self interest.

We try to forget that we are staunchly independent professionals who don't like being told what to do. Certainly we can submerge our needs for a time, but eventually our true nature bursts forward. And when it does, we break through the chains of employed existence and venture out on our own.

It has happened in the past, and it will happen again


I have worked for hospital owned medical practices. They stand on the backs of their laboring assets. Physician sweat leads to profits that exsanguinate through administrative fluff and overblown salaries. Economies of scale give way to inconsistency and bloat.

The government is sadly mistaken if it thinks that ACA will lead to a tenable solution by placing the power and money in the hands of greedy hospital systems loaded with administrators and oozing with self interest.

You want to see who's running the tightest ship in the business? Find the little guy; the few physician practice that lives or dies by its own ingenuity. There are no unnecessary administrators, no burdensome policies, no political flotsam.

The consultants say that the ACA will end private practice. They say that ICD-10 and the new regulations will make small practice untenable.

I say let's look at history.

The reports of our demise are frequent and uncompromising.

They're also greatly exaggerated.

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