Episode 136: Doctors are Selling Out and Why You Should Be Worried
The Paradocs Podcast with Eric Larson
Release Date: 07/10/2021
Episode 154: Rethinking Vaccine Mandates and the Omicron Variant with Dr. Monica Gandhi
The Paradocs Podcast with Eric Larson
Vaccine mandates, mask mandates, boosters, and variants have been a constant source of debate and controversy with the pandemic. My guest today is Dr. Monica Gandhi, an expert in immunology and infectious disease who runs the HIV clinic at UCSF. She has been a fairly prominent voice in support of the mask and vaccine mandates in her home state of California and city of San Francisco. She returns from her visit in June for SARS-CoV-2 in which she guessed that it wouldn't evade the vaccine or prior infection (spoiler alert: she was right). Do Vaccine Mandates Make Sense? Dr. Gandhi is...
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Episode 153: Crowd Health is Go Fund Me for Health Care on Nitro with CEO Andy Schoonover
The Paradocs Podcast with Eric Larson
What happens when you take Go Fund Me and put it into an ecosystem of likeminded folks who want to build a community to care for each other's health care expenses? You get which draws upon some of the concepts of crowd funding for one time health care expenses within its community. By taking people from all over the country and putting them into a community where there are expectations of caring for others, Crowd Health offers a solution to paying for health care expenses without breaking the bank. Is Crowd Health Insurance? If you've been paying attention to the US health care...
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Episode 152: The COVID Drawdown
The Paradocs Podcast with Eric Larson
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Episode 151: Health Care for Those Who Don't Earn High Wages with Dr. David Berg
The Paradocs Podcast with Eric Larson
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Episode 150: Make Sure Your Health Insurance Broker is Working for You and not the Insurance Company with David Contorno.
The Paradocs Podcast with Eric Larson
When you run a business, one person you usually meet and hire is a health insurance broker. In theory, these brokers work with the employers to secure the best deals for health insurance to meet the company's health care objectives. However, in practice, the brokers serve as a sales force for the insurance companies who lavish them with bonuses, trips, and gifts. The seedy underbelly of the health insurance broker industry is that they are really not working to save money or get deals for their clients - the checks are written by the insurance carriers and that's who they answer to. Who do...
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Episode 149: Is Asymptomatic Spread of SARS-CoV-2 a Thing? with Daniel Halperin, PhD
The Paradocs Podcast with Eric Larson
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Episode 148: Urgent Care as Primary Care with Dr. Juliet Breeze of Next Level Medical
The Paradocs Podcast with Eric Larson
There are a lot of urgent care clinics all over the country. But few of them, to my knowledge, also operate as regular primary care clinics. But that is exactly what is happening today in the Houston, Texas area with the emergence of Next Level Medical. If you think about it, it makes perfect sense to leverage all the facilities needed for a primary care clinic - exam rooms, physicians, etc. and use it to deliver regular and sometimes non-urgent care. We've discussed before that lower the cost of care with transparency so this seems like the next logical step with urgent care. We...
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Episode 147: Has the Pandemic Led to Infants Losing IQ? - with Sean Deoni, PhD
The Paradocs Podcast with Eric Larson
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Episode 146: Explaining COVID in 11 Minutes with Dr. Eric Larson
The Paradocs Podcast with Eric Larson
Imagine yourself in California at a clearing in a large forest. And it’s on fire. There are three groups of people standing before you. A large group is screaming and running around pointing at the fire. They’re yelling that we need to do something, anything we can to stop the fire. Meanwhile, there is another group (not as large) with their backs to the fire. They are mocking and ridiculing the group running around panicking. They tell them to calm down and to stop ordering people around. They insist there isn’t anything wrong at all. Of course, the largest group of people are...
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Episode 145: Surgery without Insurance with Dr. Keith Smith
The Paradocs Podcast with Eric Larson
A lot has happened since we last met with Dr. Keith Smith from the back in 2018. . We also spoke about how the system was rigged to enrich the hospital systems, insurance carriers, and PBMs (what's new right?). So what's happened since then and how has the center done with the pandemic? Is the Surgery Center of Oklahoma Thriving or Just Surviving? Not surprisingly, Dr. Smith says that the center is doing just fine and has increased its market share from other states. Additionally, the international community from Canada is now being allowed to come back into the US for their...
info_outlineEssentially, there are two main ways to classify physicians - independent or employed. Today's health care in the US is becoming increasingly consolidated as health systems and corporate entities (venture capital groups, etc.) are purchasing physician practices. With the advent of the pandemic of COVID-19 and the partial and complete shutdowns in medicine over 2020, the trend of selling practices accelerated. More and more physicians are now employed by someone - either a hospital system or corporation - eclipsing 70% of all physicians.
The era of independent physicians may be coming to a close if these trends don't turn around. The question we should be asking is why is this happening and should we care?
What are the Trends?
The Physician Advocacy Institute surveyed physicians over 2019-2020 and found that there was an acceleration of physicians selling their practices to hospitals and corporate entities. This was not unique to any specific region of the country. You can see their paper here and it is clear that this is a trend that is not going away any time soon. Over the last two years, 48,400 doctors left independent practice and moved to employed status. Nearly half of all physician practices are now hospital or corporate based leaving an ever smaller base of people who can be nimble and innovative in the health care space.
It is important to point out that many I have spoken to over the past two years have left big systems and struck out on their own to be disruptors in the space like Dr. Randy Lovell, Dr. Richard Rosenfield, Dr. Diana Bitner, and others.
Reasons Docs Become Employed
- Cash out for retirement
- Avoid overhead/business frustrations like meeting payroll, etc.
- Market swings
- Paying off student debt (usually ~$250,000 from med school and undergrad)
- Perceived stable/reliable income
- Increasing regulations and reporting for things like value based care. MediCare reporting and data mining.
- Electronic medical records
- Audit processes
Why Docs Leaving Independent Practice is a Problem for Us All
- Increased health care costs
- Less competition
- Less innovation in how to deliver care
- Prescription drug plan restrictions (and increased costs)
- Worse autonomy
- Increased utilization of midlevel providers
- Stagnant pay because no risk taking
Doctors are increasingly becoming casualties of bigness in medicine. Both through health systems and corporate entities like venture capital groups.
show notes
Episode 136: Today's show
Survey on Physician Practice Trends in the US 2019-2020: This is the article we discussed regarding what's going on with physician practices.
Physician Advocacy Institute: This is organization who conducted the survey and is committed to keeping a vibrant marketplace for physicians by helping advocate for them and providing resources to aid in their practices.
@PhysAdvocacy: Twitter for the Physicians Advocacy Institute.
Episode 088: Dr.Lovell in leaving corporate medicine to practice orthopedic hand surgery in a new way.
Episode 115: Dr. Bitner on leaving corporate medicine to practice OB/GYN in an innovative model.
Episode 117: Dr. Rosenfield on leaving corporate medicine to practice surgery in a more innovative way.
Doctor Me First: Today's sponsor and a sister show on the Doctor Podcast Network hosted by Dr. Errin Weisman.
Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts.
Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website.
Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them.
YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page.
Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
