Even an independent doctor can be "owned."

Even a completely independent doctor in his own practice, can be owned. You see, the corporate world knows how to make it look like a doctor has control of his practice, all the while they are pulling all of the strings. It really is a deception that is hard to identify, but you can figure it out if you know what signs to look for.

If the sign on the door identifies that practice as a subsidiary of a huge network, then the independence of each and every doctor in that subsidiary practice, will fall to the level of physician independence of the organization. Now believe me when I say that, in general, the bigger the system, the less independent the doctors will be, particularly if there is no other major competing system nearby. We have talked about exceptions like Kaiser, where all of the doctors work for themselves in a uniquely separate group, and there are other organizations as well that work this way, and I will get around to listing some of them, but I need to get a good look at their operation before I can comment.

Another way that doctors can appear independent and yet be owned, is in very small practices that get most of their referrals from one source. You will see this often when one system, and or one major hospital dominates an area, and control the primary care doctors. That is what big systems like to do, control the primary care doctors, and secretly direct their referrals to the specialists that support their hospital, and their labs, and scanners that rake in the dough. This is probably still OK as long as there is competition in the region. But watch out.

Most doctors really aren't very comfortable with this arrangement, but it can sneak up on them over time. The local hospital slowly buys up primary care practices, and employs those doctors, and after a while, the specialists become aware that the hospital owns 20%, 30% or maybe even 50% or more of their business. Then maybe they get a call from the hospital CEO who tells them how it's going to be, and if they don't like it, maybe the referrals can go to someone else, or maybe they will even go hire some doctor to compete head to head with them. Depending on the doctor's willingness to say no, they may be out of a job soon, and that is that. It starts out innocently enough, but it winds up like this all too often.

So you might say, how is it that a hospital, or integrated system with hospitals, doctors, and insurance, is able to just go out and find a doctor to compete with an independent local physician. Doctors don't just grow on trees, and there is a shortage that is worsening quickly. What is in it for him. The answer is money, of course.

This brings up one of the most disturbing issues in medicine today, at least that is how I see it as a doctor, and you should see it as a patient. Doctors are selling themselves to the highest bidder. Now I doubt you are surprised by that statement, but you should be shocked because of the ramifications of that fact. And all of this leads us to another rule.

Fifth Rule:

Any doctor that gets paid substantially more money, by an employer, than is justified by his personal productivity and time on duty, less overhead costs (with few exceptions) is basically just the medical equivalent of a prostitute.

This is a very strong statement I know, but it is fundamental to what is wrong in healthcare today. A small group of doctors is making it worse for all of us, doctors and patients alike. In the end, it will sell us all out, along with the doctor patient relationship.