It also spotlights benefits and drawbacks for patients and doctors alike in one of the health-care overhaul’s much-touted initiatives, set to begin next year. The law will reward teams of doctors, nurses and others if they coordinate to provide better care at lower costs. As front-line doctors, primary-care physicians are key to this effort.
In some cases, hospitals are seeking to take over existing practices; in others, they are hiring new graduates or relocating doctors from outside the region to prepare for accountable-care
organizations. Some physicians want to work for hospitals and are seeking to play one option against the other, doctors said. But many others remain wary.
Primary-care physicians wrestling with the implications of becoming hospital employees or trying to go it alone say it’s ultimately about changing the way they have practiced medicine for decades.
“All the rules are changing,” said Jonathan Plotsky, 56, a longtime Rockville internist who has talked to Shady Grove Adventist Hospital about joining the staff.
Plotsky’s father is a psychiatrist who has been practicing medicine the same way for decades. But Plotsky worries about joining a hospital and turning over care of his patients to others.
“All I have is my patients,” he said.
For many doctors, the salaried jobs may come with greater security, but the trade-off is less individual freedom over how many patients they see and how they care for them, they said.
“It’s like the local coffee shop versus Starbucks,” said one family- medicine doctor whose Montgomery County group practice rejected a hospital system’s offer. The doctor, who spoke on the condition of anonymity, did not want to name the group or system because the doctors work closely with one of the system’s hospitals.
But hospitals are moving quickly to add to their primary-care staffs.
In 2008, about half of physician practices were hospital-owned, according to an industry group. A survey last fall by another industry group found that 74 percent of hospital leaders planned to hire more doctors in the next 12 to 36 months. Most want primary-care doctors.
Locally, all the major hospital systems have ramped up efforts. In Northern Virginia, Inova Health plans to hire 200 primary-care doctors over the next five to eight years. In suburban Maryland and Washington, MedStar Health, which operates Montgomery General Hospital, Georgetown University Hospital and Washington Hospital Center, has increased its primary-care doctors system-wide to 180, jumping more than 20 percent in the past 18 months, after being static for more than a decade.