Your doctor has sold his practice: 6 tips for patients

The Affordable Care Act comes with the promise of a dramatic overhaul in what many see as a broken health care system. It promotes the potential for “better all around” – better care, easier access to hospitals, and affordable treatment. It also comes with a price. For one reason or another, the turbulence within the American health care system is causing doctors to shut down, downsizing or sell their practices – keeping fewer nurses and support staff on payroll. With fewer people to help you, your care will likely deteriorate.

When doctors sell their practices to hospitals or networks, the practices are typically restructured. When they restructure, the new arrangement can put the doctor under more pressure to treat you (the patient) more “economically,” so as to generate more income. This can mean ordering tests or prescribing medicines that you may or may not need – things that are more for “let’s just be safe” and would be avoided in a private practice.

What does this all mean for you as a patient? Other than potentially higher medical costs, possible deterioration in treatment, and a lack of personal attention as a person, it boils down simply to a conflict of interest. In other words, there is greater potential for disagreement regarding what is in your best interest according to convention and how the doctor or hospital treats you.

Your doctor has sold his practice: 6 tips for patientsIt may not seem like there is much you can do in situations such as these. After all, you want to trust your doctor and not put yourself at risk. That being said, there are some simple steps you can take to make sure you’re getting the best care possible without compromising your health.

  • First, when your doctor is recommending tests or treatments or hospitalization for you, take the time to ask if you really the treatments – ask if the doctor would do the same for a family member
  • Second, ask for a second opinion to determine if you need the recommended care – this should be your standard reaction when tests are ordered
  • Third, ask the office manager and doctor is there is a performance requirement in the practice to generate more tests, treatments or admissions – these “goals” could be influencing the doctor’s decisions regarding your treatment
  • Fourth, take notes and record conversations with the doctor (on a smart phone or small tape recorder); doctors will be very honest when answering direct questions
  • Fifth, ask the doctor if the recommended treatment complies with national guidelines, or if it is different and why. Don’t know the guidelines? Take some time to research them before committing to any treatment
  • Finally, if you suspect your doctor has a conflict of interest, always get another opinion and if necessary, find another doctor in whom you have complete confidence. There are multiple online databases and forums where patients comment and critique different doctors, facilities and treatment courses – take advantage of the experiences of others

It’s important to keep in mind that above everyone else, you are the one in charge of your care and doctors certainly aren’t out to harm you. To ensure you get the best care at all times, come having researched your condition, prepared to ask questions, and willing to fight for what you need.

Cary Presant is a hematology-oncology physician and the author of Surviving American Medicine: How to Get the Right Doctor, Right Hospital and Right Treatment with Today’s Health Care.

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  • azmd

    These are all great questions for patients to ask, but here’s a question I have: why would these questions not be better directed to the administrators who have “restructured” the physician’s practice? If the doc is no longer in control of how he or she is able to practice, why ask him or her to justify revenue-enhancing strategies that are not in the clinical interest of the patient?

    Putting pressure on your doctor, rather than the practice administrators who are really calling the shots, is just putting more pressure on an already stressed practitioner, rather than where it belongs and might do some good.

    • southerndoc1

      Disagree. I don’t think physicians should be shielded from the consequences that their actions have for their patients. If there is an apparent conflict of interest, it is appropriate for the patient to confront the doc with this.
      I’d add a couple of questions:
      1. Does your doctor have a financial incentive to refer you only to physicians in the same organization?
      2. Are you now charged a “facility fee” for routine out-patient care? If so, how does your doctor justify this? What additional services are you receiving that you didn’t before? (I would also go to your insurer and your employer, if they provide insurance, and ask them why they are paying this)

      • Alison Manders Galvan

        I think I’m somewhere in the middle between you too. Everyone keeps telling us that the day of the small independent practice is over. There may very well may come a day in the not so distant future when we are forced to sell our practice and become employed. At that point, my husband will no longer be in control of his own practice, and this should be disclosed to patients. But also, docs should not feel guilty about following the rules of their employment. It is what it is. Not good for patients, I agree. I didn’t create the system, but unfortunately we have to work in it.

        • ninguem

          “Everyone keeps telling us that the day of the small independent practice is over.”

          If that becomes true, it is not the way the dinosaurs died out.

          A better analogy would be the passenger pigeon.

          Hunted to extinction.

          As azmd said, “predatory maneuvers by healthcare systems”.

      • azmd

        I am thinking that you may not fully realize what it’s like to be an employed physician. If physicians are forced to sell their practices and become employees because of predatory maneuvers by healthcare systems (and it would be naive of us to claim that this is not happening), then I am not sure that as an employee the physician has a strong responsibility to take the blame for how the practice is structured after it is sold and the physician is working for someone else. Just my two cents based on my previous job as an employed physician.

        • southerndoc1

          Agree that it’s a tough situation. I was an employed physician, and didn’t like it.
          But for docs just pass the buck is exactly what CMS, the large insurers, and the medical societies want: the complete end of professionalism.
          The important thing is to educate patients on what they will have lost if they don’t even have the option of seeing an independent physician. Maybe just a shrug and a sullen “Don’t ask me, I just do what they tell me” will get the point across?

          • azmd

            I am not sure that the goal is the loss of our professionalism. I honestly don’t think that CMS and the insurers are thinking very hard about our professionalism at all, except to the extent that they can exploit it in order to have us take on responsibility for things that we really shouldn’t be responsible for.

            At the end of the day, an important part of being a professional is to have control over your work and how you manage it. If we allow, through some misguided notion of what professionalism means, our patients to continue to have the impression that the changes in healthcare that harm them are coming about because of choices that we are making, we are failing to clearly communicate with patients about the reality of the healthcare system they are part of. Without knowing what they are dealing with, they are less able to act effectively on their own behalf. And we are allowing larger forces to make us the bad guys in a situation where our patients are being denied good care.

            I think I’m just sociopathic enough that that’s really not OK with me, and I have set limits on the extent to which I will allow myself to be put in that position. But since the vast majority of physicians rate very low on sociopathy (unlike CEOs and lawyers) as a profession, we are getting trampled.

            On the other hand, I certainly don’t advocate for sullen shrugs and passive-aggressive remarks. I find, though, that with a lot of my patients, a sympathetic “I know, our system really doesn’t always serve our patients well these days. I hope someday it will be different,” goes a long way towards acknowledging a patient’s distress without taking the responsibility for it.

          • buzzkiller

            Is that sociopathy thing really true? I’m not doubting you. I just haven’t seen that before.

      • John Henry

        I doubt the doctor has any say in charging the facility fee, his employers do. He doesn’t have to justify it, the hospital and its lobbyists have already justified it to the CMS and insurers and they have agreed.

  • Suzi Q 38

    Good tips.

  • buzzkiller

    6th: Get out the yellow pages to find a new doctor since yours has just fired you for asking too many questions, making too many demands, and being a general pain in the neck.

  • buzzkiller

    Interesting. Thanks for the link.

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