By Stephen C. Fitzer
BCMS CEO/Executive Director
The practice of medicine is different
in San Antonio than in
any other large city in Texas.
About 50 percent of San Antonio
physicians work in solo private practice,
but these numbers are shrinking
as more and more physicians join (or
form) group practices or elect to
become employees of other physicians
or physician groups. Leading this
trend away from solo practice in Texas
are Houston and Dallas, which have
more and larger group practices than
San Antonio.
It once was the dream of many
physicians to be their own bosses. This
meant setting up private practices,
buying their own equipment, hanging
that shingle and getting close to
patients and their families in the area,
setting out to solve all their medical
problems, one-by-one.
Times are changing. Economics
now drive the business of medicine
and physicians have lots of “imposed
bosses” telling them what they can or
cannot do. The list of these imposed
bosses includes the federal and state
governments, commercial payors, hospitals,
malpractice insurance companies
and others.
The economics of medicine means
cost efficiency rules the day. How do
solo practitioners and small group
practices become cost efficient? They
make do with less, share costs, hire
fewer people to assist them, work
longer hours and take home smaller
paychecks. But these solutions are
short-term. The squeeze on physicians
continues and it will get worse. It is
clear that these imposed bosses want
to see how far physicians can be
pushed, or how the practice of medicine
can be changed to make it even
more cost efficient.
As practicing physicians know, the
administrative burden on them is
growing. Medicare, Medicaid, CHIP,
HIPAA, the TMB and insurance company
requirements are just a few that
continuously drive more paperwork. It
has become increasingly obvious that
sharing administrative costs among
several physicians is an effective
method of reducing the cost of practicing
medicine. Sharing nurses and
office help, ordering and maintaining
supplies as a group, as well as sharing
billing systems or electronic medical
records are huge improvements in
costs per patient, compared with a
solo practitioner trying to go it alone.
Negotiations with payors also are
more effective through larger groups.
Physicians know the restrictions keeping
physicians from banding together
to negotiate with payors. However,
group practices with the largest number
of physicians on staff can negotiate
most effectively for better rates.
Physicians benefit from the clout
that comes from extracting fees that
are higher and fairer for work performed.
Currently, it’s the only way
physicians have to exercise clout
against the independent payors who
need physicians in their networks.
The result of all this chaos is that
many new physicians — as well as existing
solo practitioners — are either
becoming partners in existing practices
or they are becoming employees
of medical groups. While the corporate
practice of medicine is outlawed
in the state of Texas, there are increasing
numbers of medical practices hiring
physicians to work for them.
This trend will continue and accelerate
because more physicians are making
non-traditional career versus lifestyle
choices. The numbers of physicians
who want to work a set number of
hours per week or want to work part-time
are increasing. They want to spend
more time with their families or pursue
other interests, and new employment
options have to be considered to accommodate
their wishes.
In conversations with physicians (or
physicians representing 501a corporations)
who hire physicians, I find there
are additional, interesting opportunities
to practice medicine and to deal with
the administration and capital investment
required to go it alone.
One of these opportunities is to
work for a set salary and another is“eat what you kill” arrangements
with medical practice employers,
with a percentage of the fee going to
the attending physician. A number
of other benefits can come from
working with a larger group as an
employee, such as the opportunity
to get healthcare insurance for the
physician and his or her family,
retirement plans, employer-paid
malpractice insurance, bonuses
and more.
Physicians are very intelligent people.
They must be to get into and out
of medical school. But most physicians
become physicians because they
want to spend their time practicing
medicine. This is most possible when
the administrative and economic burdens
of operating a practice are
removed, or at least minimized.
Joining a practice as a partner is
one way to accomplish this. An
equally valid way to sidestep the hassles
of practicing medicine is for a
physician to sell his or her time to an
employer at a fair rate. There exist
many opportunities for this type of
employment in San Antonio.
Some physicians who happen to
possess keen business aptitude actually
want to become the employers of
physicians who are looking for this
type of arrangement. Either way, the
benefits and opportunities of physicians
banding together are enormous,
and will most likely become
mandatory for survival as current
trends continue.
As in any career field, the practice
of medicine presents ever-changing
opportunities with specific benefits
and drawbacks. Today’s smartest,
most successful physicians are those
who decide which way of practicing
medicine suits them best financially,
time-wise and temperamentally.
With just a little research, virtually
all physicians can find the perfect
niche for the way they want to practice
medicine.
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