Commercial owners are taking over infrastructure and primary care medicine

They are, of course!!! I went to high school with a guy who became a radiologist, he worked in the US for a few years, but then moved overseas. He, and 6 or 7 other ex-pat radiologists, have a wonderful practice over there. They seem to find it very relaxed to practice that way, and they love the flexible schedule. They’re also very clever, as between them, they can cover quite a few US states. My old classmate, for example, is licensed in NY, NJ, CT, and I think PA. I haven’t been in contact with him in over 10 years, I wonder if he’s already retired. He once mentioned to me that this is becoming more and more common, he knows of an Indian radiologist that did a similar thing in India after living in the US for a while. In that case, he and his wife wanted to raise their children in India. And he earned a fabulously higher salary than any doctor could ever earn in India locally, even as a radiologist!

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It may very well be that 57% of non profit hospitals generally have hospital owned medical practices…but that is irrelevant to the point that independent primary care practices (of the type written about in the article) are rapidly being replaced by corporate owned facilities. Read the words as written…independent, individual doctor owned primary care practices. Not hospital owned satellite clinics or hospital based family practices but a primary care doctor’s office with the individual owner (s) making decisions on how it’s run. For example, say, a primary care practice like those that had offices in the medical building where I had my general dental practice.

Are you unaware that even non-profit, faith-based contract out some of their clinical work to private/corporate groups? Well, you’re not now!!

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Pretty sure that is not true.
If there’s one thing about Americans, it’s that they believe no one can be as good as them at anything.

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This is a news story only 10 years too late; it’s been going on for at least a decade that I know of - and that’s because I had conversations with both my primary care doc and my dentist about it.

The doc decided to “build his practice”, added 4 physicians and a couple of nursing assistants, kept expanding space in the strip mall, and finally sold the practice to the local university health system when he retired. He was “an employee” of the system for the last few years.

My dentist said he had that option, but doing so would have required that he rename the business (it was “Dr. Zwhatever”) into something more generic (“Smiley Dentistry”) and then add a couple of other (young) dentists to the practice. Then he could sell it to a roll-up company and exit. Instead he chose to find a young guy willing to pay him over time for the assumption of the practice, and it carries on in the same location and with much the same clientele. There has been turnover of about 2/3 of the workers, I’ll say.

Anyway, nothing new here. Same old same old.

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I agree with your perspective but still in the larger scheme of things blame private insurance.

BTW further up I mentioned the corporate positions would not last. Doctors can leave as contracts end. Their groups come and go as well.

I am more biased, dad was trained Trinity Dublin. He was the best in his specialty for a bit over three decades. Psychiatry, Hartford CT region.

One English friend told me several years ago that Trinity is better than Oxford Cambridge the sister schools because there are no legacy students enrolled in Trinity.

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I trained at the Cleveland Clinic. There are excellent physicians from Canada and England, but they set a very high bar in those countries. Typically you don’t run into physicians in these corporations that are taking over staffing in hospitals from either country. Most of the ones in these corporations are from the middle east, India, China or South America/Central…doc

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Now honestly I am confused. We were talking about larger American insurance/pharma corporations taking over clinics to control PCP actions. To enlarge the population enrolled in Medicare Advantage plans and cut their costs is the topic.

Now you are talking corporations or doctors’ groups that have foreign nationals? I see a big difference here.

Indian doctors can be absolutely excellent and trained here or in India. Many of them were raised here. In the numbers game of finding sheer talent in a population the Indian diaspora has major advantages.

Yes, we were talking about large corporations taking over PCP groups all over the US. Then I mentioned that it is happening in multiple specialties like radiology, emergency medicine, hospitalist, and anesthesia for example. I worked for one of those corporations that hold anesthesia contracts for over 200 hospitals in the US. I mentioned that when the hospital awards the contract to one of these corporations, the corporation brings in cheap labor. The motivation for these changes is financial, not quality nor efficiency. The new physicians are given an incentive-based guidelines like if you have a headache, don’t get sinus films which cost hundreds of dollars, but get a cat scan which costs over a thousand. These are the things that are changing in health care because of big corporations. Physicians don’t follow their training, they follow hospital or insurance guidelines designed to maximize profit. To incentivize these guidelines, corporate holds back 10% of your payments and gives them to you as a bonus at the end of the year depending on meeting the parameters they set and you never get the bonus if they can help it. Its rigged for the major corporate players and patients/doctors are caught in the middle…doc

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Here’s one of those groups that just went bankrupt (read that as “equity is wiped out and now the bondholders own the company”). PE loaded it up with debt, then the price of labor rose during covid, then it had disputes with insurers, and then as rates rose, it couldn’t pay the bills anymore.

Excerpt - "The failure of Envision illustrates the risks of layering debt onto a business in a rapidly changing industry. The company went from generating more than $1 billion in earnings before interest, taxes, depreciation and amortization in the year ended September 2020 to less than $250 million two years later, according to people familiar with the matter.

Other private-equity backed physician-staffing companies, which help hospitals staff emergency rooms and other departments, have also suffered. Bonds due in 2025 for TeamHealth, which Blackstone bought for $3 billion in 2017, are trading at 51 cents on the dollar, according to MarketAxess."

I would support a “clawback” law (no, I have no idea how to write it) that would say essentially: if you acquire a company and increased its debt load by x% in the first 3 years, then declare bankruptcy within 5 years, the owners will be personally liable to return any profits, loans, or other enhancements to the corporation or its successors and investors.

I am tired of seeing stories of how decent companies are rolled up, milked dry, then bankruptcy declared and they walk away with the profits. No, Gordon, greed is NOT good.

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Ah, it’s those brown-skinned ones with accents that you don’t like…

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I am late to the party but:

The COVID-19 pandemic accelerated the decade-long practice of hospitals and other entities acquiring physician practices, as physicians struggled to maintain private practices, according to a report from the Physicians Advocacy Institute and Avalere Health.

In 2019 and 2020, 48,400 additional physicians left independent practice and became employees of hospitals or other corporate entities. Nearly half that growth occurred after the onset of COVID-19.

The benefit for doctors is that they no linger have to deal with billing and arguing with insurance companies. Also they have a 40 hour work week and have regular hours. Those doctors have become employees and no longer small business operators. That can be a problem as the docs are subject to the whims of their employers and so are their patients. No flexibility allowed, rigid rules and regs. Patients ain’t patients anymore but revenue streams for the owning corporate structure.

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It could also be that he is referring to doctors from countries where an MD is an undergraduate degree (college) rather that a doctorate (graduate school).

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I don’t know how you can feel so confident in making this statement (beyond knowing just enough to be sure you’re right…but not enough to realise you’re wrong) seeing as further up you were opining quite dogmatically that the corporate involvement discussed in the thread opener pretty much didn’t exist. Stating , in fact, that the reporting was “lazy, lazy, lazy” Are the rose coloured glasses losing their tint?

The reality is that the impact of corporate ownership of healthcare staffing groups…hospital based as well as primary care…is so prevalent that, sure, doctors can leave when their contract is up and go … where? To another situation that’s corporate owned?? I’m willing to bet you wouldn’t be able to find as many as 57 hospital groups nationwide (that’s 57, not 57%) that have 100% faculty appointments for clinical services.

physiician,

Would you have a feel for how many of those hospitals are non profits? Not just the 200 you were alluding to but the overall count of bought up hospitals?

I would guess that the majority are for profit, but only an educated guess. Also, I be one of those dark tanned doctors…doc

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What? You’re not melanin-deficient?

DB2

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Whatever they have planned to do. Could be another solo practice. Joining a concierge practice service. Or even retiring. Remember: the some doctors will have significant assets (sold their practice) and thus be able to do whatever they choose (within reason).

I think you might also be unaware of the extent of corporate/hospital ownership of medical staffing groups…and the practical implications.

Solo practice, for the most part, is a past tense business model …certainly for younger graduates (pretty much anyone under the age of 50)…simply because of the overwhelming expense of operating a medical facility in today’s business environment. That also includes “concierge” practices (which is pretty much the business model I used) The market is somewhat saturated nowadays and, yes, corporate ownership has intruded here. Somehow, I can’t quite imagine a concierge practice absorbing any Medicare Advantage beneficiaries.

I don’t think “retirement” is necessarily a reasonable suggestion for those who’re up and coming and looking to make inroads into their debt burden from their training. Come to that, not such a welcome outlook for those of us who might have cause to imagine our own medical needs moving forward.

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