I read two interesting, and somewhat related, articles in medical journals this week. One of them was a review of primary care physicians’ incomes. The other was a personal story about a doctor’s decision to leave clinical medicine entirely. It reflected on a larger question of why doctors are leaving clinical practice.

In previous blog posts, we have written about the trend – which has accelerated over the past decade – of hospital systems “buying” private medical practices, so that the formerly independent physicians then become employees of the hospital system. There are many reasons for this trend, with many of them related to the stresses for clinicians trying to be good doctors but also meeting the increasing requirements of running a “business” and the demands of insurance companies.

From the perspective of the hospital system, a major reason for acquiring private practices was to assure that the patients of that practice, when hospital care is needed, ended up in beds of the hospital system.         

What the article about physician salaries found, however, was that income wasn’t a driving factor. The majority of physicians actually made less taxable income after moving into the hospital system’s practice. But what they lost in income, they gained in financial security and reduction of the “business” stresses of maintaining their own practice, including malpractice insurance. 

The other article was a reflective account of a clinician who gave up clinical work entirely, with part of the reason being the new stresses in a hospital system of responding to the demands of electronic medical records. She related how her time was increasingly spent in reviewing electronic charts, including emails from patients responding to “MyChart” information, results of lab tests and imaging studies, etc., and that the demands were eating away at her home life, intruding into time spent with her family. When she shifted to a research job, she was able to reduce that time and improve her work-life pattern. 

This reminded me of a local family practice physician who I have known for decades, and lately had the only “free-standing” private family practice clinic in a large suburban community. There once had been a dozen such practices in that community. My friend had resisted efforts by a large hospital system to “buy out” his practice, and one of the reasons he resisted was the need to meet the demands of the hospital’s electronic records system. 

He felt that, with an electronic system, he would lose the personal contact he had with his patients, some of which were third-generation patients. He said that instead of taking the time to listen to his patients, and relating to them, he would be turned away at a computer screen trying to meet the demands of an electronic system that constantly needs to be fed information.            

What I took away from the two articles is that our medical “industry” is still finding its way to how best to provide primary medical care. Free-standing private practices have their flaws, but the new hospital systems have a different set of flaws. Maybe the advent of artificial intelligence will be the answer, but don’t count on it. Providing good primary medical care is still a work in progress.