Editorials

Private practice physicians struggling

By Gary J. Vicik

Recently I attended a joint meeting of the St. Clair and Madison County medical societies. The speaker was U.S. Rep. Mike Bost, newly elected Republican from Southern Illinois. My reason for attending was to hear if Congress was aware of our plight as small independent private practices struggling to survive in a sea of burdensome, meaningless regulation and reduced reimbursement.

What I learned was that Congress passes laws that then go to various agencies for implementation, and those agencies create the rules to accomplish the intent of the law. Congress in most cases is unaware of the unintended consequences of the agency rules since there is no oversight or feedback. In our situation, small private practices do not have the finances to accomplish the costs of the implementation of ICD-10 and EMR. Besides the cost, the slowdown in patient flow further financially harms this group.

As a result, we are seeing many practices being purchased by hospitals and venture capitalist entrepreneurs who then employ the physician and dictate parameters in which they must work. All this results in a large number of unhappy physicians since our promise is to work for the benefit of the patient.

Since many of us can no longer practice as we have in the past, we are choosing early retirement, reducing further the shortage of excellent, capable physicians. But don’t worry, there is a strong political movement to graduate nurse practitioners to the status of independence, who then will be happy to take the place of the purged physicians at a more reasonable cost.

I have now completed 40 years of private practice. I truly love the freedom to exercise my expertise, but wait, can I really do that? I must get permission to prescribe certain medications, often facing denial or excessive cost to my patient. I am being financially pressured to lower my standards in order to lower the cost of health care. But I can take comfort in that the middle layer of managed care organizations are making profits and can reward the top executives handsomely and also lobby to their advantage.

Most sadly, the meeting with Bost was attended by mostly older or retired physicians; the young physicians I guess are OK with this situation because they never have been given the opportunity to enjoy the freedom and rewards of private practice.

As of now, I still can get up in the morning and go to work, not because I have to but because I love it. Under the current changes I might feel otherwise.

Dr. Gary J. Vicik is in private practice at Dermassociates LTD in Belleville.

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