How private practice must face the 'shrinking reimbursement dollar'

Steven Waronker, MD, an anesthesiologist in Alpharetta, Ga., joined Becker's to discuss the physician workforce trend he is most concerned about right now. 

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

Question: What physician workforce trend is concerning you the most currently?

Dr. Steven Waronker: Since the mid-'80s when I went into private practice, the pendulum has simply swung back and forth with no clear trajectory on how to best handle supply/demand, all in the face of a shrinking reimbursement dollar. Entities like MedPartners and PhyCor were the early equivalent to the current day private equity players. The true challenge is simple to understand and perilous to finally address — and no one wants to face the hard facts to fix. There will be a true physician shortage for years to come, and all physician parent employers must be middlemen. A slice of the pie to the partners or owners by definition must make delivery more cost-effective, or there is less for the physicians.

The conundrum so far has been somewhat mitigated by the ability to increase payments from payers as size and scope via mergers and acquisitions affords this opportunity. Going forward, it will mandate the ability to do more with fewer practicing professionals or finally acquiesce to accept that the salaries for physicians will stay flat or even decrease.

I am mostly an optimist, and for many years of running a large anesthesiology practice when my partners worried or whined about future income, I had two responses: First, none of us will ever worry about job security, and second, I would then send a picture of the physician parking lot, which tended to be flush with pretty vehicles. 

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