Primary care is target for hospitals
By Lena H. Sun
Washington Post / June 26, 2011
WASHINGTON — In one of the first concrete steps to remake the way medical care is delivered, hospitals are competing to hire primary-care physicians, trying to lure them from their private practices to work as salaried employees alongside specialists.
The push is forcing doctors to make decisions about how to deliver care to patients, many of whom have relied on longstanding relationships with trusted independent neighborhood physicians and wonder what lies ahead.
It also spotlights benefits and drawbacks for patients and doctors alike in one of the health-care overhaul’s much-touted initiatives, set to begin next year. The law will reward teams of doctors, nurses, and others if they coordinate to provide better care at lower costs. As front-line doctors, primary-care physicians are key to this effort.
In some cases, hospitals are seeking to take over practices; in others, they are hiring new graduates or relocating doctors from outside the region to prepare for Accountable Care Organizations. Some physicians want to work for hospitals and are seeking to play one against the other, doctors said. But many others remain wary.
Primary-care physicians wrestling with the implications of becoming hospital employees or trying to go it alone say it is ultimately about changing the way they have practiced medicine for decades.
“All the rules are changing,’’ said Jonathan Plotsky, 56, a longtime internist in Rockville, Md., who has talked to a nearby hospital joining the staff.
Plotsky’s father is a psychiatrist who has been practicing medicine the same way for decades.
But Plotsky worries about joining a hospital and turning over care of his patients to others.
“All I have is my patients,’’ he said.
For many doctors, the salaried jobs may come with greater security, but the trade-off is less individual freedom over how many patients they see and how they care for them, they said.
But hospitals are moving quickly to add to their primary-care staff.
In 2008, about 50 percent of physician practices were hospital-owned, according to an industry group. A survey last fall by the group found that 74 percent of hospital leaders planned to hire more doctors in the next 12 to 36 months.
Most want primary-care doctors.
What this means for patients is unclear.
Even though they may continue to see their doctors in the same building as before, patients will benefit from one-stop medical shopping, proponents say. Internists and specialists working under the same corporate roof will, in theory, be better able to care for them than a disjointed fee-for-service approach where a family doctor may not know what treatment a patient received during a previous emergency room visit.
Patients will also have greater access because, unlike private practices that can reject insurance, hospitals do not have that luxury.
But other experts say economic factors could hurt patients. Hospital-employed primary-care doctors are a way for hospitals to direct referrals to their own specialists.
© Copyright 2011 Globe Newspaper Company.
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