Medicine changes. Drugs come and go (Is terazosin still anyone’s first line alpha-blocker?), and surgeries evolve (When was the last time you seriously discussed a Mainz pouch with a bladder cancer patient?).
What surprises me is the speed with which the business of medicine also changes.
Counting residency, I’ve been in this business for about 10 years and, in that short period, I’ve watched as the paradigm has shifted.
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When I was in medical school, unless you were destined for academia, the most successful practices were single-specialty partnerships owned and run by the doctors. This was certainly not the only option, as numerous small-town doctors were sole proprietors. There were also physicians, such as my father, an ENT, who belonged to large multispecialty groups, but these seemed outliers. As a result, the decision for many young doctors boiled down to academics versus private practice.
But that has changed, with both good and bad results.
On the private practice side, the rise of the hospital-employed physician has been dramatic. This trend is found not only in urology (data from the AUA Census support this) but also in medicine as a whole, as the number of hospital-employed physicians has increased overall by 50% between 2012 and 2015, according to data released by the Physicians Advocacy Institute.
The reasons for this are obvious to anyone of us who has tried to run a business; both government requirements (think MACRA and MIPS) and insurance company policies favor large hospital systems. Further, the ability of larger systems to reduce overhead on back office staff as well as on supplies gives them an advantage. And medicine is by no means unique. The trend toward consolidation appears in just about every business; think about the small mom-and-pop shops competing against the likes of Walmart or Amazon.