Our beloved family doctor has closed her private practice — unprofitable. The orthopedic surgeon’s office next door closed. A familiar pediatrician went to work at a large medical corporation, although he had always dreamed of his own business.
The outlined trend, which in the professional world was called “the death of private doctors”, was noted several years ago by Forbes magazine. Since then, the situation has not improved – this is a policy determined, first of all, by the largest medical corporations that are actively conquering the health care market. At the same time, this trend does not bode well for the health of individual patients or for the cost of medical services. If in 2008, 62% of doctors had their own private practice, by 2014 this number had decreased to 35%. The cost of insurance has risen in price, and the plans that they offer have decreased significantly.
“If earlier insurance covered approximately 80% of the cost of medical procedures, now it is only about 10%,” says cardiologist Olga Sor. – For example, if earlier we sent our patients to an ultrasound of blood vessels and this procedure cost $ 125, now its cost is $ 1100. We are forced to artificially raise prices in order to get the same money from insurance as before. At the same time, those patients who previously could pay for it from their own pocket can no longer afford it.
Good doctor Aibolit
Last summer, it was announced that New York University now offers free education for all students of its medical colleges.
– The career in medicine is one of the most difficult. First, you study for a long time, then go through a residency before you are fully on your feet, – says Nina Wroclaw, an adviser on the choice of profession in high schools. – It used to be that everything pays off, not only because you are doing what you love, but also financially. Now the profession of a doctor is still highly valued in terms of prestige but from a material point of view … more and more of our graduates are thinking about whether they are ready to go through all these difficulties without having a clear financial plan.
A recent report by the Association of American Medical Colleges predicts a deficit of 42.6 thousand to 121.3 thousand doctors by 2030.
Now medical corporations are actively buying private practices. After all, this is an opportunity not only to earn money on one particular doctor and his patients – this is an opportunity to earn on all additional services. For example, your doctor sends you a blood test that will be done in the same medical building on the next floor. In the same place, you will be provided with ultrasound, radiology and other specialized specialists. True, it reminds a typical polyclinic of Soviet times? It would seem a very convenient structure when all medical records are stored in one system. What is the disadvantage of this for us as patients?
“Before, your private doctor could send you to the best specialist or give you a referral to a specific doctor of your choice,” says Dr. Benjamin Gaskel. – For example, I have been working as a family doctor for over thirty years. Naturally, I know all the best specialists in our district, and it is for them that I send my patients. Apart from the fact that I am responsible for the health of my patients, I am also interested in being met by good specialists: after all, if people do not like the doctor recommended by me, they will lose confidence in me and will not come again. And in such a “clinic”, as you say, employees have no personal interest. You are sent to a specialist, not because he is the best in his field, but because he works in the same system. One more thing. As a “private trader”, I decide how many patients I can accept, who needs to spend more time. Doctors working in the system can not solve it. They have a plan approved by the corporation, they must bring in money. They have up to 15 minutes for each patient – is this enough to get acquainted, to understand the history of the disease, to find out what happened, what the person complains about, and even fill out an electronic medical card? Therefore, practicing nurses and assistants are given to help the doctor in “polyclinics” – training for these professions is shorter and cheaper, respectively, and the salary is lower, so they are trying to transfer up to 80% of the work that the doctor had done before. Therefore, first, you look at the nurses, and only then – the doctor himself. You understand, about any individual approach, care, attentiveness we are no longer talking. Only money. And imagine how many managers secretaries and other bureaucrats are in hospitals, and they all need to be fed, they all have to pay salaries. What I and my assistant are doing in my office will be about ten people in a large hospital. Naturally, the cost of their services, which they send to the insurance company for payment, will be higher – and they will withdraw this money from your insurance.
Multidisciplinary practices at hospitals, which include primary care physicians, are actively developing – in 2016, these practices were 45.7% of the total number of medical institutions. And their number will increase because it becomes unprofitable to have a private practice.