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Where did our family doctor go?

By Jay MacDonald ·
Friday, November 16, 2012
Posted: 10 am ET

While we were all watching the fireworks surrounding last summer's Supreme Court battle over President Barack Obama's historic health care reform, more than a few of our family doctors were quietly boxing up their belongings and heading to greener pastures, if not out to pasture.

One of the unfortunate side effects of the Affordable Care Act is that the investment it requires in health care communications, quality documentation and patient management may prove beyond the means of the kindly family doctor you've known for years.

"Probably the most dramatic effect on primary care physicians as fallout from the Affordable Care Act is that they no longer want to continue in small private practices and instead are joining larger physician groups or becoming attached to hospitals," says Dr. Ron Greeno, who chairs the public policy committee of the Society of Hospital Medicine, a trade group for hospital-based health care providers.

According to Greeno, about 50 percent of physicians in this country now work for hospitals, while only 12 percent consider themselves sole practitioners. "Independents have trouble making the economy of scale work to stay in business," he says.

No, family doctors are not disappearing, exactly. In fact, they're in demand like never before. The Association of American Medical Colleges says we could be short 21,000 primary care doctors by 2015.

But the growing demand today is coming from large physician groups that are staffing up to form health care networks called "accountable care organizations," or ACOs. With a little patient management and coordination with other providers, ACOs are poised to share in the money they save Medicare, the 800-pound gorilla and No. 1 payer in America's waiting room.

"One of the reasons for the exodus is, if you look at the ACO regulations under Medicare, one of the requirements is that they have to have a primary care component," says Dr. Greeno. "They don't have to have a hospital or specialists, but they do have to have primary care physicians."

All this sudden consolidation will eventually be good news for your family, your health insurance and taxpayers in general if health care reform achieves its goal of containing medical costs while rewarding quality, not quantity, of care.

In the meantime, be sure to ask your family doctor to notify you in case of any change of address.

Follow me on Twitter: @omnisaurus

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November 30, 2012 at 6:37 am

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Alan R.
November 22, 2012 at 10:12 am

President Nixon signed off on Managed Health Care in the late stages of his office, somewhere in the late 70's. It started in California and once the genie was out of the bottle the profiteers got in the game.
How many Billionaires are running these companies and how much do they contribute to our Congress to keep Healthcare under there control.
The Government has always steeped in too mess with our lives at the cost of a lower quality of life for the Middle Class.

November 21, 2012 at 9:45 pm

I am currently a nurse and have been for many years. In the past Doctors made the decision when a patient was ready to leave the hospital. Hospitals were non profit. Now they are corporate owned and have share holders. Doctors do not decide when a patient leaves the hospital. A panel of three people called utilization committee decides that. They based it on a score. If a patient doesn't acquire a certain score they are. discharged from the facility. Another thing to they do not get better in a hospital. They are send to a rehab facility, another name for a nursing home. Then to, Insurance companies pay the medical centers a flat rate. The sooner they get you out the bigger their profit.

Amy Auger
November 21, 2012 at 7:55 pm

I don't think that anyone is saying that the health care system of paying in this country is great. But fiscal conservatives generally agree that a. we can't afford Obamacare, b. putting government in charge of anything has very rarely been a good thing and c. reform needs to come from the private sector. Remove the restrictions placed on where and how people can access healthcare, reform tort law in each state and we will have a start.

Also, I would like to see the facts and figures that show we don't have the best health care system in the world!! Google "British health care" and you will be amazed at how "wonderful" their system is. Or just speak to a Canadian resident!!

Joyce Morris
November 21, 2012 at 7:23 pm

Those of you who are on the bash Obama bandwagon must have been in a coma for the past 30 years or so if you think there is anything new in the practice of insurance companies dictating medical care. People are no longer allowed to enter the hospital or remain there as long as good medical care would dictate. The insurance companies and hospitalization committees decide how much care you need, not your doctor. They have been doing so for many years.

Another note: The U. S. health care system leads in world in only one category: dollars spent per person for health care. We do not lead in results, but we are just about double the next closest country in cost. Considering how poorly the U. S. Congress manages everything else, why would anyone expect an economical and well-planned program? Too many lobbyists who don't care about health care, just profits.

November 21, 2012 at 7:05 pm

Now I can see how it is to live in Canada and Europe. Thanks to oBaMa!I guess my Doctor will have to learn Spanish,