Medicine’s Worst-Paying Specialty Is Luring Billions From Wall Street. What are your thoughts out there?

[drmsb93]

This is the article just came out. Bloomberg - Are you a robot?

---

Members don't see this ad.

 

[deleted941485]

This is the article just came out. Bloomberg - Are you a robot?

I don’t see how this ends well for anybody except the overloads who runs these places

 

[IMGASMD]

It’s going to be corporate take over. In a few years, midlevel care.

The problem that I was told is that, unless cvs (or whoever) have a hospital (which they don’t) to channel their patients to, they will have hard time to generate real money. Why would hospital systems, which are recruiting their own physicians, give up anything to CVS?

 

[bronx43]

It’s going to be corporate take over. In a few years, midlevel care.

The problem that I was told is that, unless cvs (or whoever) have a hospital (which they don’t) to channel their patients to, they will have hard time to generate real money. Why would hospital systems, which are recruiting their own physicians, give up anything to CVS?

I don't know that CVS and the like are really looking at this from a hospital revenue standpoint. Owning hospitals is a fool's errand for them and probably more trouble than it's worth.
I suspect they are wanting to consolidate and control the dispensing of medications in order to gain market share as the pharmacy benefits manager.

 

[drmsb93]

So what would be the impact on income? As they might hire all the mid level providers np/pa and we already have alot of them so that competition may decrease there compensation but thats the whole essence of FM primary care that gonna taken over by these fools then? Where FM gonna stand then?

 

[deleted941485]

So what would be the impact on income? As they might hire all the mid level providers np/pa and we already have alot of them so that competition may decrease there compensation but thats the whole essence of FM primary care that gonna taken over by these fools then? Where FM gonna stand then?

So basically the average FM can look forward to working in the back of a CVS or Walgreens or some new PE firm with a catchy brand name…I guess that works lol

 

[VA Hopeful Dr]

So basically the average FM can look forward to working in the back of a CVS or Walgreens or some new PE firm with a catchy brand name…I guess that works lol

Nah, I think we'll always be more hospital owned.

 

[retroflex]

I'm an M2 in a flyover state wanting to do rural FM. I really only want to do full-spectrum FM (inpatient, outpatient, procedures, maybe OB), and I haven't encountered anything else that has piqued my interest. But as time goes on I see things like this (+ the myriad of NP/PA independence threads) and the fear hits me that what I want won't be there when I get through training.

I guess I'm just seeking reassurance for something that none of us knows the answer to since no one has a crystal ball. @VA Hopeful Dr I've lurked on the FM and medical student boards for a long time and read a lot of your comments. What do you think?

 

[drmsb93]

CVS and Walgreens took over the pharmacy profession. In the early 2000s a number of changes in the pharmacy landscape (Medicare Part D, the entry level degree changing from a 5-year degree to a 6-year PharmD) led to an increased demand for pharmacists, and pharmacists' salaries were soaring. One way CVS and Walgreens took care of that was by investing in the expansion of pharmacy schools, and lobbying for changes in state laws to loosen regulations on things like tech to pharmacist ratios and expanding the scope of practice for pharmacy techs. Within 10 years the supply of pharmacists started to exceed the demand, with some pharmacy schools struggling to fill all their seats now. Boom and bust.

It'll be interesting to see if primary care physicians will end up in a similar situation. The big question is what's the better ROI for these corporations, expanding the number of primary care physicians or the number of midlevel providers? Or maybe we'll start seeing corporations finding ways to take advantage of non-BE/BC physicians, especially considering the increasing amount of non-matched applicants each year.

 

[VA Hopeful Dr]

I'm an M2 in a flyover state wanting to do rural FM. I really only want to do full-spectrum FM (inpatient, outpatient, procedures, maybe OB), and I haven't encountered anything else that has piqued my interest. But as time goes on I see things like this (+ the myriad of NP/PA independence threads) and the fear hits me that what I want won't be there when I get through training.

I guess I'm just seeking reassurance for something that none of us knows the answer to since no one has a crystal ball. @VA Hopeful Dr I've lurked on the FM and medical student boards for a long time and read a lot of your comments. What do you think?

I think rural America will always have a place for full-scope FM unless things like OB and IM get so saturated that those doctors start moving rural. Or flying cars become a thing so that hospitals that are 3+ hours away now become a 30 minute trip.

 

[Cranjis McBasketball]

I'm an M2 in a flyover state wanting to do rural FM. I really only want to do full-spectrum FM (inpatient, outpatient, procedures, maybe OB), and I haven't encountered anything else that has piqued my interest. But as time goes on I see things like this (+ the myriad of NP/PA independence threads) and the fear hits me that what I want won't be there when I get through training.

I guess I'm just seeking reassurance for something that none of us knows the answer to since no one has a crystal ball. @VA Hopeful Dr I've lurked on the FM and medical student boards for a long time and read a lot of your comments. What do you think?

4th year med student so my experience is just anecdotal and I dont have any hard facts or numbers, however I have a lot of family/friends that are PAs or NPs. None are in the field of family medicine. When I tell them thats what I am going into they all comment that thats where they started, but the field was way too broad that they just became overwhelmed and switched into a highly specialized field (derm, orthopedics) where the field was more narrow and they got paid more. They arent even in rural areas so I imagine its even better there. I think we will be alright.

 

[retroflex]

Thanks for the replies @VA Hopeful Dr @Cranjis McBasketball . I just gotta keep my head down and keep working toward it for the next few years, while not worrying too much about things I have no influence over.

 

[hallowmann]

I think rural America will always have a place for full-scope FM unless things like OB and IM get so saturated that those doctors start moving rural. Or flying cars become a thing so that hospitals that are 3+ hours away now become a 30 minute trip.

I'm in one of these flyovers, and I can assure you that even the 30 min flying car trip won't be taken by some. There are patients at some of the outer-lying clinics that balk at the 25-30 min drive "into the city" to go the huge tertiary center because "its too far" and "traffic is crazy there". Keep in mind the city is at best classified as small and traffic is virtually non-existent compared to the city I grew up in (also not a big city). They'd rather deal with a wide excision scar or deliver at home with a midwife, than go see derm or labor in the hospital. There will be plenty of jobs for mostly full spectrum FM, it just will likely involve being employed and supervising midlevels. Those jobs are in abundance here.

 

[VA Hopeful Dr]

I'm in one of these flyovers, and I can assure you that even the 30 min flying car trip won't be taken by some. There are patients at some of the outer-lying clinics that balk at the 25-30 min drive "into the city" to go the huge tertiary center because "its too far" and "traffic is crazy there". Keep in mind the city is at best classified as small and traffic is virtually non-existent compared to the city I grew up in (also not a big city). They'd rather deal with a wide excision scar or deliver at home with a midwife, than go see derm or labor in the hospital. There will be plenty of jobs for mostly full spectrum FM, it just will likely involve being employed and supervising midlevels. Those jobs are in abundance here.

No doubt. I work right outside a small southern town and my patients get irritated if they have to drive 15 minutes to the main hospital for anything.

 

[Dral]

"Some clinicians are drawn to corporate practices by the promise of spending more time on care and less time on administrative work."

Wait....what? I find that hard to believe.

 

[Mitch Connor]

Just an M2 here but I think if you're worried about the conditions within the system just move outside the system and give it the bird and open a DPC. That's what I'd like to do. I attended the DPC virtual Summit last year and I asked one of the experienced speakers who's been in DPC a long time and worked on legislation etc if he thought that big hospital systems are or will be a source of tough competition for small DPC practices. He said no way. The big systems make enough people mad it's not hard to find patients looking for a different experience at a lower price point. Also mentioned he has seen big hospital systems trying to emulate the DPC model because everything else is just getting too expensive. Some people get real creative with how the practice. Check out this link. Just one example.

Arizona Mobile Physicians: Medical House Calls | Desert Mobile Medical

Desert Mobile Medical is a House Calls practice. We are 100% mobile, meaning a house call doctor will come to you, either to your home or to your office! Give us a call at (833) 366-3721. Our concierge medical office is here to help when and where you need us, without long waits.

desertmobilemedical.com

 

[retroflex]

Just an M2 here but I think if you're worried about the conditions within the system just move outside the system and give it the bird and open a DPC. That's what I'd like to do. I attended the DPC virtual Summit last year and I asked one of the experienced speakers who's been in DPC a long time and worked on legislation etc if he thought that big hospital systems are or will be a source of tough competition for small DPC practices. He said no way. The big systems make enough people mad it's not hard to find patients looking for a different experience at a lower price point. Also mentioned he has seen big hospital systems trying to emulate the DPC model because everything else is just getting too expensive. Some people get real creative with how the practice. Check out this link. Just one example.

Arizona Mobile Physicians: Medical House Calls | Desert Mobile Medical

Desert Mobile Medical is a House Calls practice. We are 100% mobile, meaning a house call doctor will come to you, either to your home or to your office! Give us a call at (833) 366-3721. Our concierge medical office is here to help when and where you need us, without long waits.

desertmobilemedical.com

That's certainly crossed my mind as well. I myself am a patient of a DPC practice and I love the setup. My only hesitation is that depending on the size of town I end up in, there may not be enough patients to sustain a DPC practice. But even that is changing as I know of a 1-physician DPC practice in a town of 3,000 in my state. It's definitely something I am going to keep my eye on as I get further in med school/residency.

 

[Mitch Connor]

That's certainly crossed my mind as well. I myself am a patient of a DPC practice and I love the setup. My only hesitation is that depending on the size of town I end up in, there may not be enough patients to sustain a DPC practice. But even that is changing as I know of a 1-physician DPC practice in a town of 3,000 in my state. It's definitely something I am going to keep my eye on as I get further in med school/residency.

Good to hear! I have talked to a few docs here in town and several have said that a DPC wouldn't work here. There here comes the first practice that opened a few months ago. I have met with the doc and he is steadily growing. I just hate the idea of giving the autonomy I will have worked at least 7 years for to a system that wants to squeeze me like a lemon.

 

[InvestingDoc]

CVS and Walgreens know they are screwed with their current model. There are startups in major cities that will literally bring you your medication same day no extra fee, a company called capsule is the biggest.

Patients on chronic medications now get their medications shipped directly to them every 3 months.

This is CVS and Walgreens trying to stay relevant. No one is going to want to go to this type of group outside of urgent care visits. There is too much of a stigma and brand recognition as a pharmaceutical chain selling you stuff at twice the cost of your local grocery store but they can bc they are closer to many people.

Hiring expensive physicians to man easy level 3 visits when most of these patients who are on chronic medications are going to have them shipped directly to their house anyway rather than picking him up in the same office, these companies know that they are screwed.

 

[Lurts]

Patients who would prefer for their doctor to work in a Walgreens probably aren’t patients I want in my panel.

 

[retroflex]

Walmart May Soon Become The Largest Primary Care Provider In The Country

Walmart's growing presence in healthcare is incredibly promising.

www.forbes.com

It looks like Walmart is trying to get into the game too. It sounds like they might plop an NP or three into their stores in small towns and have them function as a PCP. I could see this just exacerbating the gap between care for the well-insured and well-off and the impoverished. Maybe patients that would have gone to an FQHC (if there is one in their town) go to Walmart instead. Any thoughts on this, or pretty much the same as above?

 

[deleted941485]

Walmart May Soon Become The Largest Primary Care Provider In The Country

Walmart's growing presence in healthcare is incredibly promising.

www.forbes.com

It looks like Walmart is trying to get into the game too. It sounds like they might plop an NP or three into their stores in small towns and have them function as a PCP. I could see this just exacerbating the gap between care for the well-insured and well-off and the impoverished. Maybe patients that would have gone to an FQHC (if there is one in their town) go to Walmart instead. Any thoughts on this, or pretty much the same as above?

The next time I hear an NP talk about “their practice” lol

 

[FrustratedFamDoc]

Walmart May Soon Become The Largest Primary Care Provider In The Country

Walmart's growing presence in healthcare is incredibly promising.

www.forbes.com

It looks like Walmart is trying to get into the game too. It sounds like they might plop an NP or three into their stores in small towns and have them function as a PCP. I could see this just exacerbating the gap between care for the well-insured and well-off and the impoverished. Maybe patients that would have gone to an FQHC (if there is one in their town) go to Walmart instead. Any thoughts on this, or pretty much the same as above?

Gap in care due to nefarious system causes is played up more than it really exists IMHO.

My patient panel is loaded with Mcare/caid/no insurance. I see them all, as do all of my other hospital system colleagues. Our local private physician owned specialist giant in town that represents ALL adult specialities does the same. The overwhelming majority of primary care is hospital owned. Hospital owned systems aren't in the business of turning away care... it's wrong and a bad look. I could probably find 10 cases that were done at no charge for every one that said they were turned away.

The main problem with access lies with physician distribution. Who the heck wants to work, live and raise a family for below average money in crime ridden, poor school system areas with crappy weather and a general feeling of malaise everywhere you go? No sane spouse that wants the best for their kids would ever go for that.

The "problem" is far more complicated that the current system at hand, without even getting in to the compliance issues.

What do I do for the visit where my EMR tells me that they have been out of 6 of their 12 medications for the last 2 mos, they say that they're 'taking everything, doc.' Their BP is jacked. Their diabetes is jacked. They can't even tell me 2 of the meds they're supposed to take and they no show the 'bring your pill bottle visit' in 2 weeks or forget to do so entirely.

These are generally good, nice well meaning people that you want to reach and really like, but it's just not there, and it hasn't been for the years that you've been seeing them, despite you doing EVERYTHING that you know how. What do you do for that? This hardly represents a big number in my panel but I bet I see 1 a day.

They're screwing with your metrics which is tied directly in to your compensation. Do you fire these people? For me, no, but many will and do. Is this an access problem per say? Are you not doing your job since their health is poor? The modern system sure tells you that you are. It's complicated.

Generally, you will have more patients like this in the less desirable areas of the country, hence one of the reasons for the access issues.

Too much coffee this AM, sorry for the off topic rant.

 

[VA Hopeful Dr]

Gap in care due to nefarious system causes is played up more than it really exists IMHO.

My patient panel is loaded with Mcare/caid/no insurance. I see them all, as do all of my other hospital system colleagues. Our local private physician owned specialist giant in town that represents ALL adult specialities does the same. The overwhelming majority of primary care is hospital owned. Hospital owned systems aren't in the business of turning away care... it's wrong and a bad look. I could probably find 10 cases that were done at no charge for every one that said they were turned away.

The main problem with access lies with physician distribution. Who the heck wants to work, live and raise a family for below average money in crime ridden, poor school system areas with crappy weather and a general feeling of malaise everywhere you go? No sane spouse that wants the best for their kids would ever go for that.

The "problem" is far more complicated that the current system at hand, without even getting in to the compliance issues.

What do I do for the visit where my EMR tells me that they have been out of 6 of their 12 medications for the last 2 mos, they say that they're 'taking everything, doc.' Their BP is jacked. Their diabetes is jacked. They can't even tell me 2 of the meds they're supposed to take and they no show the 'bring your pill bottle visit' in 2 weeks or forget to do so entirely.

These are generally good, nice well meaning people that you want to reach and really like, but it's just not there, and it hasn't been for the years that you've been seeing them, despite you doing EVERYTHING that you know how. What do you do for that? This hardly represents a big number in my panel but I bet I see 1 a day.

They're screwing with your metrics which is tied directly in to your compensation. Do you fire these people? For me, no, but many will and do. Is this an access problem per say? Are you not doing your job since their health is poor? The modern system sure tells you that you are. It's complicated.

Generally, you will have more patients like this in the less desirable areas of the country, hence one of the reasons for the access issues.

Too much coffee this AM, sorry for the off topic rant.

For most metrics I don't fire yet, though I do warn the patients who refuse things that this might change with the increasing moves towards a value based payment system.

I will suggest people find a new doctor if they refuse to do the Medicare Wellness visit. Its free and they don't have to anything except answer a few questions so refusing that one just pisses me off.

 

[5150man]

My thoughts?

First thought. These will obviously be staffed by newly minted, internet trained NPs.

Second thought. I've never met a mid-level that I've worried about losing market share to.

Third thought. I'm glad Walgreens wants to corner the cannabis, bio-identical hormone, undifferentiated autoimmune disease, I want every test in the book market because that's what these solo NP shops cater to and what I like seeing the least.

Last thought. I've seen 3 different corporate backed NP clinics open and close in my community just in the last 5 years. Patients want quality care. They don't want to be referred around. They want someone who can treat a broad spectrum of disease. They'll be loyal to someone they think knows what they're doing and they feel gives them good care. The NPs can always cater to the crazies but there aren't enough of them around to keep a clinic afloat.

If encroachment is ever really a concern we can just stop training them and let them train themselves which will further widen the divide between quality of care given.

If these big corporations are ever able to flood the market with newly trained docs from a diploma mill med school I'll also gladly take my chances that I can provide better care than the applicants that couldn't get into a real school.

 

[VenusinFurs]

Thanks for the replies @VA Hopeful Dr @Cranjis McBasketball . I just gotta keep my head down and keep working toward it for the next few years, while not worrying too much about things I have no influence over.

Also a rural doc

You will be done with residency in 5 years if you go straight through, there will still be rural places that desperately need good primary care because these megacorps won’t find being in very rural areas profitable. We have one Walmart, we have one Walgreens, both are struggling to retain pharmacists and have limited hours and staffing, they are not going to bother trying to open a clinic in an area where a bunch of people can’t pay for much.

I don’t do ob (but do some prenatal care) because rural hospitals have largely moved away from that in many states meaning that labor and delivery wards are few and far between, if you decide you really want to do ob you may find it semi difficult (I also don’t do ob because l and d makes me feel scared and sad).