Sunday, April 24, 2011

The End of Family Practice

Or, at least the end of the neighborhood family practitioner who knows everyone's name, some of the same folks he spends time with out on the lake.

This is one more of those reports on the decline of traditional America, at New York Times, "Family Physician Can’t Give Away Solo Practice." It's Dr. Ronald Sroka in Maryland, who's been in practice for 32 years. He was looking to sell the practice, but no buyers. Sheesh, he couldn't give it away:

He tried to sell his once highly profitable practice. No luck. He tried giving it away. No luck.

Dr. Sroka’s fate is emblematic of a transformation in American medicine. He once provided for nearly all of his patients’ medical needs — stitching up the injured, directing care for the hospitalized and keeping vigil for the dying. But doctors like him are increasingly being replaced by teams of rotating doctors and nurses who do not know their patients nearly as well. A centuries-old intimacy between doctor and patient is being lost, and patients who visit the doctor are often kept guessing about who will appear in the white coat.

The share of solo practices among members of the American Academy of Family Physicians fell to 18 percent by 2008 from 44 percent in 1986. And census figures show that in 2007, just 28 percent of doctors described themselves as self-employed, compared with 58 percent in 1970. Many of the provisions of the new health care law are likely to accelerate these trends.

“There’s not going to be any of us left,” Dr. Sroka said.
RTWT at the link. And there's a video as well, at NYT's homepage.

When my wife and I moved to Orange County, in 2000, to get resettled for my new job at LBCC, we ended up looking through a big fat book of doctors who were part of our Blue Cross HMO. We picked a doctor just by the sound of his name, and we've been happy ever since. It's been just like the family doctor we had as kids. The doctor gets to know you. He's friendly and even offers his own personal counseling if necessary. It feels like the old days.

Yet it's been quite different with the pediatricians. Our oldest son was 5 when we moved down here from Fresno, and the first doctor we found --- also looking in the HMO physicians catalog --- was a prick. When my son was referred to a specialist for breathing problems, we ended up going with the new doctor, who had a large practice in Newport Beach, with about a half-a-dozen doctors. We're still visiting that office. Our youngest son is 9 and he's had a couple of different doctors from that medical group, but for a while it was just one women who was a specialist on learning disabilities. She helped us with some attention issues my son was having, and it worked out really well. But it's definitely a crap shoot if you don't have good references. You're picking names out of a book and ending up with these fancy, modern multi-physician practices where you'll be lucking if the doctors remember your kids' names. It's a nightmare, frankly, especially with a baby. So I can relate to this story about Dr. Sroka in Maryland. It's just him at the office. Unless he has some other local doctors to fill in for him on call he's screwed. That's why no one wanted to buy his practice. Here's the quote from NYT:

Indeed, younger doctors — half of whom are now women — are refusing to take over these small practices. They want better lifestyles, shorter work days, and weekends free of the beepers, cellphones and patient emergencies that have long defined doctors’ lives. Weighed down with debt, they want regular paychecks instead of shopkeeper risks. And even if they wanted such practices, banks — attuned to the growing uncertainties — are far less likely to lend the money needed.
That's interesting. It shows again how social changes --- especially affluence and the pursuit of leisure --- have influenced the way coming generations view traditional occupations.

In any case, what can you do I guess?

More later ...