I applaud Dr. Dorio for pointing out the potential hospitals could have to abuse the system and limit care for the sake of the hospital’s bottom line. In 2018 I wrote a similar oped in “The Hill”, a Washington, DC publication:
Though all physicians must consider the welfare of the general community in decision making, every individual patient, in or out of the hospital, needs an advocate devoted to the patient’s well being, without any hint of inappropriate divided loyalty. That is where the old system of health care performed so well.
Back then, prior to 1990 or so, almost all American doctors practiced independently. They did not work for or get salaries from hospitals or insurance companies. They worked IN hospitals, but as members of a truly independent medical staff outside of the control of the hospital’s administration. Insurance, if used at all, was a relationship between the patient and the insurance company, not between the doctor and the insurance company. Thus doctors worked only and directly for patients, who also paid them directly. But as Dr. Dorio eloquently pointed out, that has changed. Whereas then, over 90% of physicians were fully independent, today 70% of physicians work on a salary or in an equivalent contractural arrangement for some large organization. That organization can exert subtle pressures on its doctors that might not be in your best interest. Dr Dorio has pointed out many wise things you can do to minimize the risk. Plan ahead and do them well before need.
This is not a problem everywhere, though the trend toward more salaried, employed physicians is everywhere. Many hospitals, including the main ones in my own community, walk this fine line with excellent ethics. However, to make sure you are in the best possible position my advise is to make sure your primary care doctor, and the doctor directing your hospital care, is one of those 30% of doctors who are still truly independent and can feel no pressure from any hospital or insurance company to cut corners.
Among those doctors are a growing number of concierge and direct practice physicians. We work for patients directly and are primarily funded directly by our patients. We often manage our own hospitalized patients directly. We have fewer patients in our practices and thus have much more time to spend with each patient. Though such practices have a membership fee, it is affordable for most. And, though we have many community ethical obligations, we have only one “boss” for your personal care, YOU.
If you want to know more about direct practice and concierge practice visit this website. http://www.acpp.md The American College of Private Physicians is a national professional society for such doctors and can help you find one in your community. However, there are also many physicians outside of the direct and concierge medicine model with similar attitudes. Ask questions! Be sure your doctor is one of them. I can tell you Dr. Dorio definitely is.
Thanks for listening,
T. W. LaGreilus, MD
Thomas W. LaGrelius MD, FAAFP
Diplomate of the American Board of Family Practice and Geriatric Medicine
Skypark Preferred Family Care, A Concierge Medical Practice
23451 Madison St., Suite 140
Torrance, CA 90505 http://www.skyparkpfc.com
310-378-6208 office
Immediate Past President, SBIP http://www.sbipmg.com
Founder, ACPP http://www.acppmed.com
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