OPINION Response
by KENNETH ANDERSON , MD
As I retire as the Chief Medical Officer of Baptist Health Louisville , I read Revolting Sheep with interest . As we approach the beginning of 2024 , I feel that the health care systems , physician-employees and independent physicians need to work side-by-side . I agree , in the past , successful practices owned and managed by physicians prospered . However , increasing economic headwinds made it difficult for these practices to continue . As the managing partners aged out , there were fewer physicians who wanted to continue that fight . Economics , e . g ., salaries and benefits , outpaced reimbursements and it became more difficult to maintain a private practice .
Physician-employees receive market-competitive compensation for their work performed . Additionally , physician wellness is enhanced with the benefit of paid / allowed time off . Employed physicians along with the health care systems can and do maintain and even improve health care quality . Physician-employees may have less autonomy , voice and decision making when it comes to decisions related to business operations . However , the employed physician maintains the same level of autonomy as the independent physician when it comes to the provision of clinical care . However , health care systems must have mechanisms to hear physicians ’ voices to assure the best possible continuation of patient care . health insurer reported in November 2023 that it has 90,000 employed or affiliated doctors ; that equals approximately 10 % of all physicians in the U . S . This will allow them to control more of the health care delivery system . As reported , their profit margins have declined in the past couple of years as their company absorbs more physicians and takes on more patients who have complex health conditions . However , the insurer expects those margins to come back up in 2024 and beyond .
One specific health care system is not the answer for every physician . Likewise , one independent physician owned / managed practice is not the answer for every physician . Every physician needs to find a position in the best situation that fits the ideal practice , to care for their patients .
Whatever situation physicians find themselves in , they need to be the clinical health care leader and be intimately involved in the delivery of the highest quality clinical patient care . And none of us should lose sight of our most sacred duty – to care for the patients who place their trust in us , their physicians .
Dr . Anderson practices sleep medicine and hospice and palliative medicine with Baptist Health Medical Group and recently retired as Vice President and Chief Medical Officer for Baptist Health Louisville .
Our biggest threat today is not health care systems and physician-employees . Rather , it is the threat of medical care being negatively impacted by health insurance plans , particularly Medicare Advantage plans . Patient care is not being delayed or denied by health care systems or physician-employees ; it is being delayed and denied by these insurance plans . Additionally , as a result of these tactics and the added cost burden of appealing delays and denials on the independent physician practice ( and the employed physician practices ) the cost of providing exceptional care rises . Independent groups are driven to seek employment with a health care system or to be financed by a venture capitalist group . Alternatively , independent physician groups may gravitate toward membership-based models of care to the patients who can afford more timely and accessible care .
In addition to the above , the other increasing threat that may not have been totally realized yet , is that the country ’ s largest
OPINION January 2024 27