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      02-18-2013, 11:48 AM   #113
M3takesNYC
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Quote:
Originally Posted by rjdoc74 View Post
Just to add my $0.02

Practicing surgeon here. I work for a large IPA in So Cal and fortunately for us we have whole department trying to make of whats going on with rapidly changing healthcare delivery system. At this point, I am convinced that fee for service business model of healthcare is on it's way out. As ACAs come into place in every states, lion share of current fee for service patients will be forced into some form of managed care further and further shrinking the pool of available patients for fee for service providers. I do think that KP is one of very few models that will be sustainable in the future, so listen to what Sandman99 is telling you; he speaks the truth. KP spots are going to become more and more competitive in the future.

Any MD on here who disagrees with me in this should spend some time on Sermo.com. You will be convinced then.

I am quite well-versed in the changing times and I can't agree on the fee-for-service disapearing unless you are speaking of something different than I am thinking. A surgeon, unless plastics or maybe some uber high profile neurosurgeon or orthopod will not ever be able to do fee for service, however I only see more and more docs, atleast in affluent areas which is where fee for service makes sense, increase. As more docs pull out of the insurance game, more fee for service docs will actually arise and although there will be more of them, they will make a bit less as the increased supply will drive down prices they will be able to charge.

Unless obama mandates that docs have to take a single payer national system which is a ways off, than fee for service (ie not taking insurance) is continuing to grow. The docs doing it will need to either offer something else nobody else is doing (ie house-calls etc) or take a lower fee than they are now given more competition.

The managed patients will see more and more of the mid-level NP's and PA's with doctors seeing complex or rather playing more of a supervisory role in the primary care sector including OB, neuro, psych etc.

Ultimately things will balance with a bunch of MD's staying in the insurance game (still the majority) but playing a much different role than they do now which includes much more integration with mid-level's. The other bunch of docs will go fee for service and prices will be driven down from being only accessible by affluent as it largely is now, to being accessible by more average consumers given the competition driving prices down.

However a further division among the fee for service docs will emerge as the one's catering to the affluent still who will be providing either more services or going off of a better reputation to charge a premium "affluent consumer" price point and than the other tier will be the average PCP who will do a fee-based service but really provide nothing more than most people are getting now if they do see a doctor rather than mid-level. Essentially people will have to pay some fee out of pocket to see an actual physician, even if they provide limited other services as in the future people will have a hard time seeing a physician through the insurance system without going through a dense mid-level NP/PA level of service.

So I actually think the opposite is true and many PCP's (I am not a PCP) I know and are friends with see the exact same path.

I guess we all will adapt. For example if Obama "required" doctors to take a single payer system and not able to opt out of the system, than it would be linked with their ability to prescribe which means doctors wanting to do fee for service would simply hire a mid-level PA or NP and charge a fee as a medical consultant and not prescribe a thing but rather have a PA who does take the government insurance, prescribe under them. This is what the PCP's I know have already started brainstorming about.

So in the end doctors will find a way around the system to keep making a pretty consistent income and that is why the US is great. Even medicine can be conducive to being a really lucrative business if you have some creativity and business sense.

At the end of the day big changes are coming but doctors will be fine and still make about the same average income, same flexibility and roughly the same workload. It is the older docs who are not wanting to adapt (I don't blame them" who will just retire or get really screwed over as a level of adaptation will need to happen to really survive this world as a doctor and not be totally miserable