Dr. Ionescu, a gastroenterologist at Wyckoff Heights Medical Center in New York City, spoke with ASC Review about what is drawing physicians to private practice.
Question: What needs to change so more physicians can open private practice?
Dr. Gabriel Ionescu: The current employment model will drive the talented physicians with a bit of appetite for risk to private practice. The challenge is that each physician is trading in a comfortable [employed] position, albeit with limited autonomy, for potential financial risk. Keeping a practice open will take more effort to comply with government regulations and reporting, so reducing the burden may help. Unlike employment, an independent physician will have to take more charge of the customer service and management aspects. This may affect work-life balance in the short term; long-term survival will depend upon creation of avenues for passive income, although this may be challenging in certain states in which regulations may empower hospitals over smaller practices on building ancillaries such as ASCs. Ultimately, insurers may need to step in, as care in an ASC is cheaper than in the hospital for the majority of private practice patients. Eventually, building and monetizing the equity of the practice should be enough to incentivize physicians to seek alternatives to employment.
Q: What is physicians’ biggest enemy in providing great patient care?
GI: Burnout is a problem interfering with patient care. The largest contributor to burnout likely is the EMR. Although quick data-gathering is great, the order entry and execution at the team level must be flawless to ensure patient satisfaction and great clinical outcomes. It rarely works out in the big systems where the executing teams are overstretched and not always knowledgeable about the care coordination process and the customer service and communication aspects. In addition, the countless hours spent on managing the EMR correspondence, which has to do more with liability management than patient care, will drive the employed physicians out. The administrators come in a close second, by way of completely ignoring physicians’ need for flexibility in patient and time management, thus driving physician burnout. Physicians will look for more autonomy, and if the hospital systems are unwilling to reduce micromanaging, the talent will migrate to private practice or exit medicine altogether.
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