We hear a lot about the death of the independent physician practice. But perhaps the more important discussion is about the death of practicing medicine independently. That is, the days when individual physician groups could operate their businesses and treat patients independently and without regard to the surrounding network of other physicians, nursing facilities, health networks, social workers, case managers, and other support is over. It doesn’t matter whether the physician ...

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A physician I have known for many years recently told me about his decision to enter the world of concierge medicine. His reasoning was telling, saying that it came down to a very simple decision on staying independent or becoming a hospital employee. He liked being an independent solo practitioner, and that was his primary motivation: to maintain independence in a time of consolidation. Richard Gunderman, writing for the Atlantic, tackled ...

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It was recently Nurses Week in early May and there were a lot of adulations being offered on social media and throughout hospitals regarding the appreciation we have for those among us who have chosen to be on the “front lines” of caring for us when ill or injured. As an emergency physician I could speak about the many times a nurse has grabbed me and pulled me into a room ...

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2014 has dawned, and with it more than 2.1 million people have new health insurance under the Affordable Care Act. This, as they say, is where the rubber meets the road. But a new study out of Oregon is challenging a key argument for extending health insurance to millions: that doing so will reduce costly emergency room visits. The study in question showed that when health insurance was extended to Oregon residents ...

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I recently treated what looked like one of those unnecessary patients in one of our emergency departments. You know the ones. The ones that don’t need to be there because they should have gone somewhere else to receive care. She was a 28-year-old woman who presented with lower abdominal pain. Her pain started abruptly in her left lower abdomen. She had no nausea or vomiting or fever. After my evaluation and ...

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Two recent articles highlight the challenges we will face as our healthcare system changes with regard to how care is delivered and reimbursed. The first article from the New York TimesMedicare Panel Urges Cuts to Hospital Payments for Services Doctors Offer for Less, notes that large hospital-centric systems of care do not necessarily serve patients well in terms of cost and sustainability. The second on the front page of ...

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There is a persistent narrative about emergency rooms. This narrative says that emergency rooms are overly expensive places to receive healthcare, that they are a cost drain on the hospitals they are attached to, and that they are a key driver of rising healthcare costs. A RAND study released recently challenges most of that narrative, and lends support to a view that most of us emergency physicians have long held: that ...

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Amid massive change in our healthcare delivery systems and seismic shifts in many regional markets, physicians are increasingly being faced with a simple choice: be acquired or become employed as part of a large healthcare system, or stay independent while offering a compelling service that hospitals and health systems value. The changes occurring in our care delivery systems have generated great interest, innovation, and yes, fear among many in healthcare, doctors ...

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Make small bets during the era of health reform A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be. –Wayne Gretzky Recently, I attended an end-of-year review with one of our hospital partner’s executive team. We reviewed our performance for the past year, and discussed mutually strategic goals and how to improve upon our excellent service. As part of the conversation turned ...

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