Hospital residencies designed to keep physicians in system, physician says

Medical education run by hospital systems is a cycle that's keeping physicians hospital-employed, according to Edward Zoltan, MD. 

Dr. Zoltan, a urologist at New York Health Urology Division in New York City, joined Becker's ASC Review to discuss how education is keeping new physicians away from private practice. 

Editor's note: This was edited lightly for clarity and brevity. 

Question: Why aren't more physicians independent?

Dr. Edward Zoltan: What's happening in medical training — and I think a lot of it has to do with hospitals wanting to keep these residents in their system — is that we're not training residents to be independent. We're not giving the same kind of autonomy to residents like we did 20 years ago. The residents that come out now, they all want to do fellowships because they need to do fellowships, but they don't feel as well-trained. If you ask residents now why they do fellowships, it's not to just get that extra specialty like they used to, it's just that they don't feel comfortable doing that field right now. It keeps the residents wanting to stay in these hospital systems.

I'm in private practice now. I see the numbers. I'm making twice as much now than I did in the hospital. I work with residents, and I see it — they don't want to be in private practice. You have to know how to be independent, because, honestly, when you're working on your own, nobody's gonna cover for you.

Q: What do you think the dangers of this pattern are five to 10 years down the line?

EZ: We have patients that are now forced to seek out a doctor in a hospital system, and hospital systems are notoriously inefficient. We sell our practice to insurance companies in such a way that we tell an insurance company: 'Hey, look, a patient comes to Dr. Zoltan with blood in the urine. He's going to get a cystoscopy, an ultrasound and a CT scan in my office within a week, and at a quarter of the cost of a hospital.' Whereas in a hospital, these patients will have to go through the radiology department for their CT scan. They have to go through the operating room department for this cystoscopy — all that adds work for the patient, because instead of everything being done in one week, it's more disruptive to their schedule, and more expensive for the insurance companies.

Q: What are the solutions?

EZ: Residents should have more discussion and more education from private physicians. Their teachers are hospital physicians and the residents are getting training by doctors that work for the hospitals. They're going to give them their view of things, which is, you know, to stay in the hospital system. If you get more education from private practice positions, you get another view of things. I think this has to do with the hospital industry as a whole not wanting to encourage people to go into private practice, because it's the opposite. It's a competition to them.

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