Tag Archives: 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?

Independence and Autonomy

With the approach of the 4th of July, I have had “independence” on my mind. In my professional role, I always have “autonomy” on my mind, since it is often at the top of the list of things that doctors care deeply about, and I have been kicking around how the two relate to one another.

Webster’s (OK, the on-line Merriam-Webster dictionary) defines “independence” as “freedom from outside control or support” and offers up “self-sufficiency” and “self-reliance” as synonyms. “Autonomy” is defined as “the quality or state of being self-governing” and suggests “self-determination” among the synonyms.

Continue reading Independence and Autonomy

Looking for the Pony

There is an old gag about an intensely optimistic child whose bright outlook on life is so irrepressible that when he is presented with a room full of manure for Christmas, he screams with delight, convinced that there “must be pony in there someplace.” Continue reading Looking for the Pony