In 2003, 40% of physicians working at hospitals were independent. Now fewer than one in five physicians are independent, writes Lawrence Huntoon, M.D., Ph.D., in the spring issue of in the Journal of American Physicians and Surgeons.
A 2018 Survey of America’s Physicians reported that 57.5% of physicians “do not agree that hospital employment of physicians is a positive trend likely to enhance quality of care and decrease costs.”
Hospitals gain revenue from employing physicians in several ways, Dr. Huntoon notes. These include excessive testing by hospital-owned facilities and “churning specialist referrals.” Hospitals are expert in gaming the Medicare payment system. One method, he explains, is to quickly discharge the patient to the hospital-owned hospice with a do-not-resuscitate order, unbeknownst to the patient’s private physician.
To achieve total control, hospitals have many techniques for “purging” the few remaining independent physicians from the staff, Dr. Huntoon writes.
- Sham peer review—bringing unfounded accusations against which physicians have little or no right to defend themselves;
- Code of Ethics policies that characterize vaguely defined verbal or nonverbal behavior, such as criticizing the hospital, as “disruptive”;
- Having physicians go “voluntarily,” under pain of losing their admitting privileges, to self-designated treatment centers, where a psychiatric diagnosis such as “personality disorder not otherwise specified (NOS)” is generally assigned;
- Creating a hostile work environment, with constant bureaucratic demands; and
- Inflicting financial harm, as by restricting operating-room time or shifting referrals to employed physicians.
What benefits the hospital is not necessarily best for the patient, Dr. Huntoon concludes. “Hospitals should not function like hotels where the overriding goal is to fill beds so as to maximize profits. Physicians employed by hospitals who are paid a monthly stipend for being loyal to the hospital should not function as salesmen to fill hospital beds. Patients should be allowed to choose their own personal physician to treat them when they are admitted to a hospital.”
Dr. Huntoon has a third-party-free neurology practice in upstate New York, and serves as editor-in-chief of the Journal of American Physicians and Surgeons.
The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.