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Family Doctor Private Practice Near Me
Dr. Khuram Ghumman asks 5-year-old patient Tully Zorika to hop on one leg during an exam at East Granby Family Practice, LLC, where she is in private practice. Dr. Gumman takes care of the entire Zorik family. Chloe Poisson / C-HIT.ORG
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“Everyone in this environment thinks about giving up and going to the hospital every day,” said Miller, a primary care solo practitioner for 20 years. “The problem is on the business side,” he said, referring to costly and time-consuming health insurance claims and government regulations.
Dr. Khuram Ghumman took the unusual path of first working in the hospital system and then going into private practice in primary care because he opposes the “corporatization” of healthcare. According to him, a conflict of interest can arise when the owner and the doctors he hires have different goals. “I wanted to be accountable to my patients,” Gumman said.
Nationally and in Connecticut, hospital systems and private companies are increasingly buying private medical practices and taking over their businesses. Statistics from the American Medical Association show that in 2018, only 46% of physicians owned their own practice, compared to 75% in 1983.
In Connecticut, hospital health systems range from large groups such as Yale New Haven Health Services and Hartford Health Care to individual hospital systems such as UConn Health. All are nonprofits except the Prospect CT Medical Foundation, a for-profit corporation that owns hospitals in Waterbury, Manchester and Rockville.
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There are other health systems, such as ProHealth Physicians, which is owned by Optum, a division of the company that owns United Healthcare. Private equity firms have also invested in medical practices, including orthopedic and emergency medicine groups.
An area of active practice acquisition is primary care, while the demand for preventive care is increasing with an aging population.
The number of primary care physicians practicing in hospital systems with 30 or more physicians increased from 1,100 in 2016 to 1,441 in 2019, a 31% increase, according to the Office of Health Strategy (OHS). At Yale, the number increased from 368 to 491 (33%); Hartford Health Care from 73 to 198 (171%); and Middlesex Health System from 32 to 38 (19%). Acquisitions include physicians, physician assistants and nurses.
Hospital-based health systems claim to provide better, more streamlined and coordinated care because primary care providers and specialists can work together and have easier access to patient records.
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But research shows that acquisitions drive up health care costs and doctors lose the freedom to manage their work schedules.
Dr. Khuram Ghumman instructs patient Carlos Padilla where to look during his annual physical exam at East Granby Family Practice, LLC, where he is in private practice. Chloe Poisson / CHIT.ORG
Gumman, who practices in East Granby, said he spends an hour with patients on physical exercises and a half hour on follow-up visits. “I just want to ask the doctors: What do you do?” he asked.
Miller said he prefers his autonomy, is happy with how he runs his practice, enjoys its proximity and the ability to give patients the opportunity to meet with a solo practice.
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Dr. Andrew Wormser, a New Haven internist affiliated with Yale University’s Northeastern Medical Group, said “some autonomy is missing,” but added that “they still give us enough to practice the way we do.”
Wormser is part of the Connecticut Medical Group, which was created in the 1990s by a group of physicians to pool resources. A more challenging regulatory climate and the resulting need to invest in electronic health records prompted the sale of the practice to Yale University in 2012, he explained. Under the agreement, the 31 doctors are contractors rather than employees, but the company is owned by Yale University. “There are no more office management problems, which are many,” Wormser said.
C-HIT requested interviews with officials from Yale New Haven Health, Hartford Health, Trinity Health of New England, and the Connecticut Hospital Association (CHA); none were offered. The CHA issued a statement saying, “Partnerships between hospitals, health systems, and physician practices maintain and expand access to health care, support health care improvement, and often provide new value-based care mechanisms.”
Isaac Kastenbaum, vice president of the nonprofit Primary Care Development Corporation, said primary care is particularly ripe for acquisitions or mergers.
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“What is required of a primary care practice today is very different from what was required 20 years ago,” he said.
The regulatory and insurance requirements require “tremendous amounts of staffing, technical expertise and capital that independent practices often just can’t raise on their own, or it’s very difficult,” said Kastenbaum, whose organization provides loans and technical assistance to primary care. providers. .
Financial losses and costs associated with practicing medicine during the COVID-19 pandemic have increased pressure on doctors in private practice, said Dr. Gary Price, president of the National Physicians Foundation and a Clinton plastic surgeon. “Covid has made a bad situation much worse,” he said.
Independent practice is also at risk because young doctors do not want to engage in business. “They want to be employees who focus on medical practice and a balanced lifestyle,” said Victoria Veltri, executive director of TTO.
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Occupational health and safety aims to increase spending on primary care to improve health, control long-term health care costs, improve access to and quality of preventive care, and address the social determinants of health. In the 2019 report, which included 29 states, Connecticut ranked last in spending on primary care, defined as care in office and outpatient settings. A report by the Patient-Centered Primary Care Collaborative and the Robert Graham Center found that between 2011 and 2016, Connecticut spent 3.5% of its health care costs on such primary care.
The country’s goal is that by 2025, primary care should account for 10% of total healthcare costs. “A better-equipped primary care system can provide better outcomes for patients and reduce overall health care costs over time,” Veltri said.
He said there is growing interest in “team care” to meet a variety of patient needs. This means that primary care can include, for example, social workers and pharmacists in addition to doctors.
“This is how primary care evolves,” he said. “We’re trying to keep people healthy. We’re trying to intervene early on health issues and address things like social determinants of health and social determinants of health,” he said.
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It comes at a time when a shortage of primary care physicians is projected by 2033, new doctors are turning to more lucrative specialties to help pay off medical school debt, and Connecticut is struggling to attract doctors. Connecticut was ranked 41st, according to a report using 2018 data from the Association of American Medical Colleges.
At the national level in retaining physicians who have attended medical school or completed a national internship.
At the same time, the proposed legislation would give the state more control over physician practice acquisitions, allowing the state to review acquisitions of any size instead of the current eight-physician minimum. This would also remove the previous approval requirement.
“You can be Yale or Hartford Medical or Nuvance, and you can buy from seven practices, another from seven, another from four practices, another from five practices,” Veltri said, explaining that the lack of review makes it difficult to contain the growth of health care costs. According to the Physicians Advocacy Institute, patient and Medicare costs are higher at hospital-owned clinics.
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Hospitals and doctors spoke out against the proposal at recent legislative hearings. Dr. Jeffrey Cohen, director of clinical services at Hartford Health, said his system has acquired 30 practices with fewer than eight doctors in the past three years, adding that “there aren’t many practices with eight doctors.” He warned that independent doctors could go bankrupt while waiting for inspections to take place.
The Connecticut State Medical Association said in a statement that many small medical practices are struggling to survive, but noted that “it is not within the legislature’s power to determine under what circumstances physicians may choose to sell their practices.” The medical society said the state should instead focus on issues that burden independent doctors, such as insurance contracts that don’t allow doctors to negotiate rates, exclusionary policies and high malpractice rates.
Dr. Khuram Ghumman is a family physician in private practice at East Granby Family Practice, LLC. Chloe Poisson / C-HIT.ORG
Gumman said the way her practice is structured has spared her many administrative tasks: seven doctors, five nurse practitioners, a physician’s assistant and enough office staff to handle business. “If you have systems that work for you and your patients, you can still manage without being part of a large corporate system,” he said.
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He compared the current health care situation to a time when most independent pharmacies were driven out of business by chain competition, leaving them with few options.
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