5 big challenges for gastroenterologists + why to consider a cash-pay model

Gastroenterologist Gilbert Simoni, MD, of Advanced Gastroenterology in Thousand Oaks, Calif., discusses the key challenges and opportunities for gastroenterology physicians today.

Question: What are the biggest challenges you're facing today as a gastroenterologist?

Dr. Gilbert Simoni: There are five key challenges for gastroenterologists today:

1. Lack of society support in getting reimbursed for what we deserve to get paid.

2. Being bullied by insurance companies on [a] daily basis.

3. Lack of transparency from insurance plans to their consumers (our patients), which in-turn creates significant tension between patients and my office staff, causing mistrust of patients toward doctors.

4. The bogus carrot-on-the-stick for supposed "quality" of care, which absolutely makes no sense and is geared towards reducing physician reimbursements while having no real impact on patient's quality of life or care.

5. Constant and growing paradigm shift towards forcing physicians to succumb to employment model of practice all over the country, making it harder and harder to have a non-biased, patient-centric network of physicians for patient referrals.

Q: How has your practice changed over the past three to five years?

GS: I have become a slave to my practice, at the moment that I am writing these responses, it is 1:25 a.m.; I just finished my paperwork for today. With all the strict documentation needs, difficulty with EMRs and the need to increase volume, there does not seem to be much time for personal life. Since I am also a solo practitioner, I have to wear numerous hats: CEO, CFO, marketing director, customer service manager, administrative HR, business administrator and many other functions above and beyond the practice of medicine.

Due to the sheer amount of burden that is placed on practices (especially private practice), I also have to have twice as many staff members than 10 years ago which increases the cost of doing business and overhead. So, in short, practice of medicine has become torturous over the last three to five years! The toughest part is that I truly love what I do and enjoy being able to make a difference in peoples' lives as well as prevent disasters (colon cancer, esophageal cancer, etc.).

Q: Where do you see your practice evolving over the next few years? What are your biggest opportunities for growth?

GS: In the case that I survive the paradigm of forceful push toward employment and stay independent, I see my practice becoming more efficient by accepting fewer patients with awful insurance plans (while spending more time with each patient). I may be forced to completely get out of contract with Medicare (as the "quality" measures become more stringent and difficult to adhere to for a solo practice); [and] may have do the same with most other insurance plans. I have to increase cash-based mode of practice (move towards a VIP-type practice and/or offer cash-based services) and cater to patients that are able to afford the cost of a true quality physician.

Otherwise, in case that I do not survive the paradigm, I see closing the doors to the practice that I have worked so hard to create and grow, and either become an employee of an institution or pursue a completely different career outside of medicine!

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