Fwd: qotd: Why are physicians becoming hospital employees?

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-------- Original Message --------
Subject: qotd: Why are physicians becoming hospital employees?
Date: Mon, 17 Feb 2014 09:25:36 -0800
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



The New York Times
February 13, 2014
Apprehensive, Many Doctors Shift to Jobs With Salaries
By Elisabeth Rosenthal

American physicians, worried about changes in the health care market,
are streaming into salaried jobs with hospitals.

Last year, 64 percent of job offers filled through Merritt Hawkins, one
of the nation's leading physician placement firms, involved hospital
employment, compared with only 11 percent in 2004.

Today, about 60 percent of family doctors and pediatricians, 50 percent
of surgeons and 25 percent of surgical subspecialists — such as
ophthalmologists and ear, nose and throat surgeons — are employees
rather than independent, according to the American Medical Association.

Many of the new salaried arrangements have evolved from hospitals
looking for new revenues.

Health economists are nearly unanimous that the United States should
move away from fee-for-service payments to doctors, the traditional
system where private physicians are paid for each procedure and test,
because it drives up the nation's $2.7 trillion health care bill by
rewarding overuse. But experts caution that the change from private
practice to salaried jobs may not yield better or cheaper care for patients.

"In many places, the trend will almost certainly lead to more expensive
care in the short run," said Robert Mechanic, an economist who studies
health care at Brandeis University's Heller School for Social Policy and
Management.

Dr. Joel Jacowitz, a cardiologist in New Jersey, and his 20 or so
partners decided to sell their private practice to a hospital.

Dr. Jacowitz said that the economics drove the choice and that the only
other option would have been to bring in more revenue by practicing bad
medicine — ordering more heart tests on patients who did not need them
or charging exorbitant rates to people with private insurance.

"Some people are operators and give the rest of us a bad name," he said,
adding that he had changed his opinion about America's fee-for-service
health care system. "I'm fed up — I want a single-payer system."

http://www.nytimes.com/2014/02/14/us/salaried-doctors-may-not-lead-to-cheaper-health-care.html?hp


Comment: Follow the money. Hospitals consolidate to increase market
power, moving more patients into higher priced hospital outpatient
services. Doctors have joined hospitals because "economics drove the
choice." Current national policies encourage physicians and hospitals to
organize in order to provide "accountability," but this oligopolistic
power grab results in "accountability" that only their chief financial
officers would admire, certainly not the people who pay the medical bills.

Under a well designed single payer system, excess spending would
diminish by improving pricing and by reducing incentives to use
worthless or harmful health care services. Many physicians have grown
weary of having to attend to the business side of their practices when
what they really want is simply to take care of their patients.

More and more physicians will be echoing the words of Dr. Jacowitz, "I'm
fed up — I want a single-payer system." When the patients start
repeating those words, the politicians will have to follow.