Own practices

[D0CTORX]

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I know FM, plastic surgery, radiology, can run their own practices, but besides those I was just curious what other physicians open their own clinics? EM?

 

[askamsky51]

Most any specialty can open their own practice. For example, orthopedics often have their own "groups" which operate within a hospital--but run their consult businesses elsewhere.

Some people (GYN especially) can have their own licensed surgical centers as well. Laparoscopic surgeries at a GYN for endometeriosis isn't that uncommon.

 

[galaxyx]

EM can own urgent care, but in general physicians can't own hospitals they practice in. This was to keep surgeons from opening and expanding surgi-center hospitals, but has had broader effects including physicians being unable to own acute care hospitals.

 

[nychila]

in general physicians can't own hospitals they practice in. This was to keep surgeons from opening and expanding surgi-center hospitals, but has had broader effects including physicians being unable to own acute care hospitals.

Could you expand on this please? Is it not legally OK for surgeons to expand their surgical clinic?

 

[LizzyM]

In the 20th century, the common model was for a physician to be in solo practice with his own office and admitting privliges at one or more local hospitals. The patient paid the physician for his professional services and the hosptial for the bed/nursing care/use of the OR, etc. Another model was a group practice with several physicians banding together and sharing office space, office staff and sharing responsibility for handling after-hour emergencies.

At the end of the 20th century, models began to change and some physicians became employees rather than owners or partners in practices.

In the 21st century, the models are changing even more as hospitals buy the practices of solo practioners and groups and hire the physicians and employees.

Pediatricians, OBs, general surgeons, ophthamologist, oncologists, internists with boards in cardiology, rhematology & endocrinology, orthopedists all had private practices in my town when I was a kid (mid to late 20th century).

 

[Adrenaline21]

EM can own urgent care, but in general physicians can't own hospitals they practice in. This was to keep surgeons from opening and expanding surgi-center hospitals, but has had broader effects including physicians being unable to own acute care hospitals.

Correct me if I am wrong, but you can be an employee of the hospital and also hold your own practice on the side right? For example EM doing shifts in ER but also runs own walk-in clinic.

 

[galaxyx]

Correct me if I am wrong, but you can be an employee of the hospital and also hold your own practice on the side right? For example EM doing shifts in ER but also runs own walk-in clinic.

Yeah, it's just about hospitals. The ACA originally banned all new and expansion of physician owned hospitals, but now it makes exceptions, but those exceptions have to accept medicaid patients. It seems to be very complicated. The theory is that a physician will advise unnecessary treatments if they own the facility because more procedures = more profit. But, as seen in that Times article hospital profits/ charges are so completely out of whack for even not-for-profit hospitals, that it's all just crazy.

Urgent care centers aren't hospitals so they can be physician owned.

 

[nychila]

Yeah, it's just about hospitals. The ACA originally banned all new and expansion of physician owned hospitals, but now it makes exceptions, but those exceptions have to accept medicaid patients. It seems to be very complicated. The theory is that a physician will advise unnecessary treatments if they own the facility because more procedures = more profit. But, as seen in that Times article hospital profits/ charges are so completely out of whack for even not-for-profit hospitals, that it's all just crazy.

Urgent care centers aren't hospitals so they can be physician owned.

So anybody who is business-oriented or rich enough can start or purchase stake in private hospitals, but you cannot if you have gone to medical school? That's truly absurd.

 

[galaxyx]

So anybody who is business-oriented or rich enough can start or purchase stake in private hospitals, but you cannot if you have gone to medical school? That's truly absurd.

You can't practice in and have ownership stake in the SAME hospital. Having an MD doesn't preclude you from owning any hospital, just one you work in.

But the logic behind it just doesn't make any sense. Since a physician typically bills separately from the hospital anyway and is reimbursed per procedure why would a physician have any more or less incentive to over treat than a physician that has ownership stake. If anything, I would think it would cause the physician to provide better care because he/she would want more satisfied patients and repeat business.

 

[Eiot]

Everything seems so effed nowadays.

 

[D0CTORX]

Yeah, it's just about hospitals. The ACA originally banned all new and expansion of physician owned hospitals, but now it makes exceptions, but those exceptions have to accept medicaid patients. It seems to be very complicated. The theory is that a physician will advise unnecessary treatments if they own the facility because more procedures = more profit. But, as seen in that Times article hospital profits/ charges are so completely out of whack for even not-for-profit hospitals, that it's all just crazy.

Urgent care centers aren't hospitals so they can be physician owned.

So if you were an EM you could potentially own your own urgent care clinic and still have a job at the hospital? Isn't there something from stopping that, I mean doesn't the hospital have something in the fine print of a contract?

 

[nychila]

You can't practice in and have ownership stake in the SAME hospital.

But you can practice in and have ownership stake in the same clinic. Is there a legal definition of hospital vs. clinic, ie. How would you differentiate between a large multi-specialty clinic and a small community hospital, if they are both for-profit?

 

[galaxyx]

So if you were an EM you could potentially own your own urgent care clinic and still have a job at the hospital? Isn't there something from stopping that, I mean doesn't the hospital have something in the fine print of a contract?

That would depend on the contract with the hospital. There's no law against it. A hospital might care, or it might not. If you browse the EM forum, there's an example of a small group of EM physicians starting an UC on the side.

But you can practice in and have ownership stake in the same clinic. Is there a legal definition of hospital vs. clinic, ie. How would you differentiate between a large multi-specialty clinic and a small community hospital, if they are both for-profit?

I'm not sure. I can't find a clear answer on this, but I think a clinic is outpatient and a hospital has inpatients.

 

[GUH]

I know FM, plastic surgery, radiology, can run their own practices, but besides those I was just curious what other physicians open their own clinics? EM?

psych, peds, general IM