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Old 11-13-2020, 12:24 PM
 
3,105 posts, read 3,334,255 times
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I may be wrong but my experience for the last twelve years tells me that there are no longer doctors in independent practice while affiliated with certain hospitals. I am seeing them all working directly for some hospital group that tells them what to do and not do and pays them whatever the agreement is. Also, with the several I have been to, their nurses and front office people work for the hospital and are sent to the doctor's office for jobs.


I know. How they function is none of my business. It is just that I see something new and am (nosey?). I am used to doctors who have private practices and do as they want to do without a hospital controlling their offices. Are there stlll doctors with truly private practices as I grew old with?
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Old 11-14-2020, 10:45 PM
 
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It seems like doctors are teaming up with each other and hospitals in order to achieve the necessary scale to deal with health insurance companies (admin work, negotiating reimbursements).
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Old 11-15-2020, 09:26 AM
 
3,105 posts, read 3,334,255 times
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Quote:
Originally Posted by FrankMiller View Post
It seems like doctors are teaming up with each other and hospitals in order to achieve the necessary scale to deal with health insurance companies (admin work, negotiating reimbursements).

That makes sense and it does have its advantages but what I am running into is that the doctors I meet up with actually work for the hospitals and the hospitals dole out the orders. A sort of "do as we say or ...." I knew of one doctor who told a patient that he was not allowed to treat her any more because the hospital told him not to. According to the review she posted, she had fallen behind in her payments.



Used to be that doctors managed their own offices as they wanted them. They were affiliated with a particular hospital but the only requirement was that they send their patients to that hospital for surgeries and other special needs. In the old days that doctor might have told the patient that he would not treat her any more. Now the orders come from the hospital. I don't think I have met up with a doctor in totally private practice since I moved to St Louis.



Well, not important in the grand scheme of things and it has many pluses. I just got to wondering.
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Old 11-15-2020, 02:04 PM
 
Location: STL area
1,689 posts, read 817,618 times
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It's very difficult to do your job as a doctor and run a business at the same time, hence the current model.

I actually see a private practice but they don't take insurance. They will submit for labwork, but that's it. I pay out of pocket for everything else. Concierge practices will take the place of private for some, but they won't deal with insurance and they will cost. It works well for me as I go once a year basically. I'm in my 40s and perfectly healthy. I have good insurance and I do still see a regular OBGYN.
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Old 11-15-2020, 02:13 PM
 
Location: Boring suburb in the North
6,676 posts, read 2,720,213 times
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Quote:
Originally Posted by Hazel W View Post
That makes sense and it does have its advantages but what I am running into is that the doctors I meet up with actually work for the hospitals and the hospitals dole out the orders. A sort of "do as we say or ...." I knew of one doctor who told a patient that he was not allowed to treat her any more because the hospital told him not to. According to the review she posted, she had fallen behind in her payments.



Used to be that doctors managed their own offices as they wanted them. They were affiliated with a particular hospital but the only requirement was that they send their patients to that hospital for surgeries and other special needs. In the old days that doctor might have told the patient that he would not treat her any more. Now the orders come from the hospital. I don't think I have met up with a doctor in totally private practice since I moved to St Louis.



Well, not important in the grand scheme of things and it has many pluses. I just got to wondering.
I agree with your perception. I cannot communicate directly with my doctor like I used through the patient portal. She was great, always responsive and even asked to see a problem i was experiencing by sending her a picture. Now I only get speak to nurses, i am not even sure if my doctor still works there. I also think my husband gets better response than I do. Possibly because he gives them more business!
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Old 11-15-2020, 03:22 PM
 
3,105 posts, read 3,334,255 times
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Quote:
Originally Posted by STL74 View Post
It's very difficult to do your job as a doctor and run a business at the same time, hence the current model.

I actually see a private practice but they don't take insurance. They will submit for labwork, but that's it. I pay out of pocket for everything else. Concierge practices will take the place of private for some, but they won't deal with insurance and they will cost. It works well for me as I go once a year basically. I'm in my 40s and perfectly healthy. I have good insurance and I do still see a regular OBGYN.

Concierge? Are those the ones that come to your home if you want? I once talked to a neighbor who said her friend goes to one such and she is very expensive but a great doctor. Once a year is enough when you are healthy. I do not understand this insistence that we come three times a year (used to be four) when we are perfectly well. But that is something else that has changed. We go to doctor for check-up when we are well but they tell us to stay home if we are sick. Makes no sense. Well, I guess it makes sense from the other side of the desk. I went many years without ever seeing a doctor until I had a job that required once a year. Even then, that was enough.
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Old 11-24-2020, 03:33 AM
 
Location: San Antonio/Houston/Tricity
45,030 posts, read 64,408,876 times
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I don't know about St. Louis, but here many doctors have their private practice. They might also work in hospitals on a contract basis, and see private patients in their private offices after hospital hours.
Some doctors work in a multiple doctor office. They may form a group or only share the space. It's cheaper that way as they share front office and some nursing and billing staff. They also cover for each other during vacation or indispositions.
If they form a group, they usually follow the group guidelines as agreed.
If they work as individual practitioners, each set the rules for themselves. There is no boss.
In hospitals they are self-employed independent contractors (as a group or individual) and the mutual contract spells out all the rules.
Doctors who are independent contractors are not employees of the hospital but have an agreement with the hospital to use the hospital's facilities, and their pay structure is entirely different from employees. They are privately insured too.
Lots of hospitals prefer to contract doctors. That way they aren't liable for any medical negligence the doctors might commit.
As a patient you have no way to know if your doctor is on contract or hospital employee.
Many doctors are tired of dealing with the restrictions of hospital policies. They are their own bosses, set up their own fees, and can make more money being independent contractors.
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