Kremer’s Corner: Small medical practices threatened

Many things are changing these days in the medical community and some of the changes are not very encouraging. 

With each passing day some doctor, whether on Long Island,or anywhere else in America, decides to hang up their stethoscope and quit the practice of medicine. 

Many years ago your neighborhood  family doctor would make house calls, have time for continuing education and at the same time raise a family. 

But that was then and today many doctors are an endangered species. Insurance companies destroy medical practices with smaller and smaller reimbursements for services rendered to the point where a physician just can’t afford to take on more patients.

Officials in Washington were proud to advance the idea of sophisticated keeping of medical records and were convinced that it would be a great benefit to patients and physicians alike. 

For many of the smaller practices the high costs of record keeping are another reason to shut the door and walk out.

Once upon a time, most doctors were willing to take patients whose only coverage was Medicare. 

Today, with shrinking Medicare payments, doctors are forced to decide whether they can afford to take such patients. 

A Long Island doctor will perform a procedure and be paid small change compared to a Manhattan doctor who will be paid much more by some health insurance company. And the size of those payments is constantly shrinking.

It is no secret that in Albany one of the strongest pressure groups is the trial lawyers, who have been very successful in stopping any legislation that would give the doctors some relief. 

Having represented groups of local doctors I can provide many stories of how good legislation has been defeated by the trial lobby.

To add to the headaches of the doctors, the costs of malpractice insurance continue to rise and many experienced physicians have to decide whether it is still worthwhile to be in business.

New physicians who are not aware of these challenges while in medical school, are forced to quickly face the reality of staggering premiums. 

In recent years I have noticed another new development. 

Doctors who were trained in one specialty are deciding mid-career to move into another area of practice in order to survive. This may be good for survival but it also shrinks the number of doctors available for a particular specialty.

If you haven’t noticed lately, your local physician who was once an independent practitioner, is now an employee of one of the major hospitals in this region. 

There is nothing wrong with doctors deciding to become an employee of a hospital, but in many cases it is because the local practitioner has given up being on his or her own. 

One of the frequently suggested reforms that would help the medical profession is the idea that small groups of doctors should be allowed to form bargaining groups, just like unions, and be able to negotiate for better reimbursement rates. 

The idea is a good way to give doctors some leverage but the health insurance companies have battled these and other similar proposals.

There is no question that the doctor you know and love has reached a tipping point. They must decide between giving up, fighting  to survive or joining a hospital as an employee. 

Each individual takes for granted that their doctor is always going to be there but that’s not the case.

As each new law is passed and as each insurance company devises new reimbursement rates, doctors become another endangered species.

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