Leaving for Private Practice

Recently, several doctors that my family uses told me that they are leaving the hospital where they practice to become independent. I was surprised to hear this, because I had read that the the opposite is true: doctors are leaving private practice for the safety of a steady hospital salary.

Our doctors' frustrations, however, were legion. They disagreed with the hospital's billing practices, and were disappointed with the poor upkeep of the buildings. They suspected that political wranglings would block planned renovations to the hospital.

I had to agree with them on all these counts. As exhausted new parents, we tangled with the hospital's aggressive billing department just a few weeks after my oldest child was born. One of the hospital's parking garages has no elevators, which is fine unless you are pregnant, injured, nauseous, or disabled. Once, we had to carry a seriously ill child through a long, dark, underground tunnel in the belly of the hospital to hand-deliver a specimen for testing.

While sending us and our insurer bills regularly, the hospital also periodically asks for donations to its charities and building campaign. I decided long ago that we had given enough.

Despite the hassles, though, we have received excellent care from the doctors affiliated with the hospital, which kept us coming back. It's been nice to have most of our providers all in one place. Now we will need to drive all over town for doctor's visits, as our trusted community of doctors slowly disperses.

Doctors' Job Choices Have Political Consequences

The New York Times ran an interesting article today about the political consequences of the job choices that doctors are making. Historically, many doctors have owned their practices, explained journalist Gardiner Harris ("As Physicians' Jobs Change, So Do Their Politics"). As business owners, they fought for fewer restrictions on practices that they felt were hampered by business expenses such as taxes and high malpractice insurance premiums. They tended to vote Republican.

Today, however, more and more doctors are joining hospital staffs in order to avoid many of the business headaches of running a practice and to have a better work/life balance, Harris explained. "As more doctors move from business owner to shift worker," wrote Harris, "their historical alliance with the Republican Party is weakening...."

With the hospitals running the business side of medicine, these doctors have become more focused on wider social issues in medicine such as covering the uninsured. They are also more likely to vote Democratic. Harris wrote that this shift has helped Obama pass the health care reform bill.

This focus on social issues is not exactly altruistic. Hospitals benefit when more people are insured, because then the hospital does not have to absorb the cost of treating the uninsured. Doctors employed by hospitals who advocate for expanding insurance coverage benefit their employers, just as doctors with their own practices who advocate for limiting liability claims hope to benefit their own businesses.

The bottom line? Being an entrepreneur is not very appealing to many doctors these days. Many are choosing to exchange the freedom of self-employment for the stability of a staff job.

As I read the New York Times article, though, I realized that the patients that doctors treat have a very different experience of the workplace. The recession has forced many people into self-employment - whether they want to do it or not. As jobs with good salaries and benefits have gone away, people who have been downsized or laid off, or who recently graduated from college, have reinvented themselves as freelancers, independent contractors, or entrepreneurs in order to pay the bills.

Without employer-provided benefits, one thing that these accidental entrepreneurs really need is the affordable, comprehensive health insurance coverage that health care reform is trying to deliver. When more doctors were entrepreneurs themselves, they looked at health care reform through a business lens and fought it as a threat to their own livelihood. With more doctors employed as staff members, and protected from some of the vicissitudes of the marketplace, many are now more sympathetic to those who are forced to take on the risks of entrepreneurship.