Blog | Thursday, April 3, 2014

Can private practice survive?


Just read another article forecasting the demise of private practice, which is the model I practice in. We certainly feel the squeeze here in Cleveland, where our small gastroenterology (GI) practice is suffering from some breathlessness as surrounding health care institutions suck up oxygen in the community.

Now, being deprived of oxygen isn’t necessarily fatal. Many patients suffer from diseases that result in low oxygen levels in their blood. Folks who live at high altitudes don’t have the same concentration of oxygen available as do those who reside at sea level. Yet, they live active lives.

How do these folks survive? Do they have lessons for my GI practice?

Here are some options that help individuals with low oxygen levels breathe easier.
• Receive supplemental oxygen using an oxygen tank. No analogous solution for my medical practice here. For us, the “oxygen level” can’t be artificially increased.
• Reduce activity level to minimize oxygen requirement. This is why folks with respiratory conditions tend to remain sedentary so they can function at a lower oxygen level. Not sure if there’s a lesson here for our practice. Do we move more slowly in the office? Do we see fewer patients? If we doctors used oxygen tanks, would this inject more vitality into the practice?
• Attack the root cause of the oxygen assault. If the cause of a patient’s low oxygen is pneumonia, then prescribe the right antibiotic to reverse the injury. If the doctors in our practice attacked the proximate cause of our oxygen deprivation, we could go to jail.
• Train at a high altitude locale for athletic competition in the lowlands. Marathoners seek out high altitude training courses to build endurance in preparation for the big race down below. Perhaps, we should move our practice to high altitude Colorado for a year. After doing colonoscopies there for a year, imagine the increase in our performance when we returned to Cleveland? I will place this on the agenda of our upcoming practice meeting.

Great choices for us. Breathe less, do less or move.

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.