The Enterprise, "Doctors face decision: work for hospital or private practice"

Published January 17, 2014

Doctors face decision: work for hospital or private practice

By: Nicole Clark

A nationwide debate in the medical community, about whether doctors should stay in private practice or become employees of enormous health care systems, has made its way to Southern Maryland.

About 125 doctors with 45 locations in the region, mostly Maryland and Virginia, have spent the past 2½ years forming a group called the Centers for Advanced Orthopaedics. Two of those CAO practices, including nine physicians, have offices in St. Mary’s and Charles counties. This year, the CAO is focusing on promoting awareness about the group.

“The most important thing is how we care for our patients,” said Dr. Daniel Bauk, an orthopedic surgeon and partner at Southern Maryland Orthopaedics and Sports Medicine, which has seven doctors and offices in Leonardtown and Waldorf.

The Center for Advanced Orthopedics, a separate practice, also has offices in Hollywood and Waldorf, with two doctors and is a member of the CAO. Private practice, Bauk said, gives “the most quality, the most compassionate care and is most flexible to patients’ needs.”

But the controversy is complex.

Newer physicians coming out of medical school may be seeking steady income and more regular hours. Doctors who have been in the game much longer often grapple with the increasing cost of doing business and recruiting new doctors. Some are opting to work in hospital or university systems where paychecks are steady, executives run the business side of things and resources are under one roof.

American Medical Association researchers surveyed physicians in 2012 and found that 60 percent worked in practices fully owned by doctors. But there was “a shift toward hospital employment,” the AMA said.

The problem is, Bauk said, intimate doctor-patient relationships seem to be becoming a thing of the past as patients in those larger systems are shuffled from one physician to the next.

Doctors in the CAO have maintained their private practices and business models, but say their employees now fall under the CAO, their teams share resources, and they’ve reduced overhead, which will allow them to study best practices, for patients and their businesses, over the long term.

Joining forces, Bauk said, offers those physicians better bargaining power than they would have alone with insurance companies. Physicians also tend to be more motivated when they work for themselves, he said. They have more control over scheduling, allowing them to reach more patients each day.

“It’s not quite clear that that statement holds true on further scrutiny,” said Dr. Stephen Michaels, an orthopedic surgeon and vice president of medical affairs at MedStar St. Mary’s Hospital, which is part of the regional MedStar Health system with 30,000 associates and 6,000 affiliated doctors. “I think that we spend as much, if not more, time with all of our patients.”

At a hospital, physicians can focus on people seeking services, not being entrepreneurs, he said. And, the corporate business structure at MedStar “is invisible to the patient.” Specialists and a wider range of services are in one location, as well as rapid evacuation transportation to facilities where other emergency procedures — such as advanced services during a heart attack — might need to be performed, Michaels said.

The hospital also is better prepared to address disparities in health care across a community, a position making care more accessible to people of different races, in different ZIP codes and with different income levels, he said. “I categorically deny that physicians in a large medical group do not provide the exact same functions at a higher or better quality,” Michaels said. “We drill in our value of ‘patient first’ to every associate and every physician,” he said. “And if you’re not meeting that, we don’t want you on the team.”

As for physicians in the CAO, Michaels said, “I’m very familiar with this organization that they’re joining.” The main reason the CAO formed, Michaels said, “is so they can gain critical mass to negotiate with greater degrees of leverage with the insurance companies.”

Money is certainly an issue, said Denny Tritinger, executive director of the CAO. Changes in health care laws have forced doctors to make medical records electronic, and have required training on privacy laws and billing. “It’s a very expensive proposition,” he said. “It makes practicing on your own so difficult and so expensive.”

It really boils down to whether a physician wants to “be a cog in a wheel,” or someone who has control to say how everything works, Tritinger said.

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