Next month my spouse will close his busy medical practice and 8 wonderful people will lose their jobs, including him. This is in no way a voluntary decision - the massive rules and regulations under the Affordible Healthcare Act have made it impossible to stay in private practice any longer. He now spends only 40% of his time on actual patient care and the remainder on electronic medical records, implimenting scores of regulations and endless paperwork. Over time, all of his colleagues gave up their practices and have gone to work for large hospital systems. None of them are particularly happy, but had no choice.
70% of physicians used to run their own practices and now it is less then 30%. Soon it will be close to 0%. I know private practice isn’t for everyone, but it has been wonderful for my DH. He loved creating his own team of employees and mentoring medical students in his office. It is regretable he will not be able to continue running the practice he has worked hard to build for the last 25 years.
Perhaps this was an unintended consequence of the ACA, but it is sad to see the end of private practice medicine.
He would still have piles of insurance company paperwork to deal with if there were no ACA.
From a patient point of view, it seemed to me that the disappearance of private or small practices in primary care started long before the ACA. Even back in the 1990s, it was difficult to find a private or small practice where new patients could get an appointment in less than a few months for non-urgent care.
I have had the same doctor for about 30 years. He used to be independent. The paperwork forced him to move to work for a large company. I (and probably many other patients) moved with him.
Excessive regulation really is a big problem in this country, and not just for doctors.
My internist and his partner are both 68 and has been practicing for decades. He can’t find an internist for his wife. I can’t figure out where to go when he closes his practice. I have an excellent BCBS policy but finding good doctors is increasingly difficult. I have friends who have a concierge md whom they pay and extra $1500/year to be able to see. I already fly to see a long doc in SF. It’s very challenging.
I’m hoping my nephew will help us find good internists this year when he’s doing his internship in HI. At least he should be meeting the internists who are practicing and hopefully can sort good from not as good and find out which are still taking new patients.
Regulation &paperwork woes seem to be a common theme in many professions. I hear the same from teachers, nurses,architects, etc. Life truly does seem more complicated. Not sure it is the ACA, or the insurance companies.
I BIG HEART electronic records. My ortho is really good at computer stuff; types fast and can figure out how to look at MRIs from several years ago. I get that some docs just can’t deal with them, but there are low tech solutions. My gastro doc hired a scribe. She sat quietly in the corner and took notes on her laptop while I described my issues. Beats flipping burgers at McD, and did not cost the doc too much.
Yes…since Obamacare we have watched our physicians retire or go into administration. They have shared with us that they no longer can give the type of patient care they used to and are burdened with regulations and paper work. Many have chosen to end their career. We’ve watched the practice we went to (that used to be outstanding) get bought out by a large hospital and it now has a “clinic-like feel.” The doctor is followed by a scribe (more cost to us) and we are now just a number. Our own deductible has gone through the roof and healthcare is now so expensive that we only seek medical care if it seems as if there is no other option. My 84 year old father was kicked off his health plan. Our neighbor started going to the V.A. for substandard medical care because it was free. My dh stopped getting his allergy shots because they went form a small co-pay to $90 a shot. These are just some of the failures of the ACA and why it needs reform. For those who were not affected, please realize many of us were.
My friend’s H, a cardiologist, willingly left his group practice (where he was a partner) because of the arguing between the partners about everything. He had been with the practice for 30 years. He went to Cleveland Clinic and loves it. Much saner life, has regular hours, never on call, big bucks and he doesn’t have to pay for his malpractice insurance.
I also love e-records as I know everything from one of my doctors automatically goes to all my doctors - even if in different hospital groups (my gyno, my internist, and my Uro are all in different systems.) I don’t have to bring them up to speed every time I have an appointment.
Anyone who thinks that single payer socialized medicine is the solution should check out the Canadian media online, especially the English media in Quebec. One set of problems is exchanged for another.
I’ve never once in my life had an independent physician. People around here have been affiliated with hospitals for a long time. Just how it is.
And as for England and Canada, been there done that and still absolutely believe they have the answer. At least my family there has never laid awake at night wondering whether or not they’ll be able to keep coverage or bawled their eyes out at a townhall explaining how rollbacks to insurance protections can literally kill them.
Even my pediatrician, when I was wee, had a partner. (Come to think of it, so did Welby.)
And here, we have doctors in multi-doc practices, but mine is still mine. In a pinch, we can see another on staff or the PA or NP. The practice is available on weekends, too, on a rotation (for sick calls.) If we see a specialist, off site, digitized records mean they have access to our info, testing, etc. If they run a test or have comments, it’s available to my doc pretty fast.
My doc is pro ACA.
The situation for med care varies by where you are.
I too hate the fact that that doctor spends more time looking at and logging data into the computer than in interacting with me, the patient.
I recently went to a podiatrist for the first time. He actually talked to me without a computer screen between us. Are they not required to keep the electronic records? I am very dubious of non-MDs but that part of the visit was nice.
Docs who address you have to spend time afterwards logging it into the computer. They come home at 8, even though they stop seeing patients at 5.
Even small group practices are going the way of the Dodo. Too much digital overhead. And yes, it is much better in that regard in Canada, though they have their own problems. There are many, many other developed countries to look to besides Canada.
“My 84 year old father was kicked off his health plan.”
Wouldn’t your father be on Medicare?
What plan did he get kicked off of? His retirement health care plan from his employer? That wouid have nothing to do with ACA. Companies have been changing/eliminating retiree benefits for years.
I love the electronic medical record as a patient. Easy to see results online, track changes in health metrics, and for docs to get info from other docs I have seen. Paper records (in hospitals) were (are) a nightmare. I managed a medical records related department for a while. Residents “stored” records in the trunks of their cars. Once some were found stashed above the ceiling tiles – overworked resident at end of rotation just hid them instead of completing them. The odds of your record being in the right place at the right time weren’t good.
And that “scribe”? Just a real time version of the transcription service that used to transcribe the doctor’s recorded verbal notes. So the resource has moved – but they’ve always been there, you just didn’t see them. Also, no more doctor illegible handwriting! You can actually READ the record!
My doc recently started a new practice that uses the Direct Primary Care model. I pay a monthly membership fee (age dependent - mine is $100/month, kids are $20, $220 family maximum) and have almost unlimited access, not only through in-person visits but via text w/secure app, phone,etc. They do not accept insurance, which lowers their overhead by a huge amount. The office is 2 docs, a lab tech/nurse practitioner, and a receptionist. They do encourage their patients to have insurance for specialists and catastrophic events, but the membership fee covers all sick and well visits, vaccinations, labs, etc. with no copay.
Because of this, they have fewer patients, dont have to deal with insurance dictating what they can and can’t do, and can still earn a living wage.
I love it (haven’t spent 45 mins with a doc during a physical, ever) but more importantly, it gives me peace of mind this t y kids have access to her when away at school. She will coordinate their care with local providers if needed, but will also be available for questions. As she described it “text me if you have a sore throat. Try to take a pic. Then we’ll figure out if you should go to health services.”
I realize we are fortunate to be able to afford this, but I wouldn’t be surprised to see more docs going to this model.