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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 21, 2012 at 3:49 pm

well mary if u dislike everything in this country and the way its going you can be part of the solution and try to help work out these problems or u can be a part of the problem, just like you have been! I suggest if you dont like it MOVE to another country! BUh Bye

November 21, 2012 at 3:26 pm

I agree with Sharon. 15 years ago I had a "family" doctor, actually had one all my life, starting with father, adult life with son. Then along came the HMO's, now up and coming doctors cannot afford their own pratices, and are forced to be a part of the group health organizations. So I agree Sharon, this has nothing to do with Obama and is a curse that's been coming of age for the past 20 years. I don't think a person can find a doctor anymore who actually knows you, as a person and not a quota.

November 21, 2012 at 3:25 pm

Say you bring your car to a mechanic. The mechanic looks at it, does some work, then sends you on your way. 30 days later, you receive half-a-dozen separate bills for equipment, procedures, and consultations involved in fixing your car. You were never told of these in advance, never given any written cost estimate of any kind, yet you are expected to pay.

You'd sue that mechanic. If he did it to all his customers, he'd get slapped with a class action suit and possibly fraud charges.

YET, this is exactly the situation we tolerate from health care providers. You want to reform health care and contain costs? Require complete good faith cost estimates -- regardless of who pays, patient or insurer -- at the outset.

-- mm

November 21, 2012 at 3:00 pm

Obama voters made America drink the kool aide and some are just beginning to wonder why everyone feels Obamized. We will be 50,000 family medical doctors short in the near future and I don't blame doctors for packing up and quiting the profession. Canadian medical professionals left their practices and came to the US to practice 15 years ago because of socialized medicine. NOW here in the U.S the stupid, the illiterate, the illegals and welfare recipiants re elected their gifter and now wondering why they will have to stand in line and wait a turn like other socialist countries for emergency medical help or be refused as Obamacare does not feel that service is important. A beloved President said 50 years ago be Thankful for your Liberty. Obama has done his socialist job to take away our Liberty and make us a socialist counry. Watch...., United Health Care will be our national coverage of Obamacare. Many companies, school districts and unions are now limiting United Health as their only option for group insurance starting 2013, AARP is also pushing Unitied Health Care for Seniors. Goodbye private insurance and welcome to Obamacare. I can't believe half of America was so stupid they didn't see this coming and elected a socialist to construct the downfall of America.

November 21, 2012 at 2:47 pm

I am also a nurse. This problem of reinversement has been going on for years. That is one of the reasons I left the hospital setting - too many critical patients and too little staff and administration of the hospital turning a deaf ear.

Bob obtain accurate info before you start blabbing your republican blather. This crisis has been going long before Obama care. It is a scary situation, but Pres Obama did not cause. Get educated.

Mark S.
November 21, 2012 at 1:59 pm

I find it amusing that NONE of our politicians actually talk about the costs associated with running a practice. When you pay less for a broken arm , you are not cutting costs. You are cutting the income of the doctor or hospital. In Massachusetts (where the lies all began) a doctor pays the highest malpractice insurance IN THE WORLD. Who cuts that cost? Who cuts the cost of the education these doctors need to become doctors? When you have 1/2 million in student loans with a 5-7% interest rate, who covers that cost? As with ANY business the gov't hasn't got a single clue about REALLY cutting costs. How about tort reform so lawyers can't drive the costs of medicine out of sight? Oops, forgot that most of our elected officials are lawyers. Guess that one won't happen soon. If they really want to get serious about containing costs, why not start by actually getting the cost of energy down? That affects everyone. Someone should look at this from the business side of things and look at true ways to cut costs. Why is it that every single person in the operating room (other than the patient) as well as the hospital MUST have malpractice insurance? Why can't they all be covered by one policy; The hospitals? That would cut costs. There are many many sensible ideas that could actually cut costs without destroying medical care. How many can we come up with? When you do, send it in an email to your congressman or woman. Maybe if they get enough suggestions they will start to listen.

John Gerald
November 21, 2012 at 1:37 pm

A recent UC Davis study found that family doctors have much lower lifetime earnings than specialists, which is a big disincentive for medical students to decide to be famly doctors:

November 21, 2012 at 1:27 pm

What a coincidence, this site has been running pro obama care articles for months. Now the election is over, suddenly we are starting to hear about the downside. This item is the tip of a gigantic iceberg of negative things that will happen as a result of this 2500 page bill that no one read and was rammed thru by one party.

November 21, 2012 at 1:00 pm

I agree it is getting harder and harder for the independent doctor in his own medical practice to make it compared to what it used to be. I am a nurse and my husband is a physician in his own independent practice. He is the only doctor in his office and all the costs of running the business, paying his two employees all come out of the money he brings in from his patients. In fact as a nurse working in a hospital I made more money than he did last year, and I didn't have to go to college near as long as he did or have the amount of student loans to pay off afterwards. Several times in the last year with decreasing reimbursement from insurance companies and medicare he has voiced worries that he will have to close his office and go to work for a hospital where he can make more money. He tries to look on the bright side of it and says he won't have the headache of running the business on top of taking care of his patients. Unfortunately these hospitals also place quotas on the amount of patients you have to see which makes doctors have to limit the amount of time they spend with their patients in order to meet the demands placed on them by the hospital. One of the things my husbands patients love about him is he takes his time with them and really makes sure all their problems have been dealt with and that they understand everything. He's known for how well he listens to his patients and how thorough he is, and I'm afraid he could loose that quality of care working for a hospital.

November 21, 2012 at 12:37 pm

My son is in Pre-med (Chemistry) with plans to be a independent family doctor; but I'm not sure that is the best choice today...... So much invested, and an ever smaller return.......