The region of Cleveland and northeast Ohio is not hospitable to doctors in private practice. I should know. I'm one of them.
Private practice is fading as health care reform suffocates it by design. When this occurs, the public will have lost physicians who, in my view, have practiced patient advocacy and service at a higher level than our employed counterparts.
Keep in mind that the first half of my professional career was spent as an employed physician and the latter half as a private practitioner. So, I know the advantages and drawbacks of each model first hand. Of course, there are employed physicians who are outstanding doctors and private practitioners who are not, but I maintain that a physician who owns his business has a stronger incentive to provide excellent service to patients and to referring physicians. This just makes sense.
Don't we find that when we shop or dine out or stay at a Bed and Breakfast that there is a different level of service from those who own these businesses? If a store closes at 5:00 p.m. and you arrive at the locked door at 5:05, would your chances of gaining entry inside be greater if the boss were there rather than an employee? Get the point?
I recognize and have expressed in this blog that there are advantages to the employed physician model, which eliminates and reduces conflicts of interest that confront those of us who practice in the private arena. However, doctors on salary and the institutions that employ them face their own unique conflicts and challenges that can interfere with their healing mission. Fee-for-service medicine leads to over-utilization while models that restrain costs may restrict care, access and service to patients.
One service that our small gastroenterology practice offers is rapid access for patients who need or desire an expeditious appointment. This is tough for sprawling and expansive group practices, as we have in our neighborhood, to duplicate. Yet they try. The big dog medical institution in town is now advertising that they guarantee a same-day appointment to any patient who desires it. Sounds good so far. I wondered how they could pull this off since it's a vexing task for me even to reach these docs on the phone, let alone try to arrange a timely appointment for one of my patients.
Here's the sleight-of-hand. Sure, the institution will grant the patient an appointment, but it's not with his doctor and may even be across town in a satellite location. Is this what most of us have in mind for a same day appointment? While it's a tricky marketing ploy, it's a poor play at customer service. These patients would do better to present to a local urgent care, which offers a same day visit with a doctor who is likely less than 10 minutes away.
Years from now, when we are all enjoying Cadillac care at Chevrolet prices, where will I be? Private practice will be long gone, but my skills will still be useful. I'm hoping I can land a position as a docent in the fee-for-service wing in the Museum of Medical History. I'll be paid on salary, of course, like doctors will be everywhere.
This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.