Amid rising costs and declining reimbursements, more hospitals are shutting down services, leaving physicians increasingly impacted.
Five leaders joined Becker's to discuss how these market changes affect physicians.
Question: How are physicians affected by the increase in hospitals shuttering services?
Editor's note: This response was edited lightly for clarity and length.
Shakeel Ahmed, MD. Gastroenterologist and CEO of Atlas Surgical Group (St. Louis): Physicians are affected in multiple ways by these shuttering services. First, they have to find alternative facilities and venues to address their patients needs, which in this day of tight competition and draconian restrictive covenants is not an easy task. In addition, closure of services inevitably leads to either a job loss or curtailment of revenues or benefits for providers. This job loss not only affects the physicians in question, but then leads to an increased burden on those left standing to shoulder the load left behind. Lastly, these closures disproportionately affect patients in low-income areas, who already have limited points of access for their care. Misery begets more misery in these cases.
Mark Dawson, MD. Senior Partner at Acadiana Family Medical Associates (Rayne, La.): The shuttering of services often increases costs to the patients and becomes problematic to the providers since the options for places to refer patients become more limited.
Matt Mazurek, MD. Assistant Professor of Anesthesiology at the Yale School of Medicine (New Haven): Physicians do not practice in a vacuum, and most physicians rely on the availability of referring to specialty services for their patients and practice. Not having access to a specialty service can seriously affect a physician’s willingness to accept a position and may influence a physician to seek a new opportunity where the services are available. In recent years, the number of rural hospitals shuttering OB-GYN services has accelerated — leaving healthcare deserts. The patients still need the care and must travel to the next closest facility for care. Those facilities may lack the capacity or resources for the increase in volume. Call burdens for those physicians may increase, and continuity of care for the patient is disrupted. No one wins when an essential service line like OB-GYN is closed. Lastly, some physicians return to practice in an area where they were born and raised. Shuttering the service leaves the physician no other option than to leave the area to practice. It is profoundly disruptive, and there is no price tag for the emotional toll on the physician and community.
Opinions expressed by Dr. Mazurek are his own.
James McCoughlin, MD. Orthopedic Surgeon at Ivy Spine and Orthopedics (Panama City, Fla.): Hospitals shuttering services are largely due to the growth of "too big to fail" mentalities inside insurance and hospital cultures. Those mentalities are protected from competition by the Stark law legislation. Is there any other field of endeavor like medicine? What I mean, is there any other field whereby those with the most training and knowledge and boots on the ground experience are legislatively prohibited from owning and running the largest pieces of infrastructure in that business, such as hospitals?
Mark Thoma, MD. Chair of Anesthesia with The Permanente Medical Group (San Francisco): As hospitals shutter services there is significant impact to the physicians practicing there. Many have made a commitment to that community to provide a service. The moral injury of no longer being able to do that can have a profound effect on the physician Many will be forced to relocate to other hospitals to continue to serve their patients or face job loss. With this move will be different practice parameters, commute times, continuity of care and potentially decreased changes in income.