This doctor says one patient's care plan reemphasized why he has continued to stay independent in the era of consolidation.
Recently, I saw a patient with a biopsy of a thyroid that I performed, which was diagnostic of thyroid cancer. The obvious next step in this patient’s care was to refer her to a thyroid surgeon. In my community, the best thyroid surgeon is at the local medical school across town.
My ability to refer my patient to the best surgeon around unencumbered by any barrier is the essence of autonomy in clinical practice. Because I am in a private independent practice, I can direct my patient to the best physicians, without worrying about a hospital-based network or government-funded system (VA) getting in my way. My principles for directing patient care are always the same and consistent, the patient is referred to the best physician or facility for their particular problem.
The consolidation of the healthcare system with physicians joining large organizations may provide economies of scale, but in my opinion, the patient ultimately suffers at the hands of these large systems. Medicine is practiced one patient at a time, and once the physician gives up his autonomy by working for a large group, the welfare of the patient might become secondary to the organization.
Physicians, like myself, in a small subspecialty private group practice, are constantly thinking about the options of following our colleagues into the large group or staying independent. The pressure is intense to join a large group as networks narrow and independent physicians are left out. When my thoughts wander, in darker times, I remember my patient with thyroid cancer, who needed the best surgeon. She had an excellent surgical outcome, and her feedback made my day, when she told me that "I saved her life." In that moment, I knew that I would always remain independent for the sake of my patients.