Friday, December 03, 2010

Specialists' New Game: Musical Chairs

The consolidation of physician specialty practices in to larger corporate health care systems in urban areas is creating a new challenge for today's doctors when the music stops: there might not be a chair available.

There are simply many fewer hospital systems in large urban areas than there are specialy practices, so the number of specialist positions a large health care system is willing to absorb might be limited. As doctors and hospital systems coalesce into as-yet-to-be-clearly-defined "Accountable Care Organizations," the cost of too many specialists in an organization is being carefully weighed.

This is playing out in our area as more and more cardiology groups join forces with hospital systems. The concern in some circles is what will happen to laggard practices in similar geographic locales. Will they be able to go it alone and refuse government payments for services? Will they have to align themselves with an alternate hospital system that might not be there first choice? Or might they just simply fade away as the specialists in these practices retire?

It's hard to know where this might sift out, but the construct developing suggests that certain specialty services might be even harder for patients to obtain in the years ahead.

But then again, that's probably been the plan of our new health care reformers all along.



jimbino said...

I am personally looking forward to the opportunity to deal with those healthcare providers who refuse to mess with insurance, medicare or medicaid.

Anonymous said...

And, of course, as some groups are killed off, those remaining as part of the ACOs will have their bargaining position significantly strengthened. Watch for expenses to soar!

Anonymous said...

Dr. Wes,

Doesn't this consolidation of health care providers sound familar? The corporate world has been experiencing economic darwinism for years - think of the "mom & pops" that have been driven out of business when faced by corporate giants and the losers in the race to company mergers. Now you point out that medical specialists are just as vunerable.
As far as the "plan" for health care reform, something like 30 million folks (now 50?) without coverage had a little something to do with the plan. Your concern over the new hurdles for specialty docs may be well-founded, but your antipathy to this reform seems to have eroded a fair amount of perspective. And perhaps I, too, have lost all perspective for your closing comment comes awfully close to suggesting the "death panel" threat. I hope I've misunderstood.

Anonymous said...

Dr. Wes,
Don't you feel that there are too many specialists anyway, especially in desirable locations. Its time to stop allowing every physician who wants to work in Chicago/NYC/etc to put up a shingle and start doing marginal cases to support themselves.

DrWes said...


The number of available specialists depends on the specialty and years of experience. General and cardiothoracic surgeons have had trouble filling their residency positions already and the threat of more patients in the system in the years ahead might make access to the specialists, for instance. The front load of training time paired with cuts to pay makes for a less-than-perfect scenario to repleat these shortfalls in staffing.

Dan Guerrero said...

I work for a medical device company and one of my doctors recently has been subject to your described scenario. His cardiology practice was purchased by a GPO in Florida which is now forcing him to implant at a hospital in their system, which makes business sense for them. However, the hospital he did 90% of his cases previously built their cath labs and EP labs specifically for him and per his requests.

This makes me wonder how the financial ramifications of these decisions make economical sense for the hospital systems or the doctors selling their practices. I do not have a good concept of dollars involved by either party, but it seems to me that the hospitals must be paying a large sum to these doctor groups to have them justify selling the practices they have spent their careers building. Will a hospital really see a return on it's investment consisting most clinical procedures produce marginal profits and there a high labor cost involved with most of these clinics?