Monday, June 13, 2005

The Company Man...
Via hcrenewal and The Retired Doc comes this story from The Miami Herald:AMA pursues doctor hiring reform:
In a move that could have widespread effects on the nation's healthcare industry, the American Medical Association's Board of Trustees is recommending the development of proposed legislation that would forbid corporations and hospitals from directly employing physicians.

Joseph Heyman, a Massachusetts gynecologist who is an AMA trustee, said the board acted because ``we don't want to have corporations or anybody using their concerns about finance to influence the relationship between a patient and a physician. We want the physicians to . . . make the best choices for the patients.''

Of course, when the AMA goes off and does something, somebody's going to get mad:
''This doesn't make sense,'' said Frank Sacco, chief executive of the South Broward Hospital District, which employs more than 100 doctors. ``They're completely out of touch with the physicians of this country.''

''They're trying to put a genie back in the bottle that has been out for a long time,'' said Stephen J. Desnick, chief executive of Sterling Healthcare, which employs 1,000 doctors, mostly in emergency rooms. He called the AMA ``extraordinarily conservative. They're just not in line with what's happening.''
Some of the reasons that hospitals or companies employ physicians:
Corporations employing physicians have been growing in recent years as doctors in solo or small-group practices have found it difficult to make a go of it because of rising costs and squeezed reimbursements from managed care plans. Pediatrix specializes in the treatment of newborns in hospitals. Sterling focuses on emergency room doctors.

Both North Broward and South Broward Hospital districts now employ neurosurgeons because they find its the only way to get their services in their operating rooms. The neurosurgeons, who can't afford or can't get malpractice premiums, thus become government employees and have limited liability in lawsuits.

Sacco, head of the South District, says he finds it necessary to hire a broad range of specialists, including 15 or 20 primary-care doctors to handle the uninsured in public clinics.

So hospitals and companies employ physicians because:
Some physicians (especially younger ones) find negotiating the particulars of insurance contracts, office management, and other business aspects of medicine difficult. By taking employment with hospitals or companies they have strength in numbers and someone else to handle management. Such options will become more appealing as the anticipated/dreaded "shift-work" mentality associated with the 80-hour workweek becomes entrenched.

The dynamics of hospitals have changed. The advent of specialty hospitals and ambulatory surgery centers have made serving on the medical staff of a community general hospital optional. Many surgical specialists have stopped doing so. In order to provide the service in a reliable fashion hospitals have had to employ these physicians.

Under provisions of the Stark Law, hospitals cannot provide assistance with liability insurance. So many, such as the neurosurgeons above, find refuge in hospital employment. Some enjoy limited liability as government employees under those circumstances.

The uninsured and Medicaid patients need to have someplace to go, as many in private practice will not see those patients. Hospital clinics, staffed by hospital employed physicians, can provide that service.

What of physicians who work for locum tenens firms?

What strikes me is that the AMA is proposing a policy that would restrict physician career options. Of course, the AMA does engage in silliness from time to time.
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