Patients Lose as the Practice of Medicine Coarsens

Doctors don’t like the assembly-line model either

Letter to The WSJ.

"The three factors most responsible for the decline of independent practice are burdensome regulations, obsolete antitrust laws and economic benefits of consolidation to hospital systems.

Physicians spend about 20 uncompensated hours a week entering data into electronic records and complying with other regulations. This distracts from and compromises patient care and is a major factor in the high incidence of physician burnout.

Under obsolete antitrust laws, independent practitioners are viewed as competitors and therefore prohibited from bargaining collectively with insurance companies. Large healthcare systems, which are viewed as single entities, have been able to negotiate fees that are up to 300% higher than what independent practices get. The lower fees have forced many independent practices to go out of business or consolidate.

Higher reimbursement levels enable healthcare systems to afford physician salaries. They also benefit from downstream revenues generated by employed physicians, including laboratory tests, physical therapy, radiology, outpatient surgery and inpatient hospital admissions.

Our healthcare system works best when there is competition and choice in how physicians practice and patients receive care. Private practice remains a cost-effective, high-quality component of our healthcare system. Its survival depends on regulatory and antitrust reform.

Michael T. Goldstein, M.D.

Greenwich, Conn."