Category Archives: Physician Practice

Is this about Doctors or Patients?

A recent story in Crain’s New York Business cited the difficulty small independent medical practices face coping “with declining reimbursement rates from insurers, rising overhead costs and a torrent of new regulations that have come into play in recent years.” According to the article, only 26% of NY State physicians now own their own practice, compared with national rates of physician ownership of 76% thirty years ago. Honestly, I was not surprised by the numbers. Consolidation of independent medical practices into larger organizations is old news, and it is no secret that the drivers include those mentioned.

I was, however, struck by the subsequent letter to the editor by Malcolm Reid, the president of the Medical Society of the State of New York. In it, Dr. Reid states: “Physicians should have a fair choice of practice setting to deliver care to patients, whether that is in a large health system, large medical group or within a smaller medical practice,” and goes on to say that “Many physicians enjoy independent practice because of the personal attention that can be directed to their patients without external interference.”

I am sure they do, but honestly, why should we expect the government or the public to assure that physicians have a “fair” choice? To put it bluntly, Reid (and the rest of us) should get over the idea that the organization of care should revolve around what’s good for doctors. He makes it quite clear that he is not advocating that “fair choice of practice setting” is about patients, since he concedes that effective patient-physician relationships can be maintained in a variety of practice and employment arrangements. Rather, he is saying that doctors should have the right to practice in independent practices because, well, that’s how they like to practice.

To be clear – and before the pitchforks come out – I am NOT saying that independent practice is bad, and I am NOT saying that I don’t care about how physicians feel about their practice arrangements. What I am saying is that if an independent practice is worth preserving, then the case for it has to be made on the basis of what it provides to the patients we serve, and not on the basis of what it provides to the doctors who care for them.

What do you think? Continue reading Is this about Doctors or Patients?

Burnout

Physician burnout has received a lot of well-deserved attention lately. Characterized by emotional exhaustion and professional frustration, it has been tied to array of bad outcomes, from physician suicide to poor patient outcomes. Organizations are waking up to the need to measure its prevalence and ameliorate its impact.

There seem to be two broad schools of thought about the causes – and by extension, the fixes – of physician burnout.

The first is focused on the inner life of the physician. Yes, the demands of medical practice are high, but if doctors were a little more “zen” about things, then life would be better for them and the people around them, including their patients. There is now a substantial cottage industry peddling retreats, wellness classes, yoga and more to help physicians find inner peace in our tumultuous times.

The second school of thought focuses on the externalities of physician practice. Increasing demands for productivity, economic stress, loss of control over scheduling, and higher “hassle-factors” associated with EMRs and regulations have made medical practice harder and less rewarding. Burnout is just the natural reaction of sane, well-adjusted, intelligent people put into an insane environment.

Continue reading Burnout