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Thread: Is the Independent Doctor Disappearing?

  1. #1

    Is the Independent Doctor Disappearing?

    Is the Independent Doctor Disappearing?

    IT'S NO SECRET THAT over the past several years, America has been experiencing a seismic shift in the way health care is delivered. From government insurance mandates and changes to health insurance design to new reporting requirements, escalating costs and the rise of urgent care clinics, the health care picture has shifted dramatically. And it seems the independent family medicine practitioner is getting squeezed as a result.


    In many ways, physicians are feeling the same pressures that mom-and-pop stores on Main Street have already been through, with the influx of mega-corporate stores that took place over the past 40 years and changed the way Americans shop. These pressures are leading to burnout for some physicians, says Dr. Ripley Hollister, a family medicine doctor in private practice in Colorado Springs, Colorado, and a board member for the nonprofit physician advocacy group the Physicians Foundation. A 2016 survey conducted by the Physicians Foundation showed "about 50 percent of doctors are having symptoms of burnout on a daily basis," Hollister says.

    This increased burnout has resulted in part because of what Hollister calls the "intrusion of third parties into the patient-doctor relationship. We've seen in independent practice over the last few decades that there has been a definite shift in how physicians are able to relate to patients because of the growing intrusion of third parties," such as insurance companies or employers that can alter the way a doctor is able to practice. "I'm not necessarily defining intrusion as bad," Hollister adds, "but there's been this introduction of additional parties into the mix of the doctor-patient relationship that is exacerbated when physicians become employed [by a corporation or other third-party employer] and to some degree lessened when physicians remain independent."

    Nevertheless, a growing number of doctors are opting out of owning their own practices, especially in light of the fact that many will be able to make more money and have better support if they join a larger practice or hospital. This has led to health care experiencing a massive shift toward a "big-box" approach – independent doctors joining larger group-, corporate- or hospital-owned practices.


    A study released by the American Medical Association confirms what Girgis and Hollister have seen from their perspective on the front lines of primary care practice: The independent doctor is disappearing. The AMA's Physician Practice Benchmark Survey found that in 2016, fewer than half (47.1 percent) of all physicians who provide at least 20 hours of patient care per week owned their own practices. That's down about 6 percentage points from data collected in 2012. "Similarly, practice size also continued to increase although the shifts in size distribution were small. Sixty-one percent of physicians worked in practices with 10 or fewer physicians in 2012, but only 57.8 percent were in practices of that size in 2016," the AMA reports.

    These data have been corroborated by a 2016 report from consulting firm Accenture, which found that "the number of U.S. physicians in independent practice [which is defined as a doctor who owns a majority of his or her practice and has key decision-making rights] has dropped significantly in the last several years," falling from 57 percent in 2000 to a projected 33 percent in 2016.
    Short answer. Yes.

    Pete (wonders why anyone would want to be any kind of doctor any more, independent or otherwise)

  2. #2
    Database Error Put Master
    Jester's Avatar
    Join Date
    Aug 2007
    crap, I know this one!
    NYU now offers free training. Gives a hint about recruitment.

    Seriously, some fields of medicine have a "normal" salary range of 300-400 thousand. Know any other field where you cab genuinely expect a salary in that range?
    They speak in bulletpointese leftist nutjob drivel. It doesn't matter. Nothing is as great a motivator as the chance to truly be free.
    -Mr. Raceboy

  3. #3
    Quote Originally Posted by Jester View Post
    NYU now offers free training. Gives a hint about recruitment.

    Seriously, some fields of medicine have a "normal" salary range of 300-400 thousand. Know any other field where you cab genuinely expect a salary in that range?
    But if you have to give away ten years and $200k to get there, your return on investment is something like 20 years. Bad deal. Anything with an ROI over 5 years probably sucks.

    $1 million mistake: Becoming a doctor

    Worse, the cost of becoming a doctor has soared, with higher education expenses leaving the average newly minted physician with $166,750 in medical school debt, while average salaries are declining. Nearly one-third of doctors -- 28 percent - saw a cut in pay last year, according to NerdWallet's research.

    To be sure, pay is still high, with doctors accounting for the preponderance of six-figure positions in the country, according to government data. But it also takes between 11 and 14 years of higher education to become a physician. That means the typical doctor doesn't earn a full-time salary until 10 years after the typical college graduate starts making money.

    That lost decade of work costs a cool half-million dollars, if you assume this individual could have earned just $50,000 annually, and the typical medical school candidate is smart and successful enough to earn considerably more. Add in the time and cost it takes to pay off medical school debt and a dissatisfied physician may well consider pursuing medicine a $1 million mistake. (This assumes the average $166,750 medical school debt takes 30 years to repay at 7.5 percent interest -- a total cost of $419,738.)
    Pete (made a similarly poor decision becoming an attorney and only recently broke even)

  4. #4
    put-put Put Master
    Jared's Avatar
    Join Date
    Jul 2007
    Sitting in my corner
    I introduced a high school volunteer to one of the surgeons at my hospital, and when i brought up the subject, i said to the doctor, "he says he wants to be a surgeon." The doctor's retort was, "why, what's wrong with him?"

    Yes, doctors make loads of money, but they trade that for routinely working absurd hours until retirement age. That surgeon has been divorced twice, and works 60 to 80 hours a week, and he's close to sixty years old.
    "Whenever you find yourself on the side of the majority, it is time to pause and reflect." –Mark Twain


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