What Is the Future for Rural Physicians? Is There One?

The following is a guest blog post by Paul Smith.

Value based payments.  Value based care.  Meaningful  use.  Is there a place for an independent doctor in a suburban location?  This article says that these and all the technology to go with them along with physician acceptance is “Inevitable”.

I have four physicians.  I don’t see a place for them long term.  My first is my Internist.  A few years ago he was given a cell phone as a gift.  It does all he will ever want.  If it rings, he answers it.  If he has to make a call, he dials the number.  He has no computers in his office.  All his files are paper.  As a Doctor he is recognized as one of the best in the state. EHR is not in his future.  Phones, fax, copier suit him just fine.  The article that raised these questions for me was a report from Deloitte.  You might end up with some of the same questions after reading it. 

My second physician has been using EHR for as long as I have known him.  He has 2 offices and four other doctors working for him.  He needs the technology.  He hates it, upgrades only when he has to and would never do it again.  He is also recognizes as one of the best in the state.  His daughter is now in her residency and will join him next year.  My gut feel is that in 3-4 years he turns the business over to her, let’s her worry about it and sails off into the sunset.

My radiation oncologist was great.  He treated me 8 years ago.  My last visit with him was 4 years ago.  The company he worked for terminated him for not generating enough revenue.  His waiting room was always filled but with little to no wait.  His staff was great and could have easily made more money by moving to a large city.  They, like he, enjoyed the suburban life.  All were dumbfounded when he was terminated.  They also learned that for this big city practice, profit was the only incentive.  He’s in FL now, out in the sticks and owns his own practice.

Doctor #4 is a general surgeon.  He is probably the only one that could/would survive in the “inevitable market”.  His office is at the medical arts building at the local hospital.  There are 3 other surgeons in his practice.  He has a fairly up to date computer system,  though not in his location and not compatible with the hospitals new system.  I know that his definition of value based anything and mine differ.  On my last visit he kept me waiting for 45 minutes because lunch went longer than scheduled.  He’s all business.

For 3 of these 4 I see the choice of conforming and or selling out.  They are all rated in the top 25 physicians in the state.  They are not going to increase their patient base to increase revenue.

I am sure that Doctor #4 will succeed. He is all and only business.  He holds the purse strings for his practice and has absolutely no problem in spending whatever it takes for technology to increase profit.  As long as he doesn’t have to use it.

The area that I live in is not unique The hospital‘s area of reach is a bit under 60,000.  As part of that is a resort area, add another 10K for the summer months.  Is there a future for physicians like this?  If so, what will they need to do to stay viable?  Hire a business manager?  More nurse Practitioners?  Sell, retire or join together a form their own physician groups?  Any thoughts?

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  • Value based healthcare is far from a proven or anything more than an acceptable model. Having a workable and reproducible payment system for VBHC is even farther away. I think the rumors of demise of the rural physician are premature and over exaggerated.
    Current data shows that being absorbed into a big group adds 30% to the cost of healthcare in an area and we can’t afford increased costs. Assimilation into the Borg doesn’t appear to be a viable long term solution.
    The development of Clinically integrated Networks to allow central planning and contract negotiation while allowing independence and on site management of heathcare decisions might be the ultimate solution.

  • Kerry,
    The time frame might be off, but I think directionally it’s where it’s headed.

    “Current data shows that being absorbed into a big group adds 30% to the cost of healthcare in an area and we can’t afford increased costs. Assimilation into the Borg doesn’t appear to be a viable long term solution.”

    This is a really interesting stat. Where’d you find the 30% number? It sounds right to me, but I wondered if there was a study that validated it.

    Thanks for joining the conversation.

  • There are several studies recently that validate the number for the increase in costs.

    Current VBM programs are similar to someone with a desire to see the Pacific Ocean from NC. Except he has no caR ,NO ROADS NO TRAILS AND NO IDEA WHERE THE pACIFIC oCEAN IS CURRENTLY

    Premature was a kind choice of words

  • I would like to review this differently for those Rural Docs. I believe the opposite, as hospital systems find these locations less profitable and close down, I would think the door would be wide open for Care Centers, similar to Urgent Care Centers, that can work as a smaller version of the now closed Community Hospitals.

    Behind every problem is an opportunity. Just Saying.

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