05/29/2019    Joseph Borreggine, DPM

Close to Half of Last-Year Residents Would Prefer Hospital Employment: Survey

This sounds good on paper...but this is medicine
no longer being a vocation, but rather and
avocation. This is also the only real way to
control healthcare spending because physicians
are the uncontrolled financial variable base on
fee-for-service as compared to a set salary.

But, in reality, that is not so true because
hospitals see everyone regardless of insurance
and years ago patients that were seen in the ER
were sent to a local MD and not back into the
hospital system to see an employed physician who
will now create more fees based on visits, labs,
and radiological exams along with physical
therapy, pharmacy, and possible surgical
services.

Hence, containing and capturing a patient and the
medical care that is received regardless of
insurance type (that is Medicaid versus Medicare
and/or third party insurance).

This, in turn, actually drives medical costs
higher by not only keeping the patient in that
particular healthcare system, but also allows the
hospital to reap an exorbitant “facility fee”
every time the patient sees the physician for
anything.

Collectively, this “fee” in total reaches into
the billions of dollars each year that hospitals
nationwide collect on top of all the others fees
received.

The American Hospital Association (AHA) is the
largest most influential lobby in DC and has been
for years and they are the ones who have been
influencing how healthcare is delivered must more
to the benefit of their pocket book rather than
the benefiting the patient population at large.

At the end of the day, it is the non-for-profit
hospitals that control health care by using the
current tax code to never pay taxes and keep all
the trillions in profit for themselves.

So let’s see their tax returns!

Joseph Borreggine, DPM, Charleston, IL

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05/31/2019    Bryan C. Markinson, DPM

Close to Half of Last-Year Residents Would Prefer Hospital Employment: Survey (Joseph Borreggine, DPM

In the discussion about current residents
preferring hospital based employment versus
private practice, versus group practice, the
following comment is often stated: "Hospital-
employed physician medical care is certainly
driving up healthcare costs." Of course the
decision is largely based on personal and
economic realities where anyone ends up
practicing. Although very costly, starting a
private solo practice is becoming the least
desirable, but it is my belief that the emerging
health care changes will make some solo practices
golden and in extremely high demand.

On the issue of hospital employed physicians
driving up the cost of healthcare, and that their
existence hurts practices in the community, I say
that there is a selective blindness in those who
make these assertions. I am hospital employed
podiatrist and have been since 1995. In this
milieu, I and every other such physician, from
the pediatrician to the neurosurgeon provide
access to care independent of economics of the
patient that is absent in the community.

We also see the patients the community rejects
for any number of reasons, including complexity
of medical issues. In fact, a baby with a brain
tumor who is uninsured may get unfettered access
to the chief of neurosurgery through the
hospital's teaching program faster than a
privately insured patient can get an office
appointment with the same individual. Patients
who are referred to me with insurance I do not
par with can see me in the clinics and get the
same attention.

What do you do as a community DPM who does an
amputation on a patient who lives in a five story
walk-up? I have access to social workers who can
spend three days relocating the patient. Although
undoubtedly there are inefficiencies in hospital
based care that drive costs higher, some costs
are necessary and unavoidable and will never go
away.

Bryan C. Markinson, DPM, NY, NY