Medicine will likely change forever in light of the COVID-19 pandemic. Telemedicine has become essential. For now, it is still probably safer to see your doctor for a routine visit via phone or video than in the office. Until there is a successful vaccine, non-validated treatments like hydroxychloroquine may become popular.
Hidden among these changes is the likely end of private practice.
The idea that medicine is a business does not resonate well. Physicians take an oath to “apply, for benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism.” So, concepts like reimbursement and cost-benefit ratios run counterintuitive to a doctor’s mission.
Does it matter that private practice may not be viable in the future? The era of the solo practitioner carrying a doctor bag to a home visit is long over, but now even the larger private practices are threatened.
This is comparable to what many small businesses are going through. Large companies have been deemed essential, while mom-and-pop stores remain shuttered. Government grants and loans have gone to larger companies. Stores like Walmart benefit, while the clothing boutique down the street is barely hanging on. This is a similar kind of pressure that many medical practices are now feeling. Revenues are way down, patients are scared to go to the office, and most elective procedures have been canceled. Hospitals have also seen major declines in business, but like big businesses, they are protected. Large government grants were recently awarded to Philadelphia hospitals to help with the financial woes they have experienced.
This is a bittersweet prediction for me to make. I was in private practice for more than 20 years (with seven partners) before we sold our practice. The impetus for this decision was the changing reimbursement by Medicare and other insurances. There are benefits to being part of a large health system, such as enhanced income, access to more patients, and newer computer technology. But, I still miss the independence, lack of having a boss, and the ability to quickly respond to events that I no longer have as an employed physician in a large health system. My patients have verbalized how they miss the “mom and pop” warmth of our private practice. This is a warning that as practices become more corporate, there needs to be a continued focus to maintain the personal touch of medicine. That applies to all members of the team who work with patients.
It is sad that the era of private practice medicine may be ending. Many practices, even the largest ones, have seen income plummet during the pandemic. Some may not reopen, and others will struggle. Hospitals will absorb their practices and life will go on. In the scheme of loss and tragedy from COVID-19, this is a blip. Medical care that monitors and prevents illness will move forward in a post-pandemic world. Physicians and other providers will be compensated. As these changes occur let’s hope that there is a continued emphasis on maintaining an individualistic streak, personal bond to patients, attention to detail, and that attentive and caring communication to patients endures.
David Becker is a frequent Inquirer contributor and a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown. He has been in practice for 25 years.