Can private practice survive?



I ran into Peter the other day. We weren’t close back in high school 50 years ago – Peter was a jock and I wasn’t – but both of us ended up in medicine.

"How’s the radiology business?" I asked him.

"Two more years," he said. "I should be able to hang on."

"That bad?"

"We were taken over by the academic department of a big teaching hospital," Peter said.

"What’s the problem? They want you to publish papers?" I asked.

"They’re not crazy," he said. "They know what kind of papers we’d write. They just want to measure things."

"Measure what?"

"Anything they can," he said. "Productivity, quality. They micromanage everything. We’re not a private practice anymore. We don’t call our own shots."

You hear a lot of talk these days about whether private practice can survive. Judging by anecdotal chats with colleagues in other specialties, I’d say prospects are iffy. A lot of the future is already here.

"I’m going crazy," a local community rheumatologist told me. "There was just one other guy in town. The local hospital knocked on his door and said, ‘Either sell out and work for us on our terms, or you’ll never get another referral.’ So he just closed up and moved out of state."

"How about you?" I asked him. "Have they made you an offer you can’t refuse?"

"Not yet," he said.

Then I met an oncologist from my wife’s family. He is a couple of years younger than I am. "I never thought I’d be working harder than I ever did at my age," he said. "And earning less.

"But we just sold our practice. No choice, really. Reimbursements don’t cover the cost of chemo drugs, so we lose money on every patient we give them to. The hospital that’s buying us can bill for drugs at a higher rate. So I’ll work for them for 5 years, then I’m out."


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