Saturday, June 23, 2012

Solo Docs Are Selling Out

     For the first time in the history of United States medicine there are more doctors working as employees than for themselves.  The number of solo doctors has plummeted. 
     The reversal of the trend from self-employment to employee status was first noted in 2008.  Medical Economics says, "According to a 2010 PricewaterhouseCoopers report, nearly 2,910 physicians were involved in mergers or acquisitions in 2009, double the number from 2008."
     Medical Economics is a free journal sent to all physicians in this country.  It is full of advertising and contains articles purportedly advising doctors about how to make good business decisions.  The article just quoted does not explore the reasons for the trend from ownership to employee status at clinics--it bypasses this riveting question altogether in favor of catechizing physicians on how to sell their practices to hospitals.  It provides step-by-step instructions for making this "transition."
     First the article comforts physicians who are on the fence.  "If you're considering selling to a hospital or healthcare system, you're not alone."  Humans are herd animals--if everyone else is doing something the impulse to follow along is almost irresistible.  The herd instinct is visible at football stadiums and in front of television sets during playoffs, and in the drift of the S&P 500.  Now it's being capitalized on to manipulate doctors.
     "Doctors don't know anything about business," has become an annoying apothegm over the years.  There is a certain pride when a doctor says it, as though caring about patients eclipses everything ordinary.  There is scorn when an accountant, hospital administrator, or CEO of a corporate-owned physician group says it, fueling the implication that doctors should get out of the business world and leave all the profit-making to them, the rich businessmen.  No one expects doctors to care about money:  it's obscene.  But CEO's and the rest of them, they're already filthy with the mud of mercenaries.  Why not let them have it all?
     Doctors do know a lot about business.  We have been running our own businesses for centuries.  Moreover, we run them with compassion.  I, for example, have never found any use for collection agencies. If patients can't pay their bills up front, I don't chase after them from behind by using hired hands to batter them with threat-notices.  Money is important, but it's not The Most Important Thing where people are concerned.  This is a basic fact of human interaction, isn't it?--and something corporations, not being human but standing in as the greedy underbelly of humanity, do not respect.  If we turn our offices over to corporations, including hospitals, and if in our shrinking solo practices we imitate the habits of those cold-blooded entities, patients can no longer expect the benevolence and concern of the physician sector to translate into grace when it comes to unpaid balances, the need for a doctor in the middle of the night, and wide-open office hours.
     The Medical Economics article warns doctors about letting their emotions get involved when making the decision to sell.  "As difficult as it is to hear and remember, loyalty is not a financially tangible asset.  It may be an admirable and appreciated trait, but it can't translate into dollars and cents in an acquisition."
       Doctors!  the article reprimands us.  Start acting like the rest of the world!  Quit letting your feelings get in the way of your life!  The clear message is that what we considered priceless, our loyalty and our love, are without value in the real world.  "An emotional attachment to your practice might give you an inflated idea of its worth."  This is a cautionary note for doctors on the verge of selling out.  We shouldn't expect anyone to value our feelings, our attachments, or our patients' attachment to us.  Corporations appraise these at zero.  Sure, our patients may value these qualities.  But they don't matter...or do they? 

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