While I acknowledge that these decisions promoted the corporation’s health, they jeopardized our patients’ well being. An irreconciliable conflict was created once the business’s interests and our patients’ interests were no longer alligned. The businessmen were pleased, but the physicians and patients were increasingly frustrated. Since I am a physician who cares about patients more than balance sheets, I resigned.
I entered the FFS universe. My income increased, but this was never my motivation to change positions. In fact, had our corporate overseer not poisoned our beloved MSG, I would still be there. A few years after I left, the group vaporized.
Adjusting to FFS medicine was not a seamless transition for me. Previously, I never performed a colonoscopy unless I believed that the procedure was necessary and that no preferred alternative existed. I had never practiced as a technician. While those ideals sound noble and virtuous, they will not pave a pathway to success in the private practice world. In this milieu, procedurists are subject to many external pressures. While I hopefully still practice at a high ethical level, I no longer enjoy complete ‘ownership’ over the procedures I perform.
Private Practice GI FFS Medicine - The Good!
• More money. This is not evil.
• Personal freedom. Time off when I want it.
• Improved orthopedic health. Preserves knee function by no longer genuflecting before administrators.
• Enhances professionalism. While no doctor who is still breathing practices autonomously, private physicians can practice more freely. For example, we can send a patient to a rheumatologist we select, rather than refer to an official consultant list, as we did in in the MSG arena. [At the MSG, we were never expressly forbidden to consult outside the network, but those who dared to do so, would spend a few weeks in reeducation camps to reflect on their errant behavior. After a voluntary confession, the rehabilitated physician would rejoin his brethen.]
• Camaraderie and esprit de corp in an ever shrinking pool of private practitioners. These doctors will soon be on an endangered species list here in Cleveland. Then, we will be eligible for federal protection.
• Increased technical proficiency from the excessive volume of procedures we FFS doctors perform. Since numerous medical studies confirm that volume = quality, our office should qualify as a Center of Excellence.
• We hire our own staff.
• The FFS model is an incentive to improve service to patients and referring physicians.
Private Practice GI FFS Medicine - The Bad!
• Financial conflicts of interest. Sorry, my FFS confederates, but we need to admit this.
• Sending fruit baskets, candy, wine and other delectables to primary care physicians. Our practice does not do this, but our competitors do. I’d like to think it doesn’t matter. How many candied cashews is a colonoscopy worth?
• Every hour of vacation is lost income.
• Ruthless competition from regional medical industrial conglomerates.
• It’s our business. We pay for every paper clip.
• Do medical procedures on request, similar to radiologiists. Don't 'own' the procedures anymore.
• Read repeatedly that we FFS profiteers are the cancerous lesion in our health care system.
• In Fee-for-Service, fees decline but services don’t. The letters should appear as FFS to reflect proportionality.
• Personal sacrifices from missed and interrupted family events. In general, the lifestyle of private practice is more stressed than that of our salaried colleagues. It's a tough lifestyle. I doubt that any of our 5 kids will pursue a medical career, although we have tried to maintain neutrality on this issue.
Private Practice GI FFS Medicine - The Ugly!
• Hustling for patients. For me, this is the ‘root canal’ of private practice specialty medicine.
So, in the case of Salary vs FFS Medicine, which side has the better argument? You be the jury.