My own family physician is my age and is also considering retirement. His practice was bought out two years ago by the local hospital corporation. We no longer are visited in an inpatient hospital situation by our family doctor after being processed by admissions. We are treated by a "hospitalist". This is a physician employed by the healthcare institution. They work shifts just like the nurses and in some instances will cover the entire institution in off hours. I do miss the warm smile of the physician I have know since I was thirty-five. What has changed this climate? Most of it comes to regulations and finances resulting from the regulations. I began to search the media for information on this trend.
I found that the implementation of the electronic medical record, extra personnel to service the claims for payment, and slow payment from government healthcare such as Medicare facilitate a few of the changes in this landscape. Practices that do not switch to the new electronic medical records required by the government are docked 2% in payments. "The cost for purchasing, implementing, and training staff for the new
federal software can run $40,000 with additional yearly maintenance costs
thereafter. The new software is not designed to integrate with other systems used by
medical practices.(Breitbart-California, 2014)." "Doctors report that electronic systems have cut productivity
by about 25 percent. (McSwain, 2014)." Many of my friends report their physicians now spend as much time in front of the screen as focused on them. There is still ICD-10 to implement. It is a coding system required for payment. It is to be implemented late this year. That will require more training and personnel. Many physicians are hiring "scribes". That is a person that follows them around with the laptop to facilitate much of this information into the system. That is another person that must be added to the payroll. More details are available on the links below.
What I did decided is that physicians financially have little choice but join large practices or be bought by conglomerates to spread the costs around for the implementation of our cumbersome regulations.
There is a trend for concierge services. That is where one pays upfront and does not file on insurance or medicare. The costs are often posted in the waiting room and are considerably less than filing insurance. I recently was in Florida and experienced some irritation in my eye. I stopped by a concierge practice. It was a walk-in situation with the costs for all procedures posted in the lobby. My care was good. It was quick. The physician made eye contact with me. I even received a follow-up call the next day to check on my progress. It seems that was what it was like in the 1950's when my mother would take me to the doctor. No one had insurance other than for hospital stays.
The doctor's office was a one-stop shop. He even dispensed the medications under most instances. You did have to have the money to pay.
Obamacare Killing Off Small Doctor Practices. (2014) retrieved from
Swain, D. (2014). Obamacare Deals Blow to One Doctor Medicine. retrieved from
http://www.utsandiego.com/news/2014/Apr/26/obamacare-deals-blow-to-one-doctor-medicine/3/?#article-copy
