Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.
As an OB/GYN who has been in private solo practice for over three decades, I was somewhat surprised to read that in the Merritt Hawkins most recent survey of graduating residents, only 1 percent desired to go into solo private practice. Remarkably 41 percent of residents indicated they would prefer to be employed by a hospital than any other practice option.
The report authors conclude that payment reforms and emerging payment models, which are documentation-heavy and data-driven, encourage formation of large, integrated organizations such as ACOs, hospital systems, and major medical group models.
They state: “For these and other reasons, many practicing physicians express concerns about and dissatisfaction with the medical profession… Medical residents train with and are mentored by practicing physicians, and there is no doubt that they are exposed to and absorb some of the doubt and discouragement many practicing physicians feel about the state of the medical profession.”
In 1999, Simon et al studied physician’s perceptions of managed care and found that negative views were widespread among medical students, residents, faculty members, and medical school deans. In September 2014, former Secretary of State and then soon-to-be presidential candidate Hillary Clinton told a packed house of 3,000 cardiologists at the annual Transcatheter Cardiovascular Therapeutics (TCT) meeting in 2014:
"The fee-for-service model, which made a lot of sense for a long time, may not make sense for physicians, for hospitals, or any other providers and may not make sense for patients and other payers."
She added the model didn’t rely enough on evidence-based medicine and implied that it was an idea whose time has passed.
It appears to me that physicians as well as medical school faculties respond to the politics of the day. With Hillarycare resulting in the loss of Democratic majorities in both houses of Congress in the 1994 midterm election and in 1997’s As Good As it Gets, Oscar winner Helen Hunt portrayed a character cussing out HMOs to audience applause nationwide, physicians across the country felt vindicated in their practice of medicine and comfort in their oaths to Hippocrates and Maimonides.
So what has happened in the past 20 years?