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

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