Doctors and their Practices

After years of practicing neurosurgery within small, single specialty practices, I recently joined a multispecialty group as their first (and only) neurosurgeon.  The transformation for me has been stunning and immediate.  Of course, I was very fortunate that there was a high quality, doctor owned/run group in my community so I now have the best of the best.  The NY Times recently featured an article on this phenomena pointing out the dramatic shift nationwide from doctors in private practices to doctors employed by hospitals and large health care groups-now only half of all physicians are in "traditional private practices. From my experience I would say:

• Multispecialty groups do have the ability to provide more seamless, comprehensive care for patients-adding to efficiency and quality BUT this is not a given, as with any system, the devil is in the details (i could already give countless examples where patient care as dramatically benefitted in my group experience, perhaps a later post).
• Multispecialty groups allow doctors to be doctors and significantly free from administrative responsibilities BUT beware the groups run exclusively by business types, they won't understand enough about medical practice and how it differs, say, from selling knives.
• Multispecialty groups allow FAIR negotiations with insurance companies leading to reasonable reimbursement for physicians and greater access for patients (doctors can be in-network if fairly compensated).  The NY Times points out that this will raise the cost of healthcare! Perhaps but perhaps it should reduce the profits of insurance companies-after all, we pay our premiums for HEALTHCARE, ie doctors, nurses, hospitals, NOT insurance CEOs!
• Their are many potential problems: groups can get too big, hospitals don't really know how to run doctor's practices and are notoriously bad at billing/collecting (their last dalliance with employing doctors more than a decade ago failed miserably), health care organizations may develop competing priorities.

Stay tuned...will see how this movement along with recent Health Care Reform legislation plays out for doctors and patients.