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Could this be by design? A private practice seems like a waste of resources. Imagine the unused medical devices or the large number of support staff around just

Could this be by design? A private practice seems like a waste of resources. Imagine the unused medical devices or the large number of support staff around just one or two doctors. To quote, http://www.kevinmd.com/blog/2009/02/are-days-of-independent-physician.html http://www.kevinmd.com/blog/2009/02/are-days-of-independent-... `These trends will ensure that the consolidation of doctors into larger groups will continue. Whether this definitively benefits patient care is still unclear, but I suspect that patient outcomes will likely improve as this movement continues.`

jimmybot 14y ago
But why pay the doctor less than the hospital for the same treatment? The doctors can figure out themselves whether it makes more sense from a cost perspective to join a hospital, a clinic, or to remain independent.
- Evbn 14y ago
  Because doctor pay is only a portion of overall cost for the patient's care, and it s more efficient to deliver services through a hospital.
  - bdcravens 14y ago
    Perhaps, but why is there an attitude that doctors are evil and that all of them are so well off that we shouldn't care what happens? Seems to me that's the prevailing attitude. They're continually getting pinched: Tens of thousands for malpractice insurance. Hundreds of thousands in debt just to get to the point where they can practice. Seems reasonable if you have a good upside, but that upside keeps getting pressed on. I don't see how that can continue without serious reform in the other direction (tort limits and forgiveness of student debt for medical school)
    - frozenport 14y ago
      I think its rather lucrative and a secure way to make big bucks. If you can memorize and work hard you can succeed. In many fields you need talent, especially to reach the 200k level. See http://chronicle.com/article/Medical-School-Applications/129522/ http://chronicle.com/article/Medical-School-Applications/129... Medical-School Applications Hit Record High Despite Worries Over Federal Spending
    - chimeracoder 14y ago
      > They're continually getting pinched: Tens of thousands for malpractice insurance. Incidentally, the hospitals' liability cap is several orders of magnitude lower than doctors' in many cases (tens of thousands vs. millions). This makes no sense when you take into account the fact that the hospitals, not the doctors, are often the ones setting policies as to which procedures will or won't be done in response to a different result on a test, etc. So, the hospitals get to set policies to keep their costs low, shielded by the benefit of a ridiculously low (corporate) liability cap, shifting the liability instead to the doctors who will be performing the operations, at significant (personal) liability and for a significantly lower payment than what the hospitals receive.
  - caseysoftware 14y ago
    By that reasoning, we should work to close small independent stores because it's more efficient to deliver and retrieve products to one central location like Walmart.
    - lotsofpulp 14y ago
      One might say Amazon and the web are already in the process of doing this.
cturner 14y ago
I think what you're arguing is a form of premature optimisation. High utilisation of the equipment is a low priority, and not a matter of public policy. Consider the possibilities that the payment structure hampers. Could the doctor instead go into partnership with other doctors? Or rent space in a complex that has lots of specialists in it giving some kind of equipment pool? Or contract out scans to a nearby hospital? Or have a nearby hospital refer some matters to the doctor? Equipment could be rented per day. Or maybe fancy equipment isn't justified, and unit cost is lower. Having government anoint winners and losers streamlines industries away from innovation. It reduces price competition, delivers reduced patient choice, and creates environments more friendly to rent-seeking behaviour.
Daniel_Newby 14y ago
> A private practice seems like a waste of resources. Imagine the unused medical devices or the large number of support staff around just one or two doctors. Nope. Cardiologists maintain waiting lists weeks in advance to keep equipment utilization a close to 100% as practical. The large number of support staff are used to keep a pipeline of patients on standby so that when equipment becomes idle the next patient is standing there ready to begin. The patient experience is a lot like a car zipping through a Toyota factory. The steady stream of test results keeps the cardiologist busy analyzing and dictating results. Moving this to a hospital gains very little efficiency. What it does is pay for hospital lobbyists.

jimmybot 14y ago

But why pay the doctor less than the hospital for the same treatment? The doctors can figure out themselves whether it makes more sense from a cost perspective to join a hospital, a clinic, or to remain independent.

Evbn 14y ago
Because doctor pay is only a portion of overall cost for the patient's care, and it s more efficient to deliver services through a hospital.
- bdcravens 14y ago
  Perhaps, but why is there an attitude that doctors are evil and that all of them are so well off that we shouldn't care what happens? Seems to me that's the prevailing attitude. They're continually getting pinched: Tens of thousands for malpractice insurance. Hundreds of thousands in debt just to get to the point where they can practice. Seems reasonable if you have a good upside, but that upside keeps getting pressed on. I don't see how that can continue without serious reform in the other direction (tort limits and forgiveness of student debt for medical school)
  - frozenport 14y ago
    I think its rather lucrative and a secure way to make big bucks. If you can memorize and work hard you can succeed. In many fields you need talent, especially to reach the 200k level. See http://chronicle.com/article/Medical-School-Applications/129522/ http://chronicle.com/article/Medical-School-Applications/129... Medical-School Applications Hit Record High Despite Worries Over Federal Spending
  - chimeracoder 14y ago
    > They're continually getting pinched: Tens of thousands for malpractice insurance. Incidentally, the hospitals' liability cap is several orders of magnitude lower than doctors' in many cases (tens of thousands vs. millions). This makes no sense when you take into account the fact that the hospitals, not the doctors, are often the ones setting policies as to which procedures will or won't be done in response to a different result on a test, etc. So, the hospitals get to set policies to keep their costs low, shielded by the benefit of a ridiculously low (corporate) liability cap, shifting the liability instead to the doctors who will be performing the operations, at significant (personal) liability and for a significantly lower payment than what the hospitals receive.
- caseysoftware 14y ago
  By that reasoning, we should work to close small independent stores because it's more efficient to deliver and retrieve products to one central location like Walmart.
  - lotsofpulp 14y ago
    One might say Amazon and the web are already in the process of doing this.

cturner 14y ago

I think what you're arguing is a form of premature optimisation. High utilisation of the equipment is a low priority, and not a matter of public policy. Consider the possibilities that the payment structure hampers. Could the doctor instead go into partnership with other doctors? Or rent space in a complex that has lots of specialists in it giving some kind of equipment pool? Or contract out scans to a nearby hospital? Or have a nearby hospital refer some matters to the doctor? Equipment could be rented per day. Or maybe fancy equipment isn't justified, and unit cost is lower. Having government anoint winners and losers streamlines industries away from innovation. It reduces price competition, delivers reduced patient choice, and creates environments more friendly to rent-seeking behaviour.

Daniel_Newby 14y ago

> A private practice seems like a waste of resources. Imagine the unused medical devices or the large number of support staff around just one or two doctors. Nope. Cardiologists maintain waiting lists weeks in advance to keep equipment utilization a close to 100% as practical. The large number of support staff are used to keep a pipeline of patients on standby so that when equipment becomes idle the next patient is standing there ready to begin. The patient experience is a lot like a car zipping through a Toyota factory. The steady stream of test results keeps the cardiologist busy analyzing and dictating results. Moving this to a hospital gains very little efficiency. What it does is pay for hospital lobbyists.