Talking about physician employment really gets some folks' hearts racing. And now, if they want to see an independent cardiologist about this condition, they may be out of luck.
Cardiologists solo no more
Recent discussions about physician employment have centered on hiring primary-care doctors and how young physicians are not interested in the solo-medical-practice-as-a-small-business model, but it appears that cardiologists also are being lured from private practice.
James Palazzo, president of Paragon Health, a Southlake, Texas-based cardiovascular consultant and management services provider, has interesting statistics to share regarding the 20,000 or so cardiologists actively practicing in the U.S.
"Thirty-six—certainly 48—months ago, almost no cardiologists were employed by hospital systems," Palazzo says. He expects that within the next two years, one-half to two-thirds of cardiologists will no longer be their own bosses.
Palazzo says his figures are based on various surveys and anecdotal information. I asked the American College of Cardiology what it thought and was told Palazzo’s numbers "don’t sound far off," though any exact figure would be difficult to ascertain. There was some doubt about Palazzo’s assertion that fewer than one in 100 cardiologists was employed by a hospital or other health system three years ago—but he insists that his figure is accurate.
Last year, the ACC conducted a "cardiovascular practice census" of 2,413 practices. The practices included almost 13,900 cardiologists along with more than 23,800 physicians in other specialties.
Of those, 222 private practices (representing 2,455 cardiologists) had integrated into a hospital system; 220 (1,680 cardiologists) were in integration discussions; 70 practices (738 cardiologists) had merged with other practices; and 93 (278 cardiologists) were in merger discussions.
The survey found that large practices were integrating, smaller practices were merging and "solo practitioners seem to be the only private practice immune to these waves of change."
What does this mean? The ACC's conclusion doesn't offer much of a clue: "The changing practice structure has the potential to profoundly affect patient care and costs."
More detail was provided by "Health Reform and the Decline of Physician Private Practice," a report commissioned by the Physicians Foundation research and grant-making organization and completed by the Merritt Hawkins physician recruiting and consulting firm.
The November 2010 report notes that earlier integration efforts "were aimed largely at gaining bargaining power," while recent physician-hospital alignments are often geared toward meeting quality metrics that result in financial rewards from payers. It also noted that reform is not responsible for current movements in healthcare—just their pace.
"Health reform will therefore push physicians further in a direction where they are already heading—either out the door or away from the traditional, independently owned private-practice model, which is becoming largely unsustainable, and toward a number of emerging practice models," the report said. "In each case, physicians will forfeit the independent model in return for capital, technical, administrative and staffing resources provided by a larger entity. A growing number of physicians, however, will go 'back to the future,' by directly contracting with patients in boutique or concierge practices."
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