nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Wednesday, December 1, 2010

SURVEY: Private Practice On The Way Out

Some doctors will find other employment or retire with health care reform.  A significant number?

"A survey of some 2,400 MDs from around the country found nearly three quarters said they plan to retire, work part-time, stop taking new patients, become an employee, or seek a non-clinical position in the next one to three years.

But are these changes really the result of the new law?

Doctors responding to the survey seemed to think so. “Doctors strongly believe the law is not working like it needs to – for them, or for their patients,” said Lou Goodman, president of the Physicians’ Foundation, who conducted the survey." (NPR Shots, Dec 1)
First, this is not an academic survey.  Physicians' Foundation is an advocacy group for doctors in practice.  That said, the survey expresses a lot of dissatisfaction.

While health care reform is a major cause, the ongoing threat of Medicare cuts, year-in and year-out, lead the list--slightly ahead of reform--as the biggest cause.

NPR's take on the survey rests on a comment in the report that the changes in health care were needed and inevitable.  According to NPR, "Blaming the new law just gives doctors a convenient scapegoat."

We'll see.  Surveys show that, for some people, income is a reason to go through all the years of study and expense to get a degree in medicine.  But those same surveys show that humane motives and professional respect are the most important factors overall.

Maybe limitations on income will weed out the people who are pursuing medicine for the wrong reasons.  But, somebody who's disciplined enough to go through 7-10 years of post-college training could make a lot of money much easier, without all that expense and study.  So, I don't know...

Except for a few years, I was always a federal, salaried physician.  Sometimes there were not a lot of patients to see, and sometimes I was swamped.  There was no financial incentive either way, and I was most comfortable with not having to worry about seeing "enough" patients, or what I ordered (and how much it cost).

One thing we're seeing already with health care reform is physicians changing their practice patterns, joining groups or taking jobs working for hospitals in salaried positions.  They see the writing on the wall about the difficulty in trying to stay in solo practice.

Some of the pernicious influences of private practice will probably improve with that change; it removes the "push" to do more, order too much, or see as many patients as possible in a shorter time.  But, it introduces another problem:  your doctor may be an employee of an organization, and that organization may be more concerned about the financial bottom line than your health.

The pernicious part just shifts to a different location.

Doc D

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