Imagine that you are a family practitioner. You went to college. You majored in microbiology or chemistry and made all “A’s.” You are the guy that no one wanted to be in class with because you would do whatever it took to make an “A.” You would ruin the curve for anyone else in the class. You got in to medical school and endured this four years of educational boot camp. The first two years were about 6 years of graduate work crammed in to 2 years. The next 2 years consisted of taking care of patients while sleep deprived and while some insecure (and sleep deprived) and by now psychotic resident berated you at every step. You manage to graduate and find a good training program for your residency. You work extremely hard and do well. You begin to feel the incredibly satisfying feeling of using your knowledge to make a difference in people’s lives. You pass your boards and move to a town that has been desparate for a doctor just like you. You meet the daughter of a nice family in town and before you know it she is your wife and you have 3 children and are living the dream. You have a busy medical practice taking care of whole families. You are delivering babies then watching them grow up in your practice. Families from nearby towns actually travel to see you rather than go to their local yocal who is not nearly the physician that you are. All is well. Then…
A large hospital chain that employees the physicians whose practices you have hurt through no action of your own other than provide great care, decides to open a clinic in your little town. You are scared. You have a lot invested in this practice. You have spent several years of your life to get to this point. These hospital guys pay you a visit. They tell you that you can go to work for them or they will bring 5 competitors to town to destroy your practice. They tell you that they have seen to it that you will no longer be on any of the insurance networks you have been on up to this point. They tell you that this is all legal and consistent with their mission as a faith-based hospital chain.
You want to throw up. You decide to take their offer. They pay you about 20% less than you were making but absorb some of your overhead costs and malpractice insurance. The contract is for two years. About 6 months into it you realize that you don’t have to work as hard as you had been working in order to have about the same standard of living. Things seem pretty good. You miss having control of your practice, though. You miss being able to not charge people who you know need a break from time to time. You start to take vacations that you didn’t used to take. Your paychecks continue coming in even though you are on the beach. This is great. Once in a while a patient complains that you aren’t as available as you used to be, but this doesn’t seem to bother you as much as time goes by. The hospital chain brings the doctors they threatened you with to town anyway. You don’t care much because you are being paid anyway. You take even more time off. This is a cush job! You get to go to all of your kids soccer games and have time for golf and all sorts of woodworking projects.
Your two years on the contract is about up when the hospital guys show up to discuss renewal. You’re already ahead of me on this arent’ you? They offer…ready…half. Half of what they had paid you the last two years. Ouch. Oh, and by the way, the malpractice insurance, should you decide not to accept our offer requires a “tail” policy that costs $100,000, as it doesn’t give coverage for past events that might crop up in the future. Oh, and by the way, all of the patients that identified themselves as patients of yours now will now see anybody in the office and we have all of their medical records in our electronic system and you can’t take them with you if you leave.
So, that part of your practice that was “yours” is gone. You have inherited a large insurance liability, one that you probably cannot afford. You can’t affford the home that you are in now and can’t sell it in the current market. The standard of living to which your family has become accustomed is gone. You take their offer. You lose your home in a foreclosure and use up all of your savings in the transition to your new down-sized life. You hate your job now. You become so bitter with how this has all ended up after all of your hard work that patients don’t want to see you anymore.
I wish I was making this stuff up. For all the glitz, this is the real mission of our wonderful “not-for-profit” hospitals and their networks.
G. Keith Smith, M.D.
