Page 45 - issue
P. 45
Doctors 41
tors there made me keep my medical knowledge and under-
standing much more up to snuff.”
Dr. Gunderman discusses this in his article: “The physi-
cian’s lounge, once an important site of knowledge sharing
and professional collegiality, may become depopulated.
Exclusively inpatient and outpatient physicians see each
other less frequently, and medical students and residents
have fewer role models who provide comprehensive care. In
effect, the mounting walls of the hospital constitute an
increasingly impermeable barrier between the members of
the profession.”
Dr. Cooper feels that, down the line, most of the primary
care providers will be nurse practitioners and physician assis-
tants with fewer and fewer doctors doing it. He says there’s a
big push now to have doctors go into primary care, but he
does not think that it will happen.
Because the level of training may be different in the future,
says Dr. Cooper, if someone has something seriously wrong,
he or she will need to go to a specialist – and hope that their
primary care doctor/PA or nurse practitioner will be able to
allow them to go to do that. “This will fragment care even
more than it is already.”
Another unintended consequence, says Dr. Cooper, is that
“community physicians and community hospitals, like Sinai,
feed each other, meaning that they help each other. The hos-
pital gives certain things to the physician, like continuing
medical education and having physicians on hospital boards
where they could help with medical executive decisions.
There was a symbiotic relationship between hospitals and
community physicians. That is gone. That means that every
physician out there will not have allegiance to a hospital
unless he is a hospital employee.”
Dr. Cooper told me that he has been approached by hos-
pitals to become one of their employees while keeping his
practice. He is not interested, at this stage of his career, in
doing that. Although they guarantee an increase in salary for
several years to doctors who come on board, the hospital is
the boss. The doctor runs day to day operations, but the hos-
pital takes over the billing, makes major decisions, and
enforces certain requirements, such as making sure that
EMRs are done. Dr. Cooper said hospitals don’t really buy
practices anymore, but prefer this incentive system, where,
after several years, they basically own the practice anyway.
The reason they can guarantee an increased income is
because hospitals are allowed to bill more than physicians.
Once a physician works for a hospital, his office becomes a
hospital site and can bill accordingly. Of course, this does not
save the insurance companies any money, so they are not so
thrilled with this model.
While no one expects our health care system to return to
the way it was 20 years ago (and it’s never been perfect), it is
apparent that more adjustments will need to be made so that
the current system is better than simply “good on paper.”◆
u 410 358 8509 u
tors there made me keep my medical knowledge and under-
standing much more up to snuff.”
Dr. Gunderman discusses this in his article: “The physi-
cian’s lounge, once an important site of knowledge sharing
and professional collegiality, may become depopulated.
Exclusively inpatient and outpatient physicians see each
other less frequently, and medical students and residents
have fewer role models who provide comprehensive care. In
effect, the mounting walls of the hospital constitute an
increasingly impermeable barrier between the members of
the profession.”
Dr. Cooper feels that, down the line, most of the primary
care providers will be nurse practitioners and physician assis-
tants with fewer and fewer doctors doing it. He says there’s a
big push now to have doctors go into primary care, but he
does not think that it will happen.
Because the level of training may be different in the future,
says Dr. Cooper, if someone has something seriously wrong,
he or she will need to go to a specialist – and hope that their
primary care doctor/PA or nurse practitioner will be able to
allow them to go to do that. “This will fragment care even
more than it is already.”
Another unintended consequence, says Dr. Cooper, is that
“community physicians and community hospitals, like Sinai,
feed each other, meaning that they help each other. The hos-
pital gives certain things to the physician, like continuing
medical education and having physicians on hospital boards
where they could help with medical executive decisions.
There was a symbiotic relationship between hospitals and
community physicians. That is gone. That means that every
physician out there will not have allegiance to a hospital
unless he is a hospital employee.”
Dr. Cooper told me that he has been approached by hos-
pitals to become one of their employees while keeping his
practice. He is not interested, at this stage of his career, in
doing that. Although they guarantee an increase in salary for
several years to doctors who come on board, the hospital is
the boss. The doctor runs day to day operations, but the hos-
pital takes over the billing, makes major decisions, and
enforces certain requirements, such as making sure that
EMRs are done. Dr. Cooper said hospitals don’t really buy
practices anymore, but prefer this incentive system, where,
after several years, they basically own the practice anyway.
The reason they can guarantee an increased income is
because hospitals are allowed to bill more than physicians.
Once a physician works for a hospital, his office becomes a
hospital site and can bill accordingly. Of course, this does not
save the insurance companies any money, so they are not so
thrilled with this model.
While no one expects our health care system to return to
the way it was 20 years ago (and it’s never been perfect), it is
apparent that more adjustments will need to be made so that
the current system is better than simply “good on paper.”◆
u 410 358 8509 u
