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  • 13 Oct 2015 1:10 PM | Anonymous

    Practice Managers Share Best Tips

    By Marni Jameson

    The pressure on independent doctors to join a hospital can be great, especially if they’re not well insulated against acquisition. The more vulnerable providers feel in the face of that pressure, the more likely they are to succumb to it.

    Yet, if you ask most doctors, most would say they would rather work for themselves not for the hospital. As one practice manager put it, when I asked why the doctor she worked with was so staunchly independent:  “Because he gets to run the practice the way he wants want to run it, and he doesn’t have to ask anyone’s permission to take a day off.”

    Not every doctor is so fortunate. To have the luxury of being your own boss, and practicing medicine the way you – not a group of hospital administrators – want to, takes savvy practice management.

    Recently, I invited several administrators of thriving independent practices to meet with me and share their inside tips on how they helped their doctors stay successfully independent. Here are some of their best practices:

    1.       Stay positive. Attitude is everything, they universally agreed. It’s easy to get discouraged, but believing you will survive is half the battle.

    2.       Keep your community presence strong.Hospitals promote their employed doctors into the community often through media outreach and community education. Non-employee physicians rarely get that support, so they need to take the initiative to get out into the community to create a strong positive presence. Give health talks on your area of expertise. Support a local sports team. Make yourself available to the media.

    3.       Shore up your referral base. Know where your patients come from, and reach out to your referral sources, including other physicians, therapists, and employers. Don’t just send a fruit basket. Go out and talk to them. Business, including the business of medicine, is still about relationships.

    4.       Look for alternatives to the hospital. One Central Florida practice took advantage of office space becoming available next door. They took over the space, and turned it into a procedure room, where they now perform services they used to do in the hospital. The practice now receives the technical fee that would have gone to the hospital. The technical fee helps boost practice revenue, and also helps patients, since the fee to the independent practice is less than the fee to the hospital for the same procedure.

    5.       Don’t say yes to the first contract. When working with insurance companies, don’t take the first offer they give you. Sell them on your practice. Let them know what differentiates you, your quality measures, patient satisfaction scores and what your practice is worth to them. Then negotiate for more because ultimately your practice’s success rides on reimbursements.

    6.       Make the patient experience over the top. Patients are still your best referral source. If your patient has a good (or bad) experience, he or she will likely tell five people. Train your team to make patients feel like they’re first, and not just the next patient in line. Also strive to make the patient’s visit as efficient from check in to check out. If the doctor is running behind, tell the patient how much longer it will be. Don’t keep the patient in the dark.

    And lose the phone tree. One practice administrator said her patients appreciated that when they call, they never call into a phone tree or get a recording. A live human being answers the phone.

    7.       Educate your patients.  Unfortunately, most consumers don’t understand the differences between an independent doctor and a hospital-based practice. They don’t know that seeing an independent doctor will save them hundreds, if not thousands of dollars. Those who do understand have trouble knowing which practices are independent. To help educate them, many members of the Association of Independent Doctors display signs in their lobby stating that their practice is “A proud member of the Association of Independent Doctors.” Some providers go further and give patients a letter in new patient packets explaining why that matters. Here’s an excerpt from one:

    “We would like to reassure our patients that we have not been acquired, nor do we have any intention of being acquired, by a hospital system. When a physician’s practice is bought by a hospital system the costs to patients increase significantly…. This results in higher expenses to Medicare, private insurers and most importantly individual patients...As an independent practice … the only partnership we seek is with our patients.”

    8.       Make it easy to refer. To streamline referrals, provide referral sources with a Fast Fax form. They fax you a referral before the patient leaves their office, and within a few hours, your office has called that patient, scheduled an appointment, and reported back to the referring provider, assuring that his or her patient is getting prompt attention.

    9.       Be sure your stars align. Love them or hate them, star ratings on sites such as Health Grades, and on various insurance company websites hold enormous sway with patients, many of whom get their information from the Internet. Even if these scores are based on a small, random sampling, where one disgruntled patient can have an outsized impact, they count. To keep your star rating high, survey patients as they check out. Ask how their visit was, and whether you could do anything to improve. If they express a concern, follow up and ask what went wrong, and how you could make up for it. Nip dissatisfaction before patients let out their frustrations online. Some practices hire a reputation management consultant to manage their social media. When a doctor goes down a star, the consultant finds out why, and works to get his or her reputation back up.

    10.   Connect with other independent doctors.Camaraderie among independent practice managers and providers is critical to insulating practices from being acquired. So is joining an organization like the Association of Independent Doctors (, a national nonprofit with members coast to coast that gives independent doctors a voice. When independent doctors don’t feel isolated, and feel they’re part of a greater whole, they can practice better medicine with greater confidence.

    Marni Jameson is the executive director of the Association of Independent Doctors. You may reach her at

  • 11 Sep 2015 3:15 PM | Taylor Thomas (Administrator)

     1.) A wonderful article encapsulating the challenges of being an independent or employed doctor in today's healthcare system.

    2.) Is being an employed doctor worth it?


  • 20 Jul 2015 3:47 PM | Taylor Thomas (Administrator)

     Modern Healthcare's Lisa Schencker discusses just how difficult it can be to undo a done deal – in this case the merger of a hospital and a medical group that a court found broke the law -- in her article: "Court-ordered breakup is still hard to do."

    This was the situation in Idaho's anti-trust case involving St. Luke's Health System and Saltzer Medical Group. AID is proud to have played a role in this case, writing an amicus brief to support the lower court's decision, and encouraging the appeals court to uphold it, which it did. Both courts found that the acquisition of Saltzer Medical Group by St. Luke's violated anti-trust law.  

    Although this final ruling took place over five months ago, the effects have yet to fully set in as the "government and St. Luke's continue to haggle over the divestiture plan," wrote Schencker. This week the judge once again took the side of the Federal Trade Commission, which had originally brought suit, refusing to let the hospital hire a person to be in charge of the unwinding.

    St. Luke's and Saltzer had originally said that it would like trying to unscramble an egg. All the more reason, the judge decided, to let the court handle the un-merging.

    At AID we say the message should be simple: Don’t let the mergers go through in the first place. 

  • 09 Jul 2015 3:06 PM | Marni Jameson (Administrator)

    In his article, “Doctor Pay Eclipses $240,000 As Value-Based Model Boosts Primary Care,” Forbes contributor Bruce Mr. Japsen missed a key point. The biggest reason primary care provider compensation has gone up is not because of a move toward value-based models of care. It’s because hospitals are buying up primary doctors right and left to capture market share. When a hospital employs a primary care doctor, the hospital can now bill much more for the doctor’s services, because they can extract higher reimbursements from insurers. Those higher paying contracts are what allow the hospital to pay doctors more. That and the fact that the hospital now can funnel all the primary care doctor’s patients into the hospital system to hospital-employed specialists and hospital-owned ancillary services. Each time the hospital gets to layer on a facility fee and charge more because of the higher contracted rates. Who pays for that?

    This cost is being pushed directly on to employers, patients and taxpayers. What should happen is that all insurance companies should reimburse all doctors – primary care and specialists -- the same amount for the same service whether they work for the hospital or not. We need to level the playing field and compensate all doctors well, and not drive them into hospital employment, because then everyone pays.

  • 30 Jun 2015 5:19 PM | Marni Jameson (Administrator)

    July 2015

    CIN Sound to Good to Be True? Beware the Trojan Horse

    Many of you will be approached, if you haven’t already been, by one or more hospitals inviting you to join their Clinically Integrated Network.

    Though not new ventures, CINs have become more popular as a result of Obamacare, which fuels the alignment of doctors and hospitals in ways that allegedly reduce cost, waste and inefficiencies. How that gets achieved is debatable, but CINs are an attempt.

    These networks include both hospital-employed doctors, and independent ones who don’t want to work for the hospital.

    At the Association of Independent Doctors, we have had an opportunity to review privileged documents that list the terms of agreement for several networks, and urge caution. What may sound like a great deal on the surface bears closer inspection.

    Before you agree to participate in any CIN, consider these 10 points.

    1.      Who benefits? Ask what is in this for the hospital?  Clearly, the hospital can negotiate very effectively for themselves and their employed physicians.  So why now does the hospital want independent doctors to enroll?  What is in it for you?  If you think the hospital is going to negotiate better rates for you, jump to No. 5.

    2.      History and track record. When was the last time an arrangement the hospital presented truly benefited independent doctors in the long run? Why is this any different? Be suspicious.

    3.      Who controls the decisions?  A CIN board will make every decision, action, and determination for the network, including terms and conditions of contracts with payors.  Look closely at the agreement to see how this board is formed, and who appoints its members. Although this board must be “physician led” by definition, the CIN will likely remain under the hospital’s control.

    4.      How do independent doctors get protected? The hospital will likely make sure employed doctors dominate the CIN board, and thus influence the decisions and votes of those employed board members. Sure, a few token independent doctors may be on the board, but they won’t form a majority.

    5.      What about your existing contracts? A close reading of the agreements reveals that, theoretically, the CIN could force doctors to terminate contracts they have with payors, and prohibit doctors from negotiating future payor contracts, especially if those existing contracts include beneficiaries covered by the CIN’s contracts. Independent doctors may not have the option to get paid at the more favorable rates they have negotiated on their own. Again, the CIN negotiates these contracts, not you. 

    6.      How could joining impact your fees? The CIN Board could also negotiate higher reimbursement rates for the hospital and the hospital’s employed physicians, and pay for that by lowering reimbursement rates to independent physicians.

    7.      What’s the payoff if you’re more efficient than the pool? When has a hospital ever gotten more efficient as it grew? Just as hospitals’ bundled payment programs neutralize doctors’ efficiencies by combining them with hospitals’ inefficiencies, which independent doctors can’t control, the new dynamic also dilutes any gains independent doctors realize by becoming more efficient.

    8.      How will joining the CIN impact your overhead? Your overhead costs will likely go up. As an independent provider, you will still pay for your current overhead – such as electronic medical records, administrative, billing and collection costs -- plus you will subsidize the same costs for the CIN.

    9.      Who owns your patients’ data?  Once you join a CIN, the hospital will have access to your patients’ demographics and health information, and could data mine the records. Even if you leave the network, they will have your patients’ information.

    10.   Show me the papers. Be wary of hospitals that arrange lots of meetings for doctors telling them why they should join the CIN, but have no operating agreements available for review. Without the paperwork, the agreement is just talk. That talk likely portrays the CIN as a win-win for doctors and hospitals alike, but the devil is in the details.  Be highly suspicious of any agreement that the hospital wants you to “hurry up” and sign without allowing time for your attorney or CPA to review it. In short, beware the Trojan horse.

    Marni Jameson, AID executive director/407-865-4110 or

  • 30 Jun 2015 5:16 PM | Marni Jameson (Administrator)

    June 2015

    Ten Questions to Ask Before Selling Out to a Hospital

    A recent online issue of the MGMA newsletter included a blog post titled “14 Questions to Consider Before a Hospital Acquisition” ( ). The message left me unhinged. If I were a physician, or one of the practice managers whom this Medical Group Management Association publication targets, I would feel insulted. 

    Basically, the blogger, a hospital industry insider, tries to reassure practice managers that if they play nice with the hospital trying to buy their practice, they stand a better chance of employment after the acquisition -- so said the spider to the fly.

    The post opens like this: “Practice managers with independent medical groups have more control over their futures after hospital acquisitions than they might think,” said David Taylor, past MGMA board co-chair and vice president, regional services, CoxHealth, Springfield, Mo.

    Taylor, who has 25 years of experience managing hospital-owned practices in large integrated delivery networks, went on:  “If you want to be an administrator here, you need to consider whether you are seen as helpful or seen as a barrier,” Taylor explained. During negotiations, health systems judge practice managers on their behavior….If the system asks for information, is your response slow? Are you guarded with data? When it comes to communication, what are you willing to share and when?

    You get the idea.

    Now, before practice managers – or their medical group employers -- drink this hospital Kool-Aid, and certainly before agreeing to let their medical practices be bought by a hospital, I would ask them to consider these 10 questions:

    1.      How much do your doctors like their autonomy? Would they be content with an administrator telling them which gloves to use, for instance, or which devices to implant?

    2.      How would your doctors feel if they could no longer refer to the specialists or outpatient centers they thought were the best, and had to change their referral patterns so they could funnel patients solely to other hospital-employed doctors and hospital-owned ancillary services?

    3.      How would your doctors feel when their allegiance was forced to shift from their patient’s interests to their employer’s, whom they now must please or risk unemployment?

    4.      How would your doctors feel about having to meet their hospital employer’s quotas for patient admissions, procedures performed and referrals to other employed physicians?

    5.      How will your doctors feel when their contract is not renewed because they did not meet the quotas?

    6.      How would your doctors feel when their patients were charged five to 10 times more for the same procedures because hospitals would be adding their facility fees to bills, and charging consumers higher contracted rates?

    7.      When the hospital cites a low rate of turnover among employed-physicians (if the numbers are to be believed) how much of that is due to happy doctors and how much to the non-compete clauses doctors must sign? Many contracts require doctors to not practice in the service area for a period of time if they cut ties with the hospital.

    8.      When have you ever seen consolidation in health-care or in any industry improve competition, or quality and lower costs?

    9.      Besides the loss of jobs -- and yes more office personnel lose their jobs in these acquisitions than get them – how would the purchase of your medical group impact the community? For instance, if a non-profit health system is buying your medical group, all the taxes that group once paid come off the tax rolls, meaning budgets for incidentals like police officers and teachers get cut, or taxes for other community members go up.

    10.   If a hospital takes over the running of your doctor’s practice, what makes you think your job will be spared? Clearly, if you read between the lines in this blog post, the practice managers who may be spared are the ones willing to play along, who don’t challenge the acquisition and instead facilitate the transition. Is that in the best interest of your doctors?

    In short, if your doctor would feel good about driving up health costs, reducing access to health care, lowering quality, compromising their doctor-patient relationships, seeing his or her staff lose their jobs, and causing their communities financial  harm, by all means, they should seriously consider being bought.

    Marni Jameson, AID executive director/407-865-4110 or

  • 30 Jun 2015 5:13 PM | Marni Jameson (Administrator)

    May 2015

    Doc Fix Bill Helps Doctors Dodge Bullet, But More Bullets on the Way

    When President Obama signed the Doc Fix bill on April 16, independent doctors nationwide exhaled in collective relief.  They’d dodged a bullet.

    The threatened 21 percent Medicare cuts to doctors, a byproduct of the ill-conceived Sustainable Growth Rate formula, had at last ended. For eighteen years the SGR-governed cuts had been accruing and hanging like the sword of Damocles over independent doctors’ heads. They were poised to go into effect April 1.

    But the Doc Fix bill, which enjoyed overwhelming bipartisan support, with the house voting 392 to 37 in favor of the legislation, and the senate voting 92 to 8, put an end to that threat. And replaced it with another.

    Thus, the new law is a Pyrrhic victory. But let’s celebrate the victory nonetheless. Had SGRs not been repealed, many independent doctors would have faced a difficult choice, and many Medicare patients would have been without access to care. If the cuts had gone into effect, doctors would have had to choose from the following options:

    • Go to work for the hospital, (i.e., sell out).
    • Go into concierge medicine.
    • Opt out of Medicare.
    • Take a 75 percent pay cut.
    • Seventy-five percent!?

    How does a 21 percent cut in Medicare become a 75 percent pay cut?

    This is what few lawmakers and even fewer consumers realize.

    Let’s go through the math: Say an independent doctor who treats primarily Medicare patients brings in $35,000 a month in Medicare reimbursements. His overhead is $25,000 a month. That makes his monthly net profit $10,000. An annual income of $120,000 a year is by no means a killing for a primary care doctor.

    Now, let’s say Medicare reimbursements dropped by 21 percent, so instead of getting $35,000 a month, the doctor gets $27,650. However, overhead – rent, salaries, utilities, insurance, supplies -- doesn’t change. If anything it goes up. Thus, that 21 percent (or $7,350) cut, comes straight out of the doctor’s net profit, which drops from $10,000 a month to $2,650, almost 75 percent less for the same work.

    Instead of earning $120,000 a year, the doctor’s income would drop to $31,800 -- less than their office managers.

    Fortunately, that didn’t happen. But we came too close.

    We came dangerously close to a perilous outcome for doctors, patients and America’s health care system for two reasons:

    • The misguided notion that doctors’ fees are the problem.
    • The dreadfully poor representation of independent doctors in government.

    Doctors are not why health-care costs too much in this country. In fact, physician fees account for only eight cents out of every health-care dollar spent. Far larger shares go to hospitals, ancillary services and pharmaceuticals.

    But independent doctors are easy targets, and somewhere along the line, they found themselves in the crosshairs.  This is largely because – until recently -- they have been notoriously bad at coordinating their efforts, defending themselves and lobbying effectively.

    Some believe it’s the American Medical Association’s job to lobby for them. But, of course, the dwindling membership of the AMA comprises mostly employed physicians and academics. The only national organization dedicated exclusively to the rights of independent doctors is the Association of Independent Doctors (, a two-year-old nonprofit who has begun to take up the fight to give these doctors a voice.

    Part of that fight will include helping doctors dodge the bullets loaded in the Doc Fix bill.  Just as they exhale with relief from cuts that would have made maintaining their private practices unsustainable, they  now had better brace themselves for what else was buried in that bill.

    Under the new law, doctors who see Medicare patients will get a modest pay increase, but those payments will be tied to how well doctors comply with government mandates. Whether doctors get rewarded or penalized for their performance will depend on how well they comply and coordinate care. As one analyst anticipates, “Expect heavy lobbying from the physician community on every element of implementation.”

    When Obama signed the Doc Fix bill into law, doctors got a short-lived reprieve. They got themselves out of the frying pan all right. Now they will need to get out of the fire.

    Marni Jameson, AID executive director/407-865-4110 or

  • 30 Jun 2015 5:09 PM | Marni Jameson (Administrator)

    April 2015

    Independent Doctors Like Law that Would Make Facility Fees Transparent

    The National Physicians Council on Healthcare Policy convened on Capitol Hill last week and the mood was grim. The group of 50 independent physicians and lawmakers meet in the Rules Committee Chamber of the Capitol building to discuss legislation that would impact them. While the news regarding regulatory changes coming at them was less-than-encouraging, there was one bright spot.

    When my turn came to address the group, I began by saying, “I hope after I’m done speaking, you will all see a little ray of hope.”

    Rays of hope are few and far between for independent physicians these days, but at the Association of Independent Doctors we are creating them. During my 15-minute talk, I gave three examples of what our national nonprofit advocacy group, which is based in Winter Park, was doing nationwide on behalf of independent physicians. Each example was met by a round of applause.

    There is hope.

    One of the three examples I shared was A.I.D.’s work to advance a law recently passed in Connecticut. The law is a push for price transparency. Specifically, it requires hospital-employed physicians to disclose to patients before their appointments that they will be charged facility fees and how much.

    Moreover, it requires these doctors’ offices to tell patients that if they went to an office not owned by a hospital, they would not be charged facility fees. And it requires providers to tell patients in clear written language.

    This should be the law in every state.

    Hospitals charge facility fees for outpatient services performed by employed physicians that independent physicians and free-standing facilities do not charge. Facility fees are separate from professional fees, and can increase the total cost of a service by three to five times compared to the same service provided by an independent physician, according to the Medicare Payment Advisory Committee.

    Facility fees are why a Medicare patient can go to his doctor for a heart ultrasound one month and pay 20 percent of $189, Medicare’s contracted rate with the doctor’s office. The next month, if a hospital has bought the doctor’s practice, the same patient will pay 20 percent of $453 for the same test in the same building by the same doctor using the same equipment. Taxpayers, of course, pay the balance.

    The extra payment that hospitals get is what’s driving hospitals to buy up medical groups, a trend that is causing health-care costs to skyrocket. The much higher bills are compounded by the downstream effect: Hospital-owned groups refer exclusively to other hospital-owned providers, which charge -- you guessed it -- facility fees.

    More transparency would not only spare consumers sticker shock and let them vote with their feet and their dollars, but it also might curb hospitals’ appetites for private practices.

    This Connecticut law has already had a positive impact on independent physicians. A version of the law is moving forward in Kansas, thanks to A.I.D. member Dr. Elizabeth Rowe, of Lenexa, Kansas, who got the bill into the Kansas Senate. The bill has strong bipartisan support.

    In Florida, other A.I.D. members are working with local and state medical associations to push forward a similar proposal, one that would also require doctors to clearly disclose whether they are employed by a hospital or independent.

    "The point is very straightforward," said Dr. Rowe. "If there are two offices reasonably close to each other, and one charges facility fees and one does not, then the hospital-owned office needs to notify patients about this cost difference before they use those services. As it is now, patients have no warning.”

    At A.I.D., we believe patients have the right to know facts up front that will triple their bill and likely lead them to receive less access to care because their doctor must refer only to other hospital-employed doctors, even if the best doctor is independent.

    That’s what I told the National Physicians Council on Health Care in Washington last week. That’s when they applauded. However, this concept deserves more than a round of applause. It deserves to be the law.

    Marni Jameson, AID executive director /407-865-4110 or

  • 30 Jun 2015 5:01 PM | Marni Jameson (Administrator)

    March 2015

    U.S. Appeals Court : Merger of Hospital, Big Medical Group Breaks Law -- AID Contributes to Ground-Breaking Decision

    In a striking victory for independent doctors, competition and the future of the nation’s health care, the U.S. Court of Appeals for the Ninth Circuit ruled Feb. 10 that a lower district court was correct when it found the 2012 acquisition of a large medical group by a major hospital system in Idaho violated federal antitrust laws, and ordered the merger to be dissolved.

    “This is a case the nation has been watching, because it will have a wide ripple effect,” said Tommy Thomas, a Winter Park CPA, and founding member of the Association of Independent Doctors, a national nonprofit that played a role in the decision.

    “Today’s ruling puts hospitals on notice,” Thomas said: “Buying up market share to the point of creating a monopoly in the community is against the law.” He hopes the decision will spur more lawsuits to unwind similar hospital-doctor mergers. The doctors’ association filed an amicus brief last August asking the Ninth Circuit panel of judges to uphold the lower court’s decision, which it did on all counts.

    Antitrust attorneys around the country took note of the decision, the Idaho Statesman reported.

    Many felt the ruling sets a precedent that might slow merger activity in the health-care industry, where consolidation has increased in recent years.

    "It certainly puts a spotlight on any hospital looking to acquire physicians," Jonathan Lewis, a partner and antitrust lawyer at Baker Hostetler in Washington, D.C., told the Statesman.

    The purchase of independent medical groups by hospitals is a national trend. Hospitals claim the mergers help integrate care, but analysts say it’s a way for hospitals to capture market share and higher revenues. Studies show such mergers dramatically increase health-care costs, and do not improve outcomes.

    The new ruling involves St. Luke’s Health System’s acquisition of Saltzer Medical Group and its 34 doctors. The Nampa County practice was Idaho’s largest independent medical group before it sold to the hospital system, for just under $30 million, according to court documents.

    St Luke’s claimed that the merger would be better for the patient community as it would help “integrate care” and “enhance efficiencies.”

    However, nearby St. Alphonsus Medical Center disagreed and said that the merger created a monopoly that reduced competition, increased costs and was not in the best interest of patients. The purchase gave St. Luke's 80 percent of the primary care doctors in Nampa and significant bargaining leverage over health insurers, according the Idaho Statesman.

    The Federal Trade Commission joined St. Alphonsus and filed suit against St. Luke’s claiming that the merger violated antitrust laws. The U.S. District Court for Idaho agreed and ordered the parties to unwind the merger.

    St. Luke’s instead appealed the decision to the Ninth Circuit Court of Appeals.

    Shortly after, the Winter Park-based doctors’ association retained Washington law firm Mayer Brown to write an amicus brief affirming the district court’s decision. Robert E. Bloch, an attorney from Mayer Brown who helped write the brief, said, “The association’s brief provided its unique perspective to the Court of Appeals and described the significant challenges independent physicians face. The association’s fight to provide the best, most cost effective care is an important part of this case.”

    In addition to AID, four other groups -- attorneys general from 16 states, a group of economics professors, America’s Health Insurance Plans, and Catalyst for Payment Reform -- also filed amicus briefs asking the Ninth Circuit to affirm the lower court ruling.

    Orlando has a vested interest in this ruling, said Thomas. “All Americans, but especially those in Central Florida, have felt firsthand the negative impacts these mergers have on costs, care and communities.”

    Central Florida has two of the nation’s largest health systems, which are rapidly buying up medical groups to secure market share.

    Florida Hospital and Orlando Health are respectively the No.2 and No.6 largest nonprofit health systems in the country, according to Becker’s Healthcare, yet Orlando is only the 26th largest metro.

    “Most metros don’t have one system this big, and Central Florida has two,” said Thomas. “It will be up to the community, and its independent doctors, to keep the systems in check.”

    AID, which has members coast to coast, is the only national trade association that solely represents the interests of independent doctors on the national stage. To continue fighting this fight for Americans, we need independent doctor everywhere to join our cause

    Marni Jameson, AID executive director/407-865-4110 or

  • 30 Jun 2015 4:59 PM | Marni Jameson (Administrator)

    February 2015

    Burned Out? We’re Working on It. But Hospital Employment Is Not the Answer

    As a non-physician who talks to a lot of doctors, I’m often struck and saddened by how frustrated they are.

    Last month, after I spoke at an American College of Cardiology summit, I was besieged afterward by doctors asking for ways they could stay independent and not succumb to hospital offers of employment.

    They wanted to know, privately, if we at the Association of Independent Doctors could help them get fairer contracted rates with insurers; that is, reimbursement rates closer to what insurers and Medicare pay hospital-employed physicians for the same procedure.

    Wouldn’t that be nice? We’re working on it.

    They wanted help forming an IPA, so they could get better leverage and clout with payers.

    We’re working on it.

    They wanted to know if we could help them combat the fact that hospitals direct patients only to employed physicians, cutting independent doctors out of the referral network.

    We’re working on it.

    They wanted a life raft, or at least a life preserver, to help them keep cash flow up and disillusionment down.

    To reassure them, we tell them, yes, at A.I.D., we are working with media, lawmakers, the judicial system, insurers, doctors and consumers on all those issues. They are big, complicated, and entrenched, but we are making a difference.

    I want independent doctors, particularly those not yet members of the association, to know that someone is working for them, because I get frustrated when I read articles – two this past week – reporting that doctor burnout is on the rise.

    One editorial titled “How Being a Doctor Became the Most Miserable Profession,” in The Daily Beast, opened with the cheery news that nine of 10 doctors would discourage others from joining the profession, and that over the past few years being a doctor has risen to become the second-most suicidal occupation.

    Burnout, according to a January report by Medscape from WebMD, the second article that appeared in my inbox, was a problem for 46 percent of physicians – up 16 percent in just two years. The study defined burnout as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.

    These are not qualities we want in our doctors.

    Among the top reasons for burnout, were too much bureaucracy, too many hours, not enough income, computerization, impact of the Affordable Care Act, and not enough time to provide quality care.

    We’re working on it.

    But this much is clear: Employment is not the answer. We get that for burned out doctors, folding up their tent and going to work for a hospital seems like a good way out. But we know from those who have left independent medicine, the grass is not greener.

    We know because we have many physician members who were employed by hospitals and have returned, wiser, to private practice. One internist was frustrated because her hospital employer was insisting that she see 25 patients a day rather than her average of 17, a number she felt she could see in one day and provide quality care for. When she didn’t pick up her pace, her employment contract wasn’t renewed.

    Another A.I.D. member, whose practice was purchased by the hospital, quit when he went to request his vacation time, he found he didn’t have any.  The surgeon, who typically worked 12 to 15 hours a day Monday through Thursday, and saw patients Friday mornings, played golf every Friday afternoon. The hospital employer had counted his Friday golf as vacation time. He is back practicing independently after sitting out a year per the terms of his non-compete clause.

    Most doctors are by nature autonomous. Not too many like hospital administrators telling them how many patients they need to see, or when they can play golf. Most don’t go into practice so they can do unnecessary procedures, order unnecessary tests, and meet quotas, to please their employers and keep their jobs.

    The same week I spoke to the cardiologists, and read those two doomsday articles, I got an email from a physician and A.I.D. member asking for help. The medical staff had elected him to be chief of surgery at his hospital. However, at the meeting where the board was to confirm his position, it was not approved. The board wanted an employed physician in that seat.

    These injustices keep happening and will continue to happen unless independent doctors unite and speak up.

    We’re working on it.

    As we told this ill-treated doctor, and as we tell everyone who asks, who is frustrated about the state of health care, the only way independent doctors are going to gain ground, protect their interests and secure their professions is to develop a unified, nationwide voice that patients, hospitals, insurers, and governments listen to, take seriously and respect.

    This is exactly why we formed the Association of Independent Doctors. But we can’t do this without your support. If you’re independent, and believe in our efforts, please support us by joining our cause. To become a member of A.I.D. go to  Let’s do this together.

    Marni Jameson, AID Executive Director/407-865-4110 or

Contact us

Address: 400 N. New York Ave., Suite 213 | Winter Park, FL 32789

Phone: 407.571.9316


The Association of Independent Doctors (AID)  is a 501(c)(6) non-profit organization. 

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