There are all types of endangered species. We have heard for years about the dwindling number of American eagles. Over in Africa, the number of elephants is rapidly declining. With all due respect to the profession, here at home there is a group of people whose survival is very much in danger. It’s the independent physician.
For the better part of our lives, many of us have had a family doctor who operated a modest practice and worked long and hard hours to care for his or her patients. They were totally independent and had privileges at a number of local hospitals. Somehow, they managed to find the time to deal with any and all emergencies, regardless of the time of day.
Regrettably, for a lot of reasons, the number of independent physicians is rapidly declining.
There are many outside forces that are causing those doctors to either give up their private practice and become employed by a hospital or just leave the business altogether.
Government regulations have forced doctors to incur heavy costs for automated record keeping and imposed other costly burdens on them. Politicians in Washington continue to penalize doctors who accept Medicare and Medicaid patients. The authorized fee structure, which gets lower and lower each year, is a disincentive to taking these types of patients.
There is no doubt that the major culprit is the health insurance industry that chokes off their income with lower reimbursements and arbitrary decisions dictating how they qualify to be paid. A doctor in Manhattan will be reimbursed $2,000 for a procedure and the same doctor on Long Island will be paid $175. I recently heard the story of the orthopedist who moved his office from Manhattan to Brooklyn and saw his insurance reimbursements drop by 25 percent.
There are plenty of statistics to back up this sad story. Currently the number of independent physicians practicing in New York State is 25.8 percent. The national average is 37.7 percent. The American Medical Association reported that in 1983, 76 percent of the doctors were in private practice. The AMA reports that younger physicians are more than twice as likely to be employed by hospitals and not be out on their own. This is not meant to infer that there is anything wrong with a doctor being an employee of a hospital. You will get the same quality of services, no matter what your status is.
But, having worked with many local doctors for years, I have learned that many of them would like to stay independent, but between the government mandates and the insurance companies, they are being pressured to sign up with a large institution or quit the profession. There is nothing that will happen in the near future that will encourage new doctors to go out on their own or keep highly skilled physicians in charge of their destiny. That is a sad tale, not only for the doctors, but for the patients.
Former State Assemblyman Jerry Kremer is a partner at Ruskin Moscou Faltischek in Uniondale. The views expressed are not necessarily those of the publisher or Anton Media Group.
