I just opened my private practice last year and continue to work as a subcontractor at my hospital. Although I do not accept insurance, I find myself inundated with Prior Authorization requirements in order for my patients to receive prescription coverage. I’ve encourage many of my uninsured patients to get an ACA exchange plan. They’ve done extremely well with it.
Being a case practice allows me all of the time I need to address my patients’ needs. So, private practice isn’t dead. It’s difficult for a lot of reasons beyond the ACA. Top of the lost is declining reimbursement.
Again, it’s going to vary by state. My doc is up on where Priors are needed, how to word it. (Not saying that’s perfect.) But it’s not the docs doing the paperwork. It’s staff.
“It’s against what I see as the mission of medicine.” That’s my doc’s attitide. After 2008, before ACA, a portion of the practice’s patients became uninsured. They continued to see these folks, at reduced or no charge.
I wrestled with the concierge concept, too. But most of you have been here long enough to know about my medical history. Someone’s got to have the full picture (besides me). It is extraordinarily difficult to get any doctor to make decisions about care when there are other specialities that are affected, and it is rare when the three major docs involved in my care actually communicate with one another. The onc is reluctant to recommend Drug X because there are cardiac side effects and she’s not a cardiologist to know how serious the risks are, the cardiologist is not about to make a recommendation about said drug because she doesn’t know chemo, etc., etc.
At the suggestion of my oncologist, I’ve identified a cardiologist in Baltimore who specializes in the cardiac side effects of the various chemo drugs associated with my rare form of leukemia, so I am likely adding yet another doctor to the mix, though I will probably see her only once or twice a year. My internist and onc are on board; my new regular cardiologist (the last one has ghosted) is not thrilled because she thinks I’m questioning her judgment.
@CountingDown I’d have a hard time not going to concierge if my PCP or my Rheum suddenly went that way. This is the first team that’s figured out what’s wrong with me and my PCP has followed with me even a few years before we figured out what was wrong.
I can’t really afford that so my fingers are crossed. I can’t see my Rheum ever leaving (though he’s on the verge of retirement) but I could see my PCP going that way or switching to a different hospital system. I will follow her like a lost puppy for as long as I can.
The rest of my specialists though I would just switch. I like them but not enough to pay an arm and a leg. They can be replaced.
My internist is 68. His twin brother is a retired pathologist in CO. His practice partner is also 68 and H’s MD. We have NO idea when we will do when they retire. My internist is still trying to find an internist for his wife as well. It’s VERY challenging. For now, I’m trying my best to keep track of everything, including my new lung doc in SF. At some point, I’d much prefer an MD or other healthcare professional coordinate everything.
We will be begging my nephew to help us find new internists when he’s in HI for a year, interning in internal medicine.
My doc took a head job at a hospital so left the large practice he started. I stayed with the mid level who has been with the practice for a couple decades. I suppose at some time at my age a crisis will occur that the mid level will not handle but I am not going to align with any of the young docs until I have to I guess. The landscape is ever shifting and has been since I was a young adult and hmos became the rage. We will all survive and as soon as Cerner and Epic emrs start talking to each other easily I will be happy and won’t really care who treats me.