Question of the Week: Physician Independence

I would like to have a discussion.  Please leave comments here but also check Facebook for those comments left there.  This blog really couldn’t be made into a poll because it’s not that simple.  Here goes:

Do you think there is a chance doctors can unhinge themselves from being employed by hospitals?

  • Would that be a good thing?
  • Could they do it without billing insurance companies?  An example would be DPC for primary care.  Specialists may never be able to have a membership model but could offer cash price ONLY and screw the insurers.  Is this possible?
  • Do you have any other ways to create physician independence and control?  Unionize?

(The image is me from years ago for the cover of the now defunct Placebo Journal)

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  9 comments for “Question of the Week: Physician Independence

  1. Arnold Wolf
    August 11, 2018 at 3:18 pm

    Private practice and small group practices are a target of the politicians to bring to an end. With all the new EMR rules like MACRA, MIPS, new regulations etc. with short patient visits, small practices will be a thing of the past. In the future, if a young person selects medicine as a profession, they will be forced out of business with lower, lower and lower fees. Only those who become employed by large hospital groups or private corporate medical groups, a salary will be the answer with all the government violation of HIPPA laws, will be feasible.

    If you go to a supermarket, clothing store, building contractor and gives you a price for their goods or services. Tell them that the US government only allows 1/3 the costs asked. How long would any company or business stay in business?

    Compare and contrast healthcare with rising insurance rates and rising medications cost factor which is paid for in hundreds of thousands of dollars spent daily and monthly in the form of lobbyists. The AMA doctors see no patients and pay no lobbying payola to the politicians who control socialist policies.

  2. JRDO
    August 8, 2018 at 3:51 pm

    I am a PCP in a 2-physician private office where we see patients for 36 hours/week. I use a hospitalist so that I don’t have in-patient responsibilities. I take time-off when I want to without having to ask permission. I don’t have a boss to suck up to for performance evaluations. My income is adequate but I would like more. In short, other than the administrative burdens my professional life is good. So, yes, I think there is a chance more doctors can unhinge themselves from being employed by hospitals. I understand researchers and educators being employed in academic settings, but full-time clinicians can and should be in private practice.

    As a separate rant on some employed physicians, any physician who has traded in their stethoscope for a business suit or has gone to work for insurance companies (especially prior authorization “medical directors”) are contemptible in my opinion.

    • Frank Rubino
      August 8, 2018 at 4:41 pm

      Yes!

    • RSW
      August 8, 2018 at 4:55 pm

      My situation is very similar.

      Paper charts, no quality measures/P4P, non-par cash at time of service for most Medicare all make the finances quite comfortable.

      Hope to practice until I’m 80.

  3. Jennifer Hollywood
    August 8, 2018 at 10:21 am

    I do believe that doctor’s could leave the employment of hospitals but it would require a total reprogramming of the way the public and politics and government and physicians look at and coordinate/manage health care. We should have open and easy access to community services (nutrition classes, social work support, therapy and counselling, nurse follow up after admissions, etc) for our patients without undue burdens placed upon us for referring to said services (ie-pages of orders to sign). Presently things are so disconnected and there is so much red tape that the system gets in its own way. We would have to remove all the mandatory pay for performance and other reporting programs, which just cost time and provide no benefit. We would have to change the way that physicians look at things. No more 15 minute appointments. No more evaluate and simply refer to the specialist by primary care. No more unnecessary testing because we can – plus it pays more (such as physicals with excessive over-testing or cardiologists that order every test that they own). Specialists should refer patients back to primary care after consulting as they used to, now they just try to keep them forever. Patients need to actually participate in their health by making efforts to eat well, exercise, and get plenty of sleep. Employers need to let their employees take off work to see their doctors, without penalty. It’s a systemic and societal issue.

  4. PW
    August 8, 2018 at 9:08 am

    The only way for doctors to be able to treat patients the way they should be treated is to free themselves from the oppression of the government and insurance companies.
    To quote William Wallace from Braveheart at his final gasp “Freeeedoooom!”

    • PW
      August 8, 2018 at 9:10 am
  5. Martha Oreilly
    August 8, 2018 at 8:12 am

    The worst thing that happened to medicine is loss of physician autonomy and the overall death of private practice. DPC restores that autonomy.

  6. Fred powell
    August 8, 2018 at 7:32 am

    I always heard one has to give Medicare the lowest price. Might not be true. B/c I have bcbs contracts for less than Medicare’s fee sched. I always that that would get in the way of lower cash pricing.

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