The End of Private Practice?

A recent article in the New York Times noted a steady migration of doctors from private practice to hospital-owned health systems. The main driving force appears to be economic -- it is too difficult to run a business, especially when much of that entails fighting multiple insurance companies for reimbursement.

Some of the older physicians interviewed expressed "puzzlement" at younger doctors who chose salaried positions rather than private practice, with the suggestion that salaried doctors are somehow less committed.

When I chose to be a salaried physician after my training, I viewed it as a natural choice to express my commitment to medicine. After all, I wanted to practice medicine, not run a business. One beautiful thing about being salaried is that I have absolutely no financial conflict of interest with regard to my patients' care. Nothing that I recommend or prescribe alters my income. This is very reassuring both to me and to my patients.

What intrigued me most in the article was the observation that "as doctors move from being employers to employees, their politics often take a leftward turn." The article noted that the American Medical Association finally gave a "tepid" endorsement of the Obama health care reform.

With the shift toward the left among physicians, perhaps there will be a stronger momentum toward a single-payer-plan. Nearly the entire world has found this to be the most equitable way to deliver health care, to ensure that health care is available for everybody.

Only in America is health care a profit-driven enterprise. Though this may finally be changing.

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Danielle Ofri is a writer and practicing internist at New York City's Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. You can follow Danielle on Facebook, and Twitter, or visit her homepage.Her newest book is Medicine in Translation: Journeys With My Patients.