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Morning Read: The long, slow death of private practice

Highlights of the important and the interesting from the world of healthcare: The long, slow death of private practice: The ever-evolving worlds of medicine and business are conspiring to render traditional private practice medicine obsolete, says physician-superblogger KevinMD. That it to say, the days when a young primary care doctor came out of medical school […]

Highlights of the important and the interesting from the world of healthcare:

The long, slow death of private practice: The ever-evolving worlds of medicine and business are conspiring to render traditional private practice medicine obsolete, says physician-superblogger KevinMD. That it to say, the days when a young primary care doctor came out of medical school and opened her own private clinic, or banded together with another doc or two to do so, are verging on extinction. As recently as 2005, more than two-thirds of medical practices were physician-owned — a share that had been relatively constant for many years, but within three years, that share dropped below 50 percent, the New York Times reports.

The reasons for this trend are many, though, as is usually the case, the primary drivers are financial. For, starters doctors are typically burdened with about $150,000 in debt from medical school and they understandably flock to the stability of salaried “hospitalist” positions. Further, administering their own practice leaves doctors overburdened with paperwork and hassles in dealing with insurance companies–and takes away from time spent with patients, typically the most rewarding aspect of physicians’ jobs. (Though cynics might chuckle at the last statement and say some doctors’ mentalities are best characterized by Dr. Nick Riviera from The Simpsons who once famously said after a patient encounter: “The most rewarding part was when he gave me the money.”)

But that’s not to say the demise of private practice is all about finances. For some, it’s simply a lifestyle choice. Younger doctors value their free time, and a salaried position with regular hours often frees them from the burden of being on-call 24 hours a day. For patients, the negative consequence of this evolution could be in some cases the loss of years-long intimate personal relationships with their physicians. And the cost of care factors into the trend as well–as doctors flock to large health systems, these big groups can tighten their local monopolies and negotiate higher prices with insurance companies, which the insurers then pass on to consumers.

Harvard steps up comparative effectiveness research: Harvard Medical School has hired five new faculty members over the past nine months to investigate whether various prescription drugs really provide much bang for the buck. The move highlights the growing importance of comparative effectiveness research, studies of how well a certain medicine treats a given disease. The federal health reform package devoted $3 billion to the field, and that follows on the heals of $1.1 billion toward comparative effectiveness research (CER) in 2009’s federal stimulus act.

Yet skeptics of CER remain. One health consultant says the research is “probably going to be ambiguous 70 or 80 percent of the time,” while the Healthcare Economist questions whether it’ll really yield much in the way of cost savings. Nontheless, the view from here is that CER represents one of the most promising arrows in the quiver to dramatically cut spiraling health costs in the U.S. And it’s about time we focused on it. “Finally the health-care system has begun to ask questions companies all over the world have been asking for generations,” a Harvard researcher says.

The return of retail clinics: After reports earlier this year that retail health clinics, such as those found at Wal-Mart or CVS, were struggling to survive and watching growth stagnate, new reports indicate that they’re back, thanks to a shot in the arm from federal health reform. CVS Caremark says it plans to double its number of clinics in the U.S. within five years, to take advantage of the influx of 32 million Americans into the health insurance system, as well as the aging population. CVS operates about 500 MinuteClinics in 25 states, making it the largest player in the industry.

“There will be a gap in the number of providers available in an already constrained system,” a CVS official says. “Our MinuteClinics are a very nice complement to that environment. We will easily double the number of clinics and maybe even more than that.”

Still, clinic operators are attempting to find a way to overcome the seasonal nature of the business, which has caused some companies to shut clinics outside of flu season, the Wall Street Journal reports.

Photo from flickr user NatalieMaynor

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