STEVEN PORTNOY is not complaining. Portnoy is a lawyer who brokers marriages between hospitals wanting to buy doctors' practices and the doctors who will sell, if the price and other conditions are right. According to Portnoy, his matchmaking has recently become much easier. "A firm 'no' (from doctors) two years ago is often a reluctant, if not enthusiastic 'yes' today," he says.

Practice-buying can be lucrative for doctors, hospitals and their brokers. But the effects on patients and medical costs may be far from beneficial. Recent surveys suggest that these arrangements are increasing rapidly so that physicians, patients -- and policymakers -- ought to consider the consequences before it is too late to reverse them.

The American Hospital Association's magazine recently reported that 20 percent of hospitals in a national survey -- including both for-profit and non-profits -- had bought at least one physician's practice. Another 13 percent had considered such purchases in 1986. A subsequent article revealed that resulting revenues for the acquiring hospitals ranged from $2.2 million a year for practices of heart surgeons in the Northeast, to $76,000 a year for ophthalmologists' practices acquired in the Midwest.

Many hospitals have a very direct interest in obtaining almost guaranteed access to a physician's clients. Because of poor planning there are at least 200,000 too many hospital beds in this country. Each empty bed means about $240,000 in lost revenue a year. Thus, a 240-bed hospital, running one-third empty (about the national average), could gain $9.6 million a year if it could fill 40 of its 80 empty beds.

As Steven Portnoy points out, "Hospitals can obtain overnight increases in market share through conversion of active private practices into hospital satellites. This is especially true where those practices never before referred or admitted patients to the acquiring hospital and can result in an immediate shift in market share from one hospital to another."

Doctors too may have much to gain from the arrangement. A buy-out assures an income that may be hard to attain on a fee-for-service basis in a doctor-glutted market. It can also provide some relief from the increasingly unpleasant business aspect of practicing medicine.

Depending on the number and type of patient in the practice, the price paid by the hospital to the doctor can vary from $25,000 to $4 million. According to Robert Krypel, a Chicago consultant who helps to arrange such sales, "Nobody wants public aid patients and hospitals do not want Medicare patients unless there is a good mix of DRG's." DRG's are the Diagnosis-Related-Groups, some more profitable to hospitals than others, upon which hospital reimbursement for Medicare patients is based. Medicare patientsfill up beds, but too many are undesirable from a profitability standpoint because of government cost controls.

The contract signed by the doctor and the hospital spells out the details of the sale of office equipment, building and land, as well as the schedule of payments to the doctor, often spread over a five to seven year period. In some agreements, the doctor continues to collect money from patients on a fee-for-service arrangement. In others the doctor -- and, perhaps, the office staff as well -- become salaried hospital employees. Typically, the doctor also agrees to perform "consultative" services for the hospital, such as reviewing the care given to transferred to a nursing home, or serving as a preceptor for hospital residents (doctors) who want to see what office-based medical practice is like.

The contract, however, rarely if ever mentions the main financial issue which underlies these purchases: the expectation of more business for the hospital when the doctor switches his or her referral pattern from the "old" hospital to the one that has bought the practice.

According to Baltimore attorney Sanford Teplitzky, an expert on these joint ventures, "putting it {a promise of hospital referrals} in the contract is like turning yourself in." Such a promise would violate Medicare and Medicaid fraud and abuse laws making it a crime to pay anyone for referring Medicare or Medicaid patients to the person making the payment.

Still, as Krypel said, "the hospital does not pay $200,000 for a chair . . . . The only real asset in the practice, as far as the hospital is concerned, is the admission of patients to the hospital" and the resulting volume of services that the hospital provides to those patients.

What's wrong with this new variety of mergers and acquisitions? Nothing, according to some prominent defenders. The American Medical Association's new president, Dr. William S. Hotchkiss, told Physicians Financial News, "We study hard and train hard as residents to become good doctors. This hospital ownership won't decrease our desire to provide quality care."

Others familiar with these arrangements, are less sanguine. Mr. Portnoy says, "When a big organization owns a practice, you have to wonder whether the patient-physician relationship is going to change and whether that will have a negative impact on quality of care." Dr. Arnold Relman, editor of the New England Journal of Medicine, speaking about so-called "joint ventures" between hospitals and doctors, said "These arrangements may manage to skirt legal restrictions -- at least for the time being -- but in my opinion they are medically unethical, for they place physicians in a position that is basically in conflict with their obligation to act as the patient's agent and trustee."

The patients themselves may not even be aware that their doctor is no longer a "free agent." Krypel says that doctors do not ordinarily tell their patients that their practice has been sold. Those who need hospitalization may get a rude awakening when they are no longer admitted to their favorite hospital, which just might be better than the one which bought their doctor's practice. Evidence which is beginning to be made public shows major differences among hospitals in the quality of care. Of course, patients can change doctors, but the normal reluctance to do so may be even greater in the midst of an illness.

Finally, these arrangements are likely to add new costs to our already overpriced health care system -- projected by the Commerce Department to cost $512 billion in 1987. The "brokerage" fees, plus the sale price, are already being added to this staggering bill. The long-term costs may be even higher to the extent that doctors, whose continued contractual arrangement with a hospital depends, at least in part, on the volume of patients referred to it, may tend to hospitalize patients more readily.

This buying and selling of doctors and patients further clouds the vision that the main purpose of the health care system is to serve those who need its help. By contrast, the market model, as practiced in this country, keeps a growing number of people -- the more than 35 million without health insurance -- out of or on the fringes of the marketplace. It is also increasingly less than hospitable to the millions more, such as public aid patients whom, as Mr. Krypel described, "nobody wants." Now even people who, because they are adequately insured, are more welcome in the marketplace, may find that their purchasing decisions are in the hands of a doctor who sells them to the hospital that bids the highest.

Sidney Wolfe is director of the Public Citizen Health Research Group.