It wasn’t only the size that differed. This huge practice is part of one of the two major hospital systems in my area. Both of these systems have been gobbling up doctors throughout the region in a competition to build the largest organization, presumably to attract the greatest number of patients.
Recently the same hospital brought a major orthopedic practice into its fold.
I read of one instance when the hospital offered each physician in a different coveted practice a bonus of $500,000 if they would sign up. They eventually did.
A few months ago, my new primary care office referred me to a cardiology group, also a part of the same hospital. And to a pulmonary group, also a part of the same hospital.
I can understand why this type of arrangement would appeal to doctors. They no longer have to be concerned with insurance claims and malpractice coverage. My former doctor had to hire several people just to handle all the paperwork. And malpractice insurance has been an increasing worry for physicians in our litigious society. All that effort can now be centered in one area and the doctors can concentrate on what they trained so many years for and presumably love to do.
I know all the paperwork had, in the past, detracted from the joy of practicing medicine and many doctors left the field in frustration.
Also, I have no problem with the level of care I received by this arrangement. Furthermore, the concern and friendliness I sensed from receptionist to nurse to schedular to doctor seemed genuine.
In spite of the excellent care, however, I do worry about the marriage between physician practices and hospitals.
Suppose I had a medical problem that required specialized treatment and my family doctor was associated with Hospital A. Suppose, further, A has an excellent associated surgeon specializing in the needed area. On the other hand, Hospital B also has such a surgeon who is world renowned and recognized as the leading one in his field.
Would my doctor recommend seeing the one associated with the opposing hospital? Of course, I don’t know the answer. I do know that such a question was raised in one of the newspaper reports. The response from the hospital was something akin to the following: yes, our doctors are free to recommend whomever they wish. But the comment was extended to: but we would expect significant justification to be provided. My worry was exacerbated by a recent article describing a doctor’s lawsuit alleging his firing was the result of treating a patient outside his home base’s system.
Let’s look at another scenario. Suppose Hospital B had equipment that could treat my ailment and A did not. Would I be informed of it by my doctor or would I be treated by Hospital A with the best they had to offer, but not the best available?
I don’t have any reason to suspect my medical team would advise anything less than what would be best for me. But I have a healthy suspicion that any organization’s desire for the almighty dollar might result in significant pressure on them to stay in house.
The possibility of a conflict of interest seems high. And I suspect, if anyone were to suffer from the arrangement, it would be the patient.