Physicians now have many choices

A few weeks ago, I called to schedule a visit with my family's primary care doctor, and was surprised to learn that he had left the group. My doctor, a young man in his first few years as a practicing physician, already has moved to a concierge practice--in this case, one affiliated with Virginia-based PartnerMD.

This incident brought home for me something I've been watching emerge over my career as a healthcare editor (nearly 20 years). Of course, over the past decades, managed care has greatly restricted physicians' freedom to practice as they see fit, not to mention subjecting them to huge patient loads, in most cases. But particularly in the last five years or so, it's been striking how many new options have been emerging for physicians that didn't exist, or weren't realistic choices, when I began covering this industry in the early 1990s.

For one thing, my wonderful, dedicated primary care physician could have become a hospitalist rather than working solely in a traditional family practice, something that didn't exist when I started out. He could be a supervising physician for the explosively growing retail clinic market, or in one of the hybrid retail clinic/urgent care clinic models that have sprung up. Before long, I think there also will be a new "medical home" specialty of some kind that re-defines the family care role.

Specialists, meanwhile, increasingly are succeeding by building ambulatory surgery centers. A small handful are becoming telemedicine specialists, a job category that is likely to see a great deal of growth in coming years--especially for cardiologists and critical care specialists--if my research is any indication.

Not only that, for those who are cyber-friendly, a small but growing number of doctors are choosing to conduct some or all of their practice online. Insurance companies increasingly are paying for e-visits, and web technology has advanced to the point where coordination of care, patient charting, practice management and even real-time monitoring of patient care data can be done remotely... sometimes with just a smartphone.

While some of these trends may create health system imbalances for a time (my doctor's decision took one more PCP out of the traditional primary care business, for example), I believe that they will work themselves out in the long run. Hospitals may have a role here, as they certainly can lend their creativity to providing doctors with new, valuable outlets for their talents. And of course, managed care companies can think outside the box in rewarding and motivating physicians, too. (I guess pay-for-performance has some potential there, though it's not exactly a showstopper of an innovation.)

In the mean time, it's great to think that physicians like my ex-primary care doctor don't have to put decades into an unsatisfying practice model just to do what they were trained to do. Let's hear it for medical innovation. - Anne

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